DR CHEW-LIN YIP | UROLOGIST

Dr Chew-Lin Yip performs vasectomy for patients from Mandurah, Rockingham, Murdoch and the wider Peel and southern Perth region. Vasectomy is a permanent method of contraception. It is not effective immediately, and other contraception must continue until semen testing has confirmed clearance.

Each testicle produces sperm, which travel along a tube called the vas deferens to join the fluid that makes up semen. A vasectomy divides and seals both vas deferens, so sperm can no longer reach the semen.

Vasectomy is not intended to alter testosterone production, sex drive, erections, orgasm or sensation. Because sperm make up only a small part of semen, most patients notice little change in ejaculate volume, although individual experiences vary. Sperm that continue to be produced are broken down and reabsorbed by the body.

Vasectomy is intended to be permanent. Before proceeding, it is worth being satisfied that:

• the patient has completed their family, or is certain they do not want children

• the decision has been discussed with a partner, if there is one

• the decision is not being made during a crisis, relationship breakdown, or immediately after a difficult pregnancy or birth

• reversal is not guaranteed and is not routinely funded

Anyone who remains uncertain should postpone the procedure.

Dr Yip will discuss the patient’s reasons and circumstances, examine the scrotum to confirm both vas deferens can be felt easily, and explain the procedure, risks and follow-up testing.

Conditions that can make the procedure more difficult — previous scrotal, groin or hernia surgery, undescended testis, a large hydrocele or varicocele, or obesity — are identified at this point.

Dr Yip performs vasectomy under general anaesthetic as a day procedure. The patient is asleep throughout and usually goes home the same day.

A small incision is made in the scrotal skin. Each vas deferens is identified, brought through the incision, divided and sealed. The cut ends are usually separated further by placing a layer of tissue between them, reducing the chance of the ends rejoining. The skin is closed with dissolving stitches.

The operation itself takes around twenty minutes, although several hours should be allowed at the hospital for admission, anaesthetic and recovery.

Dr Yip performs vasectomy at Peel Health Campus in Mandurah and Hollywood Private Hospital in Nedlands. Assessment and follow-up consultations are available in Mandurah, Murdoch and Rockingham.

Because a general anaesthetic is used, the hospital’s fasting instructions must be followed. A responsible adult is needed to take the patient home afterwards. Driving, operating machinery and making important decisions should be avoided for 24 hours.

Tell the practice beforehand about blood-thinning medication, previous scrotal, groin or hernia surgery, and any problems the patient or family members have had with anaesthetics.

The first 48 hours. Rest, use an ice pack intermittently and wear supportive underwear day and night for the first week. Simple analgesia such as paracetamol is usually sufficient; avoid aspirin unless a doctor has advised otherwise.

The first week. Avoid heavy lifting, sport, cycling and strenuous work. Many patients doing sedentary work return after two to three days; physical work usually requires about a week away.

Bruising and swelling are common, can look alarming and usually settle over one to two weeks.

Sex can usually resume after about a week, or once comfortable, but contraception must continue until clearance.

Seek medical attention for increasing pain or swelling, fever, or redness spreading over the scrotum.

Vasectomy does not work immediately. Sperm remain beyond the point where the tubes were divided and must clear before the procedure can be relied upon.

Other contraception must continue until Dr Yip has reviewed the post-vasectomy semen analysis and confirmed clearance in writing. Contraception should not be stopped merely because a particular amount of time has passed.

A post-vasectomy semen analysis is arranged to confirm the result. Dr Yip’s protocol is to perform the test three months after the procedure and after at least 20 ejaculations. Both conditions matter.

The request form and laboratory instructions explain how and when to collect and deliver the sample. Follow those instructions carefully because specimen requirements can differ between laboratories.

Clearance. If no sperm are seen, Dr Yip can give clearance and other contraception can stop.

Special clearance. Some patients continue to show very small numbers of non-motile sperm without any motile sperm. Where these persist at a very low concentration, clearance may still be given. The risk of pregnancy is regarded as very low but not zero.

If motile sperm persist. Repeat testing is arranged. Persistent motile sperm suggest the tubes may have rejoined and the vasectomy may need to be repeated.

Dr Yip will explain whether clearance, special clearance or further testing is needed.

Vasectomy is commonly performed, but no operation is without risk and individual outcomes vary.

Bruising and swelling are common and usually settle.

Bleeding into the scrotum can form a collection that causes discomfort and occasionally needs treatment.

Infection can affect the wound or the epididymis and testicle and may require antibiotics.

Blood in the semen can occur during the first few ejaculations.

Sperm granuloma is a small tender lump caused by sperm leaking from a divided end. It usually settles without treatment.

Ongoing scrotal pain. Around 3 in 100 men develop scrotal pain that persists beyond the expected recovery period. It is usually mild, but in a small number it affects daily activities and may require further treatment. It cannot always be fully resolved.

Early failure. In about 1 in 200 men, the semen test continues to show motile sperm because the tubes have rejoined. Testing detects this before clearance and the vasectomy can be repeated.

Late failure. Very rarely — about 1 in 2,000 — the divided ends rejoin after clearance and fertility returns. Any pregnancy after vasectomy should prompt medical review.

Vasectomy is not intended to change testosterone production, sex drive, erections or orgasm. Any unexpected change should be discussed with Dr Yip. Current evidence has not established that vasectomy causes prostate or testicular cancer. Vasectomy does not protect against sexually transmitted infections.

Reversal is technically possible but should not be assumed. It is a longer and more complex operation, it is not routinely funded, restoring sperm flow does not always restore fertility, and the chance of success falls as the interval since vasectomy lengthens.

If there is a real possibility that future fertility may be wanted, vasectomy may not be the right decision now and sperm storage is worth discussing.