Vasectomy and Sexual Function


As summer comes to a close, so does one of my busiest times of the year.  Urologists perform vasectomies all year long, but summer tends to be one of the more popular seasons to get snipped.  Perhaps it’s because men tend to take more time off work during the summer or because births are highest from July to October, but every year around this time, my office is flooded with men wanting to undergo vasectomy.  Add to that the recent Dobbs v. Jackson Supreme Court decision allowing states to restrict women’s reproductive freedoms, and you suddenly have an overwhelming number of men seeking out vasectomy this summer.

When I first meet with men to discuss vasectomy, they have a lot of questions, as one would when you’re considering a procedure on your family jewels.  They, of course, want to know about the pain.  They want to know how long it takes and if it’s reversible.  They want to know how often it fails.  Let me answer those quickly.  First, there is minimal discomfort.  Vasectomy is a relatively quick office procedure (around 30 minutes) and is reversible, but reversals are not always successful.  And vasectomy fails < 1% of the time.

Still, a lot of questions I get asked about vasectomy have to do with how it might affect sexual function.  Men are very concerned that elective sterilization may negatively impact their sex lives, but there is no evidence to support those concerns.  What follows is a review of some of the concerns men have regarding how vasectomy might affect their sexual function.

a couple speaks to a doctor

 

What exactly is a vasectomy?

Before delving into the discussion at hand, it’s worth noting what exactly a vasectomy entails.  Vasectomy is a procedure that cuts, ties, and/or sears shut the vas deferens, which is the tubular structure that allows for the transport of sperm from the testicle (where they are made) into the ejaculate fluid.  Did you know you have two vas deferens (the plural being vas deferentia)?  That’s right. Each testicle has its own vas deferens.  So as you can imagine, vasectomy involves cutting, tying, or searing both of these tubes.

When it comes to vasectomy, there’s more than one way to skin a cat.  But no matter how it’s done, vasectomy always involves disrupting the sperm transport system.  There is no cutting, tying, or searing of anything else.  The penis and testicles are nearby but left alone in the process.

Vasectomy is one of the most reliable forms of birth control.  When finished, vasectomy blocks the pathway for sperm to make it into your ejaculate.  You don’t stop producing sperm; they just, in essence, have nowhere to go.  They get made, mature, march down the ol’ sperm pathway, and simply get absorbed by the body once they run into the cut end of the vas.

It’s important to keep in mind that the birth control effects of vasectomy are not immediate.  Sperm cells can still be present in the vasa deferentia for awhile, and I always counsel my patients to continue using contraception until we confirm the absence of sperm in a post-vasectomy semen sample several weeks later.  It usually takes at least twenty ejaculations to “clean out the pipes,” as we say.

Will vasectomy affect testosterone?

We’ve talked a lot previously about the importance of testosterone and male sexual health.  It’s arguably the most crucial hormone that supports sexual function.  Testosterone is produced primarily in the testicles, so one might assume that vasectomy could influence testosterone production.  I get asked this a lot, actually.

Thankfully, there’s no need to worry.  Testosterone production does not change after vasectomy.  Cutting the vas deferens has no influence on the function of the testicle.  Remember, sperm continue to be produced in the testicle despite vasectomy.  And the same is true for testosterone production.  In fact, some studies have even suggested that men who undergo vasectomy may have higher testosterone levels than those that have never gone under the knife.

couple in bed having sex

Does vasectomy impact sex drive?

Men are often curious about how vasectomy will affect their libido.  The short answer is it won’t in most cases.  Sure, you may not be as eager to get busy immediately after your procedure, especially if you’re experiencing any discomfort.  But any decline in sex drive following vasectomy is likely to be short-lived.

In fact, I usually hear the opposite from my patients.  Vasectomy often provides men the freedom to have sex without worrying about pregnancy.  Sex can be more spontaneous, carefree, and fun after vasectomy.

It is important to keep in mind, too, that many different factors can negatively impact libido.  Stress, whether it be from a relationship or other external factors, is a libido killer.  You can read more about that here.  A history of depression is also a risk factor for a low sex drive.  If a person has any regret about having undergone vasectomy, this too could result in a decrease in libido.

Does vasectomy cause ED?

Perhaps more than anything, I get asked about whether vasectomy will interfere with erectile function.  No one wants to risk their erections, even if vasectomy is super reliable at preventing pregnancy.  Perhaps we should take a minute to discuss how erections work exactly.  First, sexual stimulation causes the brain to trigger the arousal (erection) process.  This results in relaxation of the smooth muscle in your penis.  Penile arteries expand, allowing more blood to enter, thereby creating a firm erection.  Expansion and filling of the erection tissue leads to constriction of veins, helping maintain rigidity during sexual activity.  After ejaculation (or when sexual stimulation ceases), the blood is released back into the body, and the penis becomes flaccid once again.

As I mentioned above, vasectomy spares the penis and therefore does not alter any of the organs or processes needed for an erection.  If you get good quality erections before vasectomy, then you should continue to afterward.  One study even found that men who underwent vasectomy had better erectile function scores than those who hadn’t (Engl).  So never fear – your boners are safe!

man looking into his boxer briefs

Will vasectomy change my orgasm?

Men often have difficulty distinguishing between semen and sperm.  Sometimes they think that because vasectomy affects fertility, they will suddenly stop ejaculating altogether.  I also get asked all the time if vasectomy will change the way a man orgasms.  Some men assume that their orgasms will feel different, weird, or less pleasurable.  This couldn’t be further from the truth.  After vasectomy, you continue to produce semen and ejaculate and orgasm just like you always have.  There are just no more swimmers in your spunk.

Does vasectomy increase my risk of prostate cancer?

There are mixed data on the link between vasectomy and prostate cancer.  But even in those studies that have found an association between vasectomy and prostate cancer, the increased risk is pretty minimal.  It’s also incredibly hard to control for confounding factors when trying to decide whether vasectomy increases your risk of prostate cancer.  There are demographic, genetic/familial, economic, environmental, and even hormonal factors to consider.  It’s important to remember that correlation does not imply causation.  So, just because the two have been associated or correlated with one another in some studies does not mean that vasectomy causes prostate cancer.

a man and a woman smile at each other in bed

How will vasectomy affect my relationship?

One wouldn’t think that a procedure like a vasectomy could have an effect on one’s partner, but research has shown otherwise.  One study found a positive impact of vasectomy on sexual satisfaction amongst couples (Mohamad).  Researchers in this study queried both men undergoing vasectomy and their female partners before and after the procedure.  93% of the males in the study and 96% of their female partners said they would recommend and do vasectomy again.  But perhaps the most interesting finding was that the best improvement of sexual function was noticed in the female partners, not the men.  Significant improvements in sexual desire, arousal, orgasm, lubrication, and overall sexual satisfaction were noted in female partners of men who had a vasectomy.  Additional studies have found similar improvements in sexual satisfaction from vasectomy amongst couples (Engl).  So getting snipped may be good for you and even better for your partner.

Conclusion.

Hopefully, this has helped clarify some of the questions and/or misconceptions you might have had about vasectomy and sexual function.  Overwhelmingly, vasectomy has been associated with improvements, not decline, in sexual health.  Vasectomy is certainly not something to be taken lightly, and you should think seriously about it before getting cut.  But it’s one of the most reliable methods of contraception, and it may ultimately be of benefit to you and your partner.

 

Mohamad Al-Ali B, Shamloul R, Ramsauer J, Bella AJ, Scrinzi U, Treu T, Jungwirth A. The effect of vasectomy on the sexual life of couples. J Sex Med. 2014 Sep;11(9):2239-42. doi: 10.1111/jsm.12567. Epub 2014 May 12. PMID: 24820516.

Engl T, Hallmen S, Beecken WD, Rubenwolf P, Gerharz EW, Vallo S. Impact of vasectomy on the sexual satisfaction of couples: experience from a specialized clinic. Cent European J Urol. 2017;70(3):275-279. doi: 10.5173/ceju.2017.1294. Epub 2017 Jun 23. PMID: 29104791; PMCID: PMC5656365.

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