written by Dr Loh Chit Sin on 7 April 2011

Vasectomy is a simple procedure designed to render permanent sterility in a man. The vasa deferentia are most accessible in the scrotum making scrotal vasectomy a simple, low morbidity and reliable procedures. Popularity for vasectomy varies from culture to culture. In part of China, combination and publicity campaign and the introduction of minimally invasive technique had resulted in vasectomy being 3 times more popular than tubal ligation. Worldwide, some 50 million vasectomies had been carried out (5% of all married couples) but female sterilization remains 3 times more popular. Currently, the “no scalpel” technique developed by Li should be the preferred method for its lower complication rates. Percuteneous method employing sclerosant injection, though attractive, is technically more challenging and generally less reliable.

Sterility is closed to 100 % in experienced centers and achieved after about 10-14 ejaculations (2-3 months). It is customary to obtain 2 azoospermic specimens 2 weeks apart before declaring sterility. Late spontaneous recanalisation had been reported and occurs at a frequency of 1 in 3,000 cases and can occur as late as 20 years after the procedure.

Though simple, complications are common and closely related to techniques. Haematomata remained the most common complication (0.1 – 29%, mean = 2%). Infection rate averaged 3.4% and sperm granulamata 0.1 to 3%. Chronic testicular pain ranged from 0.01% to 3% and can be reversed by reversing vasectomy. If the pain is localized to the epididymis, epididymectomy can be considered. Long term postulated complications such as prostate cancer, testicular cancer and atherosclerosis remain unsubstantiated by large-scale review. Reversal can be highly successful (up to 80%) but success rate inversedly correlates with the period of vasectomy. Microscopic techniques yield superior results.

Compared with female sterilsation, vasectomy is a smaller, simpler procedure with low complication rate and better reversibility than female sterilization. Public education remains the key to popularity of this procedure in our society.