Lying flat on my back on the operating table in a Toronto hospital, I turned my head to survey the tray of gleaming surgical tools and tried not to think of grapefruits. Or oranges. Walnuts seemed pretty upsetting, too. Really, I didn’t want to consider anything that might resemble the kind of swelling I could expect after those sharp implements met my man parts, so vulnerable down there under my thin blue paper gown.
With a head full of locker-room horror stories and gory Google images that could not be unseen, I wasn’t exactly looking forward to my vasectomy. But what dude would be? Sure, I was confident about my decision — my wife and I had completed our family with a beautiful daughter three years ago. We were done. The fact that my partner experiences adverse reactions to many contraceptive methods only reinforced my belief that this was my move to make. Nevertheless, my anxiety level still soared when the first tool made contact down below — in this case, it was a razor, handled by an unflappable nurse charged with finessing my lacklustre pre-op grooming.
I was so keyed up I was slow to notice the music coming from the speakers at the far side of the room. As the fading thunder of a guitar riff was followed by the radio DJ’s New Jersey accent, I realized, with more than a little surprise, that I was listening to Little Steven’s Underground Garage, the hard-rock radio show hosted by Bruce Springsteen’s long-time sideman and pompadour-wearing former cast member of The Sopranos. When it comes to background tunes for healthcare settings, you expect Mozart or Adele — this was no one’s idea of mild mood music. But for a certain type of guy in a certain situation, nothing could be more soothing than Little Steven introducing a rude blast of garage rock. As my urologist arrived and got down to business, I fixed my attention on the sounds that seemed to say to me: Hey, you and your boys are gonna be OK.
I was hardly alone in this special ceremony. The day I got on that operating table, I joined the estimated 55,000 Canadian men who undergo the procedure every year. Tens of millions worldwide have had the snip, with rates continuing to rise with the popularization of less-invasive surgical methods. Like many urologists, mine used the “no-scalpel” technique, which some studies suggest causes less pain and bleeding, and a faster recovery.
No matter how many times men have been told this is the safest and most effective method of permanent contraception for them (not to mention virtually free, as it’s covered by most provincial healthcare plans), countless compatriots remain averse, uncertain — or flat-out wrong — about the vasectomy. Here’s what you need to know, in a nutshell (and no, the testicular puns don’t end here).
The nuts and bolts
The objective of a vasectomy is to interrupt the two ducts that transfer sperm from the testicles, past the ejaculatory duct (where it mixes with other fluids) into the urethra, before it makes its merry way out of the body. In the words of Keith Jarvi, head of urology at Toronto’s Mount Sinai Hospital and professor of surgery at the University of Toronto, “It’s essentially a plumbing issue, and all we’re doing is blocking the pipes.”
These two pipes, called the vas deferens, are located on the left and right sides of the scrotum. Firmer and more muscular than the veins, arteries and lymphatic vessels all bunched up in there, each vas is relatively easy to discern since it feels like “a steel wire,” says Gerald Brock, a urologist in London, Ont., and president elect of the Canadian Urology Association. Once the doctor finds the ducts, a local anaesthetic is administered to each side — mine was done via a needle just under the skin (not nice, though I’ve had worse), but some doctors use other means, like a high- pressure jet gun (that would probably seem totally awesome and un-terrifying in any other context). Then, one at a time, each vas is brought up through an opening created either by a small incision with a scalpel or, in the no-scalpel method, two small perforations made with a small piercing tool.
While every doctor does it a little differently, what typically happens next is the tubes are cut and then separated. They may be folded back and then secured with clips, tied off in knots or cauterized (burned), or a combination of a few methods. In my case, the cauterizing caught me by surprise — when I saw the strange wisps of smoke rising up from my crotch, I wondered if my doctor had snuck a vape pen into the room. Mercifully, I couldn’t smell anything.
Once the two ducts are snipped and secured, they’re tucked inside the scrotum and the incision is closed with a couple stitches, some glue or a bandage. The procedure typically lasts just 15 minutes and the anaesthetic wears off in one to three hours. In most cases, swelling and soreness last about a week — over-the-counter pain meds and frozen veggies can help with this. Patients should avoid heavy lifting, strenuous exercise and, yes, sex for about a week. Many doctors book vasectomies on Thursdays or Fridays (they average about 15 procedures a day) to give guys a chance to relax over the weekend (avoid piggybacks and beware rogue elbows below the belt).
The persistent myth of manliness
So what makes a man, exactly? We’re no longer needed to hunt and drag protein back to our tribe — we have online grocery delivery services for that — but we may still be depended on to keep the tribe going. Whether we’re aware of it or not, some men fear a snip will somehow change or remove something fundamental.
Though the success rate is nearly perfect (well over 99 percent) and complication and infection rates are low — especially when compared with invasive tubal ligation surgery for women — the fear of pain is a very real, very strong disincentive, even for guys who are otherwise ready and willing to be snipped. Adam*, a father of two in Toronto, confesses his fear of pain keeps him from committing. “My wife pushed two babies out, so I had no problem about it being me who does this,” he says. “I did book the appointment, but when they called to say it was in two weeks, I cancelled it. I got scared — I know it’s going to be awful.”
Jarvi has dealt with countless panicked patients. “Most guys would rather have their right arm amputated than have anything done to their testicles,” he says with a laugh. “I’ve had patients who do crazy sports like motocross, and they’ll have fractures all over the place and treat them like they’re nothing. Then they pass out during a vasectomy.”
For those who fight through the nerves, many are shocked to realize — myself included — that it’s not so bad. “Weird” is the most common description from the men I know who have experienced it.
The myths and misconceptions persist, and Brock, who also chairs the Canadian Male Sexual Health Council, has heard them all: A vasectomy will alter sexual function or pleasure; it will change the way ejaculation feels; it will significantly reduce the amount of semen. “All of those are not true,” he says.
The function of the penis is not affected, Brock explains, because its blood supply comes from deep in the body, far from the scrotum. Also, sperm accounts for just two to five percent of semen (it’s mostly made up of other proteins and fluids), so the difference in the amount of ejaculate is very minor, less than 10 percent. As for pleasure, many men actually find they enjoy sex more after a vasectomy, since they’re a lot less worried about getting their partner pregnant.
For those who report troubles with post-snip sex drive or performance, it may have more to do with their own firmly held attitudes about manhood. Jarvi explains that for men in many cultures, a vasectomy may still be considered as drastic as castration. “People think that when you cut this off, you cut off their manhood,” he says.
That notion is pretty widespread. Without the hunter-gatherer distinction, says Jonathan Stack, a filmmaker in New York, “the one thing that still defines you as a male is your ability to impregnate.” Stack dug into the subject when he decided to get the snip himself. His 2013 documentary, The Vasectomist, and accompanying web series explore many of the anxieties men feel upon their decision to “exit the gene pool.” He was intrigued by the notion that men have the natural right to spread their seed well into their golden years. (That icon of eternal virility, Mick Jagger, comes to mind. Last December, he welcomed his eighth kid at the age of 73.)
The flip side of being way too invested in one’s manliness is, of course, not being invested enough. Face it: Guys are lazy about seeing the doctor. “Men are just bad at taking care of themselves compared with women,” says Stack. “They think going to the doctor is a sign of weakness.”
Stack would rather frame getting a vasectomy as a courageous act of love and consideration for the people in your life and the world at large. In his eyes, taking care of your family means assuming responsibility for birth control. For his series, Stack interviewed hundreds of men immediately after their vasectomies to ask why they had done it. “Most of them made a declaration of love that was very beautiful and genuine,” he says. “When you get a vasectomy, you’re making a real sacrifice for love.”
On ice: Recovery and side effects
So you could say having a vasectomy really takes balls. But you should know a little bit more about what those balls go through. One doctor friend of mine jokes that the slogan “Netflix and chill” has a special meaning when it comes to recovering from a vasectomy. That’s because sitting on the couch with frozen peas in your lap may be the wisest thing to do. And frosty produce is pretty much the only thing you should be applying to your junk. John, a father of one in Toronto, learned that the hard way.
His vasectomy went smoothly enough, but he did get an infection at the perforation site. “My girlfriend at the time was a bit hippy-dippy,” he says. “I suspected the area was becoming infected, and she told me to put tea tree oil on it, that it would clear it right up. So I did, like an idiot, and it made it 100 times worse. The next morning it was a festering mess down there. His doctor prescribed antibiotics and told him to keep the area very dry. “Which was the opposite of what I’d done,” John says.
Post-vasectomy infections are pretty rare though—rates run from one to two percent—and are generally easy to deal with. Another uncommon, albeit more worrying, side effect is chronic pain. In the months following his vasectomy, it became clear to Michael, a father in Victoria, that he was one of those unfortunate few. “‘Chronic’ makes it sound like it’s constant, which was definitely not the case,” he says. “Maybe three times a year, I’d have ball soreness for two to three days.”
Michael’s pain eventually resolved itself, which Jarvi says is common—most pain will fade away over time—but for others the pain may never disappear and, in very rare cases, could require a reverse vasectomy. Experts aren’t sure how to explain it or predict it, but Jarvi notes this outcome seems to be more common among men who had chronic testicular pain before having a vasectomy. “Testicular pain is actually really common, but it’s something no one hears about, because guys don’t talk about it.”
Don’t drop the ball
You’ve done it—good for you! But your job doesn’t end in the frozen foods aisle. Follow-up testing—to be sure your sperm hasn’t broken on through to the other side, which is the whole point—is crucial. Viable sperm can hang out in a man’s plumbing for several months after a successful vasectomy (failures run at about one in 2,000). And yet Jarvi cites a U.S. stat that says as many as 40 percent of men skip the follow-up testing, which essentially involves dropping a sample at your nearest lab (not even seeing a doctor) and waiting for a call to confirm the all-clear. As Brock puts it, “You’re not sterile until your doctor tells you you’re sterile.” (In the meantime, it’s imperative patients stick with other birth-control methods while those last swimmers leave the pool.) I didn’t miss this last step. After delivering a sample to the lab three months later, I was good to go.
At the time of my vasectomy though, I didn’t feel particularly heroic. It didn’t hurt much, and there was no swelling. None of my worst-case scenarios bore any resemblance to this thoroughly untraumatic event. I also got the chance to close the loop on my vasectomy experience in a very cool way. Earlier last year, I wrote about Bruce Springsteen’s latest tour. Among the people I interviewed for the piece was my personal snip angel, Little Steven. At the end of our talk, I couldn’t resist the opportunity to tell him about his unexpected presence during this special moment in my life. Down the other end of the phone came a raspy Jersey chuckle, one that expressed a certain kind of warmth and understanding. Every man knows it when he hears it.
*name has been changed