Sacramento Vasectomy | No-Needle No-Scalpel Vasectomy | Dr. Brian K Golden - No-Needle No-Scalpel Vasectomy in Sacramento | Dr. Brian Golden

No. Vasectomy does not alter sex drive, erections, or sexual ability.  There is no change in the production of testosterone, the male sexual hormone.  Similarly, sexual pleasure, orgasm, and ejaculation are unchanged.  Conrtrary to one common pre-vasectomy anxiety, sex for most couples is actually better after vasectomy, due to the elimination of the worry surrounding unintended pregnancy.

There is no perceptible change in a man's semen after vasectomy, except when examined under a microscope.  This is because the ejaculate is comprised mainly of fluids (from the prostate and seminal vesicles) which support and transport sperm.  Sperm actually only makes up 3% of the total semen volume. Removing the sperm from the semen does not change the volume, appearance, or consistency. 

"Open-ended" describes a method of treating the testicular end of the vas deferens at the time of vasectomy, namely leaving it open. 

In the traditional vasectomy, the vas is cut, then both ends are cauterized or tied.  Because the testicle continues to make sperm and associated fluid, which cannot escape through the obstructed end, increased pressure in the testicle and "congestive epididymitis" may result in a higher incidence of chronic testicular pain.

In the "open-ended vasectomy," the testicular end is not obstructed in any way, minimizing the risk of post-vasectomy pain.

The abdominal end of the vas, however, is treated in the following ways, which together minimize the chance of vasectomy failure:

1. abdominal end of the vas is trimmed by 0.5-1 cm  
2. the inside of the abdominal end of the vas is cauterized for a short distance
3. finally, the sheath is closed over the abdominal end of the vas with absorbable suture.  This final manuever is known as "fascial interposition," regarded by many experts as the best method to prevent vasectomy failure.

Various vasectomy techniques have been described.  Dr.Golden's technique has evolved over hundreds of cases, always keeping in mind the goals of patient comfort, maximizing success rate, and minimizing complications.

• scrotum shaved the night before the procedure
• Sterile prep and drape
• No-Needle anesthesia with lidocaine delivered using Madajet spray device
• Skin is stretched over the right vas deferens in the scrotal mid-line and held in place with small "ring clamp"
• The "pointy mosquito clamp" is used to puncture and spread the skin and vas sheath, exposing the bare vas deferens
• The "pointy mosquito clamp" is used to pierce the exposed vas and lift it out through the small skin opening
• The vas is cut, a short segment (~0.5cm) is removed from the abdominal end of the vas, and the inside of the abdominal end is cauterized for a short distance. 
• The abdominal end of the vas is "buried" inside its own sheath, which is then closed with an absorbable suture.  **This manuever is known as "fascial interposition," which is the key to preventing failures.  (no permanent materials are implanted, as some foreign bodies can be felt forever and may be an annoyance to some men.)
• The testicular end of the vas is not obstructed in any way.  No cautery, no suture.  See FAQ entry just below, discussing "Open-ended vasectomy" or Click Here for a thorough discussion of this topic with references
• The vas is released and withdraws back into the scrotum
• Through the same skin opening, the same exact procedure is performed on the left vas deferens
• At the end of the procedure, no skin suture is necessary and the skin opening is barely noticeable

Using a needle for vasectomy anesthesia has several downsides:

• Many people are afraid of needles, leading to anxiety before and during the procedure.  Some men who would benefit a vasectomy avoid the procedure just to avoid the needle
• Trauma to the tissue from a needle results in higher incidence of bleeding complications
• Most of the medicine from a needle is deposited in the same tissue plane, reducing effectiveness
• Risk of needle-stick injuries

The spray technique in No-Needle Anesthesia improves the vasectomy procedure in several significant ways:

• The numbing effect is nearly instantaneous, with almost no discomfort.
• The anesthetic spray spreads through multiple tissue layers, numbing more completely with less medicine
• Multiple studies have shown higher satisfaction from patients having No-Needle anesthesia for their vasectomy
• Risk of bleeding during the procedure or scrotal hematoma afterward, are significantly lower than with use of a needle
• Fear of needles is eliminated, so patients can relax and be more comfortable during their procedure

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The testicles continue to produce the same things after vasectomy as before, namely testosterone and sperm. The testosterone is released into the bloodstream just as before vasectomy.  Sperm, however, come to the cut end of the vas and have no place to go.  After a short time, sperm cells break down into their components (proteins, lipids, DNA...), which are recycled by the body.

The cost of a vasectomy in Sacramento depends on insurance coverage.  Many insurance providers cover 80% of the total cost.  The cash-pay price as of mid-2011 is $100 for the initial consultation plus $750 for the procedure and all follow-up.  This includes includes the confirmatory semen analysis 6 weeks after procedure.

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Most men experience no pain or just minor discomfort during and after no-scalpel vasectomy.  The scrotal skin and the vas deferens are anesthetized (numbed) with lidocaine, but some men feel a vague pulling sensation or a brief pinch when the vas is grasped.

Most guys just need 24 hours of tylenol after vasectomy.  Dr. Golden reports that after he did his own vasectomy (yes, he did his own procedure), he just took two tylenol.  Some people require something a bit stronger, so all patients are given a prescription for hydrocodone, the generic of Vicodin.

Click here to hear patients describe no-needle no-scalpel vasectomy with Dr. Golden in these Audio Recordings.

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Yes, although medication is rarely necessary. While it is normal to be a bit nervous, most men can remain calm duing the brief vasectomy procedure. We'll even listen to music during the procedure.  Despite reassurance, however, some men may remain quite anxious about the procedure. If this is anticipated ahead of time, Dr. Golden can prescribe a dose of a relaxation agent, such as valium, which should be taken an hour prior to the procedure. The downside of taking an anti-anxiety medication is that someone else must be available to drive home after the procedure.

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All procedures, medications, and even contraceptives carry some risk.  With that in mind, No-Scalpel Vasectomy (NSV) is quite safe. The rates of the most common complications are significantly lower than the rates of problems after conventional scalpel vasectomy. The following statistics have been compiled from several large series:

• risk of hematoma formation (bleeding into the scrotum) is 0.4%
• risk of scrotal infection is less than 0.1%
• risk of vasectomy failure (sperm still present in ejaculate) is less than 1 in 500. Despite the low risk, the downside of an unanticipated pregnancy is potentially devastating.   For this reason, vasectomy patients must use another reliable form of contraception until a semen analysis 6-8 weeks after the procedure which shows he is "shooting blanks." Until this test is performed, each patient must consider himself fertile.
• post-procedure testis or epididymal pain/pressure occurs in some men, but typically resolves within a month or so.  Ibuprofen and scrotal elevation with snug briefs or a jock strap during the day and a rolled towel between the legs at night are often helpful. Very rarely (3 in 1000), a man will experience a chronic testicular symptoms that leads him to seek additional treatment.

Immediately after vasectomy, plan to return home and relax.  Most men can return to their normal routine after a few days. You can do desk work the day after the procedure, but should avoid sexual activity and lifting anything over 20 pounds for at least 5 days. A scrotal support (snug briefs or jock strap) for the first 48 hours after the procedure can alleviate tension on the scrotum and minimize bruising.  An ice pack on the scrotum intermittently helps minimize swelling and bruising.  A bag of frozen peas serves this purpose very well. This might sound obvious, but avoid situations where scrotal trauma is likely. Watch out for young children who might run into you!

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No. Sperm are still present in the tubes beyond the vasectomy site for a while after vasectomy.  About 6 weeks after the vasectomy, a confirmatory test is done to confirm abscence of sperm.  The first option is microscopic examination of a semen sample.  There is no additional charge for the post-procedure semen analysis. The second option is home use of SpermCheck Vasectomy.  Whichever option is selected, it is highly recommended to follow through and confirm success of the procedure. Until then, fertility must be assumed and another form of contraception must be used.

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Yes. A home test kit, SpermCheck Vasectomy, allows the confirmatory test to be performed in the privacy of your home. The test works by detecting specific proteins found only in sperm. The test is available by mail-order directly from the manufacturer.

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In the 1980s and 1990s, some doctors thought there was a correlation between vasectomy and prostate cancer, but this has since been disproved.  There is no established association between vasectomy and cancer or any other medical problems.  Interestingly, a well-respected journal published a study that shows men who have undergone vasectomy have a lower risk of mortality from any cause.  It must be recognized this is a statistical relationship and does not demonstrate causality. 

• Giovannucci E, Tosteson TD, Speizer FE, Vessey MP, Colditz GA. A long-term study of mortality in men who have undergone vasectomy.
  N Engl J Med 1992;326:1392– 8.

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Vasectomy does nothing to alter susceptibility to infections like herpes, HIV, chlamydia, syphilis, or any other bacterial or viral infection that is contracted through sexual contact.

This question is a red flag. While vasectomy is an easy procedure and inexpensive long-term contraceptive, vasectomy reversal (vasovasostomy) is a much more complex and expensive undertaking. Vas reconstruction is typically a 2-3 hour microsurgical procedure, requiring general anesthesia.  Basectomy reversal costs around 5-8 thousand dollars, is not covered by insurance, and is not always successful.  If you are not certain you are finished having children, then another form of contraception should be used until reproduction is no longer desired.

Sure, cryopreserving sperm is a reasonable option to consider.  This question is a bit of a red flag, though.  If you think there is a good chance of needing your sperm for reproduction, then vasectomy probably isn't the best form of contraception for you at this time.  Dr. Golden insists you are certain that your family is complete before performing your vasectomy.

Most vasectomy patients can be seen within a few weeks.  Call or email the office to schedule the initial consultation.  A brief medical history will be taken and a physical exam performed.  The procedure will be reviewed in as much detail as you would like, after which you will have the opportunity to ask any remaining questions.  After this initial consultation, your procedure can usually be done within a week or two.  Dr. Golden generally performs vasectomies on Thursdays and Fridays, so patients can take the weekend off and return to work early the following week.

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