Everything you need to know about vasectomies

Men do not have many contraceptive choices. There are condoms and there are vasectomies. Both are very different, and while condoms are widely used, they are not failsafe or universally loved. Vasectomies, on the other hand, are at least 99 per cent effective at preventing pregnancy.

The latest figures available show that in England in 2020/21 (during the pandemic), 4,486 men underwent vasectomies in sexual reproductive health clinics and NHS hospitals. Before this, numbers were stable at around 11,000 to 12,000 a year, having dropped from a peak of 19,510 in 2010/11.

Availability varies widely across the UK. In Northern Ireland, for example, there are reports of some people waiting years for a vasectomy, while some clinical commissioning groups (CCG) have stopped or suspended funding for the procedure, leaving people in those areas with little choice but to go private.

Dr Martin Kittel, Thames Valley Vasectomy Services’ clinical director, has performed over 12,000 vasectomies.

He explains: “NHS figures have dropped over the years because a lot of CCGs do not provide the service on the NHS anymore. In Berkshire, for example, West Berkshire CCG doesn’t provide, and East Berkshire does. It is a real postcode lottery now.”

He also reveals that demand is rising among young men.

“Ten years ago, we used to see about one man under 30 every three months. Now we get one to three inquiries a week. The world is changing, and the way people think about having children is changing,” he says.

The reasons people decide to have a vasectomy are not widely studied, a point made in a 2022 report by the Institute for Psychological Sciences at De Montfort University, Leicester. The authors found that although the number of men using contraceptive services has increased in the last 16 years, vasectomies and vasectomy reversals have declined significantly.

The report concluded: “Women are bearing the burden of contraception, and the decline in vasectomies and reversals observed in the United Kingdom is also occurring in other developed countries, with no research to explain this global trend.”

What is a vasectomy?

A vasectomy, colloquially referred to as “the snip”, is a minor operation in which the two tubes carrying sperm from the testes, called the vas deferens, are blocked or cut. This interrupts the flow of sperm, which are carried along the tubes to a spongy area of tissue at the back of the bladder where they are mixed with liquid in preparation for ejaculation. If sperm is not ejaculated, it can live in this reproductive production line for up to 74 days. After this, the cells die and are reabsorbed by the body.

After a vasectomy, the sperm already in the reproductive tract will be gradually depleted until eventually the system will be free of sperm completely. The volume of ejaculate does not change noticeably and the production of testosterone by the testes is unaffected and continues to go directly into the bloodstream, so sex drive and libido are unaltered.

What types of vasectomy are available?

There are two types of vasectomy. Both take around 15 minutes and are usually conducted under local anaesthetic. In conventional vasectomies, one or two small incisions are made in the scrotum, through which the vas deferens are lifted, cut, cauterised or stitched, and replaced. 

In minimally invasive vasectomies, a keyhole method is used. The doctor feels for the tubes under the skin of the scrotum and holds them in place with a small clamp. Instead of making two incisions, one small puncture opening of around 5mm is created, through which the vas deferens are accessed and cut. 

Sometimes a hyfrecator instrument is used, where electrical current heats and destroys the tissue. Generally no stitches are needed with this method and there is little bleeding. It is thought to be less painful, and recovery time is quicker with less risk of complications. A doctor will decide on the best option for the patient.

What should I consider before having a vasectomy?

Chris*, 49, from the Isle of Man, already had two sons aged 12 and 10 when he decided to book a vasectomy. The first operation was cancelled at the last minute, and in the interim the couple fell pregnant again. After their third child was born, Chris rebooked the procedure.

“We had enough children and didn’t plan on having any more, and we didn’t want to worry about contraception,” he explains. “It was definitely the right decision, and several years later I have no regrets.”

His procedure was undertaken by his GP, who was training and under the supervision of a surgeon.

“It was his first,” Chris laughs, “but it was quick and painless. I listened to a Radio 4 documentary on Russian warfare while he was doing it. The only thing I felt was tugging and there was a slight smell of burning when he cauterised the ends of the tubes. I was a bit tender afterwards, but I was back on my bike after a week.” 

According to the NHS, you should only have a vasectomy if you are certain you do not want any more children or do not want children at all. Although the procedure can be reversed in some circumstances, it should be considered a permanent form of sterilisation.

Each patient should have an initial consultation with a doctor, who will ask about circumstances, provide information, and may recommend counselling before agreeing to the procedure. If you have a partner, it is vital to discuss it with them before you decide. If possible, you should both agree to the procedure, but it’s not a legal requirement to get your partner’s permission. You should also consider whether your views or relationship may change over time, particularly if you are young.

“The most common reason for regret,” explains Dr Kittlel, “is when people end a relationship, then get together with someone new and want children with them. Regret rates among men who have vasectomies and never have children are low.”

A doctor can refuse to carry out the procedure, or refuse to refer you, if they don’t believe it’s in your best interests.

According to NHS guidance for providers of vasectomies in the community, patients must also be of sound mental capacity and should have received counselling about the availability of alternative, long-term and effective contraceptive methods. Potential patients should also be aware that sterilisation does not prevent or reduce the risk of sexually transmitted infections.

How can I book a vasectomy?

The first step for many men is a GP appointment where your doctor will tell you whether vasectomies are available on the NHS in your region and, if so, will discuss the surgery with you and explain what your options are. They will refer you and you will be put on a waiting list until you receive a consultation with a provider to discuss the procedure, followed by an appointment to have the vasectomy, which may be carried out within an NHS hospital, community clinic or through an approved qualified provider, such as MSI Reproductive Choices, British Pregnancy Advisory Service, or at a private clinic contracted by the NHS. Some GPs are also trained to perform vasectomies.

If you elect to go private, you can book your consultation directly with the provider, who will usually also check whether you qualify for NHS funding. Costs vary between clinics. MSI Choices, for example, takes NHS referrals and charges private patients £70 for a consultation and £480 for the procedure. Thames Valley Vasectomy Services, which is also an NHS-approved provider, charges £490 for a complete no-scalpel procedure, including consultation, procedure and follow-up semen test. Clarewell Clinics charges £750 for a consultation and procedure.

How do I prepare for a vasectomy?

Sarah Salkeld, the associate clinical director at MSI Reproductive Choices UK, explains: “A good starting point is to get as much information as possible through a reliable website, such as ours, or the NHS. It’s important to be well informed to start with.

“Most people are suitable for treatment, but occasionally there may be a medical reason why we can’t perform the procedure – if, for example, someone is taking certain types of blood-thinning medication.”

Some clinics, such as Thames Valley Vasectomy Services, hold webinars for patients.

What are the risks?

As with any minor surgical procedure, you can expect to experience some discomfort after the procedure but, in most cases, this is minor pain, swelling and bruising that lasts for a few days and can be reduced with paracetamol. An ice pack is also recommended to reduce swelling. It is also advisable to wear tight-fitting underwear under shorts for the first few days and nights after the procedure to help support your scrotum.

Generally, vasectomy is a low-risk procedure. There is a small risk of infection, so it is important to keep the area clean, and shower or bathe before attending your appointment.

According to a study published in 2023, vasectomies are much less likely to cause complications than expected. Data analysed by researchers from Gloucestershire Hospitals NHS Foundation Trust, from the outcomes of over 90,000 vasectomies performed over 15 years, showed that existing leaflets explaining the potential complications to patients are based on outdated figures.

For example, one of the most significant complications of a vasectomy is chronic scrotal pain, which is quoted as affecting “up to 5 per cent of all patients” in the British Association of Urological Surgeons (BAUS) patient information leaflet about vasectomies. Reviewing the more recent data, the team found that the rate was in fact as low as 0.2 per cent of patients.

The chances of post-operative infection, quoted as between 2 and 10 per cent of patients in the BAUS statistics, was actually closer to 1.6 per cent. Haematoma rates in patients could be as low as 1.9 per cent. Vasectomy failure rates, where motile sperm is found after three months, is 0.6 per cent, and late failure, which occurs when the severed ends of the vas deferens join up, occurred in just 37 patients out of a total of 72,624 who answered the relevant question from the dataset used in the study – or 0.04 per cent.

How soon can I have sex, exercise, work and drive?

It is not advisable to drive home after the procedure, as leg motion on the pedals may aggravate the wound, and insurance may be invalidated in the event of an accident.

Patients are advised to wait until tenderness subsides before any long periods of standing, walking or driving. Contact sports should not be played for a month afterwards.

NHS guidance states: “You can usually return to work one or two days after a vasectomy, but should avoid sport and heavy lifting for at least a week after the procedure to prevent complications. See a GP if you still have symptoms after a few days.”

“If you have a manual job, I will usually say stay off for a week,” adds Dr Kittel.

Patients are advised to avoid sexual activity for at least seven days after having a vasectomy. It is common to find some blood in the first few ejaculations after the procedure. Patients must have a routine semen test between 12 and 20 weeks after the procedure to make sure it has worked, and it is important to use another method of contraception until you have a negative test, as it can take time for the remaining sperm to leave your tubes.

Salkeld explains: “You can’t rely on it as a contraceptive method until after you’ve had that check to make sure it’s worked.” 

Dr Kittel leaves a 20-week gap. “I am one of the latest testers in the UK,” he says. “I’ve only ever had one possible late failure in over 12,000 patients. If you test too early and you have a positive result, you must do other tests.” 

What happens to the sperm in the testes after a vasectomy?

Sperm is still produced by the testes but it is absorbed back into the body. The same process occurs when a man does not have sex for a long time. The testicles continue to produce testosterone, which enters the bloodstream, so libido, sensation and the ability to have an erection are not affected.

Can a vasectomy be reversed?

Vasectomy should be considered a permanent solution. Some men decide to have the procedure reversed if their circumstances change and they want to have children, but the process does not always work, and the NHS does not fund vasectomy reversal. In a vasectomy reversal, surgeons reconstruct the vas deferens tubes.

The chances of success for a vasectomy reversal depend on how long it’s been since the initial procedure, the type of vasectomy you had, what surgery you may have to reverse it, and how experienced your surgeon is. A successful reversal does not guarantee a pregnancy. According to Bupa statistics, the chances of a pregnancy after vasectomy reversal are 75 per cent if the reversal is within three years of the original vasectomy, reducing to less than 10 per cent if the vasectomy was more than 20 years ago.

Sperm produced in the testes after vasectomy can be obtained by testicular biopsy and subsequently used in assisted conception. However, a 2005 study concluded that sperm yields “significantly decreased” post-vasectomy.

Vasectomy myths busted

“It is a very minor procedure,” explains MSI Reproductive Choices’ Sarah Salkeld. “Some people tend to think that female sterilisation is better, but it has a higher failure rate and is mostly a general anaesthetic procedure, whereas vasectomy is local anaesthetic, quick and less invasive. A lot of men don’t realise how minimal it is and how quick the recovery is.”

And, according to Dr Kittel, common misconceptions include the vasectomy causing impotence and that the procedure involves an injection into the testicles.“It is a small incision in already numb skin so you cannot feel anything. It is a very straightforward procedure with tiny needles,” he says.

*Name has been changed. Procedure prices were correct at the time of compiling