Though rare, bleeding (hematoma) and infections are the most common complications of a vasectomy. A no-scalpel vasectomy, the procedure performed by Central Arizona Urologists, reduces their likelihood because the blood vessels responsible for bleeding are less likely to be affected and because the opening in the scrotum is so small.

Another potential risk is failure to achieve sterility. A vasectomy is not guaranteed to be 100% effective. Even when the operation is performed perfectly, it is possible in very rare cases for sperm to find its way across the void between the two blocked ends of the vas deferens. This situation, called recanalization, is highly unusual but does occur. Recanalization usually occurs in the first 2-3 months after a vasectomy, but has been known in extremely rare cases to occur even years later. We request a semen analysis after twenty(20) ejaculates to verify zero (0) sperm.

Sperm granuloma, a hard, sometimes painful lump about the size of a pea may form as a result of sperm leaking from the cut vas deferens. The lump is not dangerous and is almost always resolved by the body in time. Scrotal support and mild pain relievers are usually all that are needed for symptoms, though I may suggest other treatment.

Congestion, a sense of pressure caused by sperm accumulation in the testes, epididymis, and lower vas deferens, may cause discomfort some 2 to 12 weeks after a vasectomy. Like granuloma, congestion usually resolves itself in time. The same conservative therapy used for sperm granuloma (local heat, anti inflammatory, and scrotal support) applies to the feeling of congestion.

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In fact, most men don’t experience any pain during the procedure, aside from minor discomfort at the time anesthesia is administered. No worse than a dental anesthesia. As we will review shortly, minor discomfort, swelling, and bruising may develop after a vasectomy, but these symptoms usually subside within a few days provided patient’s follow some simple recommendations.

Dr. James Fishman specializes in the no-needle/no-scalpel vasectomy approach, which is a simple and safe procedure. First, this uses a unique jet injector tool to introduce anesthesia. And the no-needle instruments access the vas deferens through a single puncture to the scrotum. The procedure typically takes 10 to 20 minutes to complete and patients can return home the same day. Even better, a vasectomy is typically performed in the physician’s office. Only on a VERY rare occasion is a surgery center visited for the procedure which will be determined during the first consultation.

If you do undergo a vasectomy, there are a few things you can do to manage your discomfort during the recovery process.

Here are our five steps for recovering after a vasectomy

1. You must limit your activity

While the procedure is minimally invasive, it’s important to follow all of the written post-procedural orders, like limiting physical activity for at least 48 hours.  The general advice is to NOT leave your home for the first 48 hours, and ice/rest will be mandatory for the first 24 hours after your procedure. No shower for 48 hours. And the amount of activity in the first week should be very light. NO SIGNIFICANT PUSH, PULL, or LIFT. No sexual activity for the first week after your vasectomy. Not following these instructions could result in increased pain.

2. The vasectomy surgery site must be kept clean

There will be no showering until 48 hours after the vasectomy.  But it’s imperative you keep the surgical site clean and dry during the recovery period. If there are any surgical sutures on the skin you will be advised in wound care after each day’s showering. It’s important you wash your genitals lightly but thoroughly. This will avoid injury and encourage wound healing.

3. Wear Supportive Undergarments

Wearing supportive underwear (or a compression short) immediately after your vasectomy will help reduce pain caused by increased pressure at the vasectomy sites within the spermatic cord. You should wear supportive underwear until you no longer need them; just be sure to change into a clean pair every day. Also, any reintroduction of athletic activity should be accompanied by compression shorts.

4. Please take all medications as prescribed

Pain medications will have been sent electronically to your pharmacy. STANDARD first level of pain management will be rest/ice/Tylenol). But narcotics can be helpful to take the edge off discomfort for the first 48-72 hours. The post-vasectomy pain will resemble the throbbing feeling you might experience after a dental event. Dr. Fishman rarely may prescribe antibiotics to reduce your risk of an infection. Post-vasectomy complications are rare, but if pain is INCREASING after day 3 that warrants a phone call to Dr. Fishman’s office . Lastly medication allergies should be brought to the doctor’s attention so that pain medication alternatives can be considered.

5. Lastly, follow all Post-Op Instructions

Lastly, be sure to follow all of Dr. Fishman’s post-operative instructions. These were given to you in writing. Premature activity is NOT advised, and remaining calm 48 hours after the procedure is mandatory. If you have any questions or concerns regarding your recovery, do not hesitate to contact Dr. Fishman at his office number (602.242.1556) or after hours directory (602.365.0089).

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The current practice in Dr. Fishman’s office is a semen analysis to be checked after twenty ejaculates. The patient will be given a specimen cup to transport the semen specimen to a designated lab. The delivery of this specimen is NOT emergent. It can typically be acquired the evening prior, refrigerated, and then brought to the lab the following day. On average, patients can be expected to clear twenty (20) ejaculates within six (6) weeks. However, this is NOT a race, and however long it takes to reach the 20th ejaculate is fine, so long as a contraceptive method remains in place.

Very rarely does a patient not achieve zero (0) sperm count after the 20th ejaculate. This is less than 3% of patients. This patient would be given a second opportunity to submit a regular post-vasectomy semen analysis.

In the even rarer event that a second semen specimen does not reach zero (0) sperm count, then Dr. Fishman would meet with the patient to review the next steps. Typically, a patient would then be advised to submit a fresh semen analysis on site at a reference lab. This would be a Total/Quantitative lab trying to determine if there are any motile sperm still remaining in the ejaculate, and what the overall sperm count. Urologists have agreed that a provisional diagnosis of infertility can define a patient with less than 100,000 sperm/ml that are entirely non-motile (i.e. dead sperm). That patient could then be allowed to resume unprotected intercourse without fear of impregnating their partner.

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