What you need to know before the procedure: "Besides the acute post-operative pain, swelling, and bruising that we have spoken about, which most men find are very time-limited, fairly trivial, and manageable with ice and Tylenol, I need to tell you about the risk of chronic testicular or epididymal pain after vasectomy. The incidence of any testicular pain may be as high as thirty percent in the first year. Severe pain that can affect sexual function or quality of life is lower, but still 2 to 5%. Some men find that this pain during sex diminishes the sensation of orgasm or pleasure from sex. Between 1 in 30 and 1 in 60 men regret having the vasectomy due to chronic genital pain. If you end up in this latter group, your treatment options will include warm soaks, Motrin, and time. If it does not resolve, you may need a vasectomy reversal and it may not be covered by insurance and could cost $4000 to $12,000. You have an approximate 75% chance of responding to the reversal. Of course if you have a reversal, you will likely be fertile again. If the reversal is ineffective, you might have to consider further surgery that could include removal of your epididymis (a mushy organ connected to the testicle) or rarely, removal of the testicle itself.
The problems with being told this are two-fold:
The information would be hard to agree on as it varies widely from study to study. Some men would change their mind after hearing this info and walk out of the appointment or cancel the planned procedure. Some surgeons have better outcomes than others, perhaps due to experience or skill. They would likely object to using worldwide statistics for outcomes. Clearly, they could use their own, if they knew them, but follow-up after vasectomy is frequently poor. Many men suffer in silence and fear further surgery. Nonetheless, statistics aside, this statement or another with similar intent should be included on all vasectomy consent forms with the statistics reflected in the medical literature or those consistent with the surgeon’s own practice at the very least. This is currently not required in the United States. Any practitioner can use any consent form he or she wishes to augment the usual pre-operative counseling that should precede all vasectomies.
EI Shapiro and SJ Silber, Open-ended vasectomy, sperm granuloma, and postvasectomy orchialgia., Fertility and Sterility, 32: 5, 546-550, November, 1979.
"Vasectomized men exhibit significant testicular histologic changes and increased autoimmune activity as compared with fertile control subjects. These histologic changes are not directly associated with antisperm antibody status, suggesting that some other pathophysiologic process must be responsible." Urology 1994 Apr;43(4):521-4. Jarow, et al.