DEAR DOCTOR K:

My wife and I don't want any more children, so I've scheduled a vasectomy. What will happen during the procedure?

DEAR READER:

A vasectomy is a minor surgical procedure that will make you unable to father any more children.

The sperm that is ejaculated during sex travels through two tubes, one on either side of the scrotum, the sac that contains the testicles. Each tube is called the vas deferens. The tubes run from the testicles (where sperm is formed) to a storage area where the sperm are mixed with semen. That storage area then empties into the penis. A vasectomy cuts or blocks the vas deferens. As a result, no sperm reach the storage area, and none are ejaculated.

Vasectomies are usually done as an outpatient procedure. The procedure requires no preparation on your part. Your doctor will give you a local anesthetic to numb your scrotum.

In a traditional vasectomy, the surgeon uses a scalpel to make one or two small cuts in the skin of your scrotum. Once the vas deferens are seen, they will be cut. The cut ends of the vas deferens tubes may tied, burned shut with a hot tool or blocked with surgical clips. (Just in case this sounds painful, remember that your scrotum is numbed -- you won't feel anything.) The doctor then will close the small surgical cuts with two or three stitches.

A less-invasive approach requires only tiny incisions. The surgeon makes one or two punctures to access the vas deferens. Then the surgeon cuts or blocks each one. The puncture site is covered with a tiny dressing. No stitches are needed.

The entire procedure takes only 15 to 30 minutes. The reported success rates are 98 percent -- very good, but not perfect. Not surprisingly, the surgeons who do the most procedures seem to have the best batting average. Look for a surgeon who does 50 or more vasectomy procedures per year.

After your vasectomy, you may experience some bruising and mild discomfort. This can be relieved with an athletic support, an ice pack and nonprescription pain medication.

There should not be any change in your sexual desire or performance after the procedure. Indeed, some of my patients who have had a vasectomy tell me they feel that sex has improved because they no longer have the apprehension that sex may lead to an unplanned pregnancy. Typically, testing is done after vasectomy to confirm that the procedure has prevented sperm from entering the ejaculate.

Over the years, concerns have been expressed that having a vasectomy might increase the risk for various diseases. These concerns have proved to be false alarms.

Keep in mind that a vasectomy is intended to be permanent birth control. Special surgery can reverse a vasectomy, but success cannot be guaranteed.

If you have even the slightest doubt about ending your chances for future fatherhood, then consider another form of birth control. And don't forget that while you won't need to wear a condom for birth control after vasectomy, a condom still is important in protecting against sexually transmitted diseases.

(Dr. Komaroff is a physician and professor at Harvard Medical School. Go to his website to send questions and get additional information: www.AskDoctorK.com.)

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