How a Vasectomy Works (and How to Tell If It’s Right for You)

When you have a male reproductive system, it can be easy to think that you have limited birth control options. But a vasectomy can be a great option if you decide you don’t want to have children. It’s a surgical form of male birth control, and it’s a very common procedure. The risks are low and vasectomies are quite effective. 

What happens when you get a vasectomy?

A vasectomy is usually done in the office by a urology specialist.Your healthcare provider might recommend that you do it in a surgical center if they think you need to be asleep. But most people don’t need to go to sleep to have a vasectomy.  

No matter where you do it, your healthcare provider will use the same techniques. During the procedure, your surgeon will inject a local anesthetic (such as lidocaine) into the skin to numb the scrotum. They’ll clean the area with an antiseptic and make a tiny incision in the scrotum. Your provider will find the vas deferens (the tube that carries sperm from the testes), then they’ll cut and tie it. In some cases, your surgeon will cauterize it — burning it at the ends. 

Your provider will place the vas deferens back into the scrotum and close the skin of the scrotum with stitches. Then they repeat the same procedure on the other testicle. It’s a relatively quick surgery and only takes about 30 minutes to complete both sides.

Another method of performing a vasectomy is a “no scalpel vasectomy” (NSV). A NSV takes place in your provider’s office and requires only one small puncture hole and also uses local anesthesia. 

NSV has several advantages over traditional vasectomy, including a reduction in:

• Bleeding

• Hematoma formation

• Infection after surgery

• Pain 

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Not all providers offer NSV. Make sure to ask your surgeon which surgical method they use for vasectomy.

What happens after a vasectomy?

You might notice some mild, blood-tinged drainage after the vasectomy. This should clear up in 1 to 2 days. Your surgeon will probably advise you to limit physical and sexual activity for about 5 days. In most cases you can shower the day after surgery. But you shouldn’t submerge your incision in water for about 1 week. 

After 2 weeks, most people can resume their normal activities. But your healthcare provider will give you instructions based on your particular circumstances.

You may have sperm in your semen for a few months after a vasectomy. It can take up to 30 ejaculations to clear out all of the sperm. During this time, you may be able to get your partner pregnant, so you’ll need to use another form of birth control. 

Your healthcare provider will do a semen analysis 2 to 3 months after your vasectomy to check for sperm. Your urologist might ask you to repeat the sample, especially if there are sperm present. Once there are no sperm on the semen analysis, you don’t need to use another form of birth control. 

How much does a vasectomy cost?

On average, a vasectomy costs about $1,000. You might have to pay extra for follow-up visits and your semen analysis. You should check with your insurance provider to make sure that they cover a vasectomy. You should also find out what your copay and deductible are so you’re not surprised with unexpected expenses.

Over 80% of vasectomies take place in a urologist’s office, and it’s likely cheaper to do so. One study compared the cost of having a vasectomy in the office versus a surgical center. It found that the total cost for a vasectomy can be three times as much when done in a surgical center.

What are the pros and cons of a vasectomy?

A vasectomy is safe and effective, but all surgical procedures have some risk. So it’s important to weigh the pros and cons of any elective surgery.

Vasectomy pros

• Highly effective form of birth control. For every 10,000 couples that use a vasectomy as birth control, fewer than 15 pregnancies occur.

• It’s permanent and doesn’t require anything on your part. It’s a “get it and forget it” form of birth control.

• It's cost effective. This is especially true when you do the procedure in a healthcare provider’s office instead of a surgery center. 

Vasectomy cons

• It’s permanent. Vasectomy reversal is possible, but it’s expensive and not guaranteed to work. You should be sure you don’t want to father children in the future.

• It doesn’t prevent sexually transmitted infections (STIs). If you’re engaging in sexual activity that puts you at increased risk, you should still use a condom.

• Complications are rare, but they can happen.

What are the complications of a vasectomy?

The complications with a vasectomy are not common and usually are not severe. Some of the most common complications include:

• Hematoma: Bleeding into the scrotum can occur. To prevent this, you should not engage in vigorous physical activity for 1 to 2 weeks after your surgery.

• Infection: Make sure to follow your healthcare provider’s instructions. You can reduce your risk of infection by keeping your incision site clean and dry. 

• Failure: The risk of vasectomy failure is much less than 1%. But it can happen. It’s important to follow up with your surgeon to have a semen analysis after your surgery. 

• Sperm granulomas: These are small lumps in the testes caused by sperm leaking from the cut end of the vas deferens. They form in up to 40% of people after vasectomy and can be painful.

• Pain: Pain after the procedure is common, but usually it isn’t severe. It typically lasts just a few days. But about 2% of people can have post-vasectomy pain syndrome and persistent pain that requires treatment.

How effective is a vasectomy?

A vasectomy is one of the most effective forms of birth control. It’s almost 100% effective in preventing pregnancy. But sperm may still be present in semen in the short term after a vasectomy. 

A semen analysis after your vasectomy will help you and your provider figure out when you’re protected from pregnancy. You should continue to use an alternate form of birth control until you get the OK from your provider.

Can you reverse a vasectomy?

A vasectomy is a permanent form of male birth control. But each year about 6% of people who have had a vasectomy change their mind. 

It’s possible to reverse a vasectomy, but it’s a much more difficult surgery. Vasectomy reversal is an elective procedure, and most insurance does not cover the cost. You can expect to pay up to $15,000 out of pocket.

There’s no guarantee that a pregnancy is possible after a vasectomy reversal. In fact, only around half of couples end up getting pregnant after a reversal procedure. 

What are the best alternatives to a vasectomy?

Condoms are the only approved male contraceptive alternative to vasectomy. When you properly use a condom every time you have sex, it’s about 98% effective in preventing pregnancy. But most people don’t alway use them correctly every time. The “real-life” effectiveness is probably closer to 85%. That means that if 100 couples only use condoms for their birth control, 15 of them will get pregnant.

Even though condoms aren’t as effective at preventing pregnancy, they’re great at preventing STIs (when you properly use them). If you’ve had a vasectomy, you should still use a condom if you engage in sexual activity that puts you at increased risk of STIs.

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Written by:

Frank Schwalbe, MD

Frank Schwalbe, MD, is an assistant professor of anesthesiology at the Yale School of Medicine. He has practiced anesthesiology for 30 years.

Edited by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

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