Before Your Vasectomy at Buenafe Clinic in Winnipeg
Patient Instructions for Winnipeg Vasectomy Procedures
Once your surgery date is scheduled it is important that you follow the instructions below. Please also review the After Vasectomy information so you know what to expect after the procedure.
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The Week Before Your Vasectomy
Starting seven days before the procedure, do not take any aspirin or other anti-inflammatory medication. These thin the blood somewhat and increase the risk of bleeding. You can still take other pain relief medication like Tylenol.
In addition to aspirin you must entirely avoid Non-Steroidal Anti-inflammatory Drugs such as Ibuprofen, Motrin, Aleve, Advil, Naproxen, Diclofenac, and others. Tylenol (acetaminophen) is acceptable because it does not impact your risk of bleeding during and after surgery.
Don’t take aspirin and the other anti-inflammatories for your own safety. Our doctor may not perform your procedure if you have taken these drugs recently. If you have a medical requirement to do so, please discuss with Dr. Buenafe.
Consider a vasectomy to be permanent contraception.
Two Days Before
Please avoid alcohol for at least 24 hours before and after the surgery.
Wash and then shave your scrotum two nights before your surgery. We recommend shaving then instead of the night before so that any discomfort due to shaving will have passed before you come into the clinic for your vasectomy procedure.
The image below shows where to shave, and you may choose to cut first carefully with small scissors prior to shaving with a safety razor or an electric shaver if that is your preference.
Shaving Before Vasectomy
For our improved visibility and for hygienic reasons (keeping hair out of the surgical area), we recommend that you shave from the base of the penis and along front and sides of your scrotum. Avoid dry shaving; do it while showering.
While we could easily perform your procedure without having you shave at all, we believe that this is an important step in performing a meticulous surgery.
The Day of Your Surgery
Wear very supportive underwear. Please do not wear boxer shorts, as they do not provide the necessary support.
Wear comfortable clothing. Choose pants that you won’t mind getting iodine on after the procedure. We also recommend that you wear a T-shirt because the room in which we do the procedure is hot and anything heavier may be uncomfortable for you.
The heat of the room relaxes the scrotum and makes the procedure easier to perform. You can imagine yourself on the beach on a southern vacation during the brief surgery.
Eat a good breakfast! You will feel much more comfortable during the procedure. Minimize coffee, but have one if skipping it causes you material stress.
Plan to arrive a little earlier for your appointment.
In Clinic Preparations
Our staff will usher you into one of the surgical rooms where you are not required to fully undress; you just need to lower your pants, lie back and relax.
One of Dr. Buenafe’s assistants will prepare you for the procedures by washing the scrotal area with iodine solution and placing surgical towels on your body. Dr. Buenafe then enters and puts a small amount of freezing into the skin using a small needle or No-Needle Anesthesia with MadaJet.
Most men describe the administration of the freezing using the No-Needle Anesthesia as being similar to the flick of an elastic band and virtually painless. It’s then time for the actual vasectomy, which takes approximately 10 minutes. Afterward, you will be brought back to the waiting room, where you will receive a cold drink and have time to relax. When given the thumbs up you can drive yourself home.
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Consideration Before a Manitoba Man’s Vasectomy
Choosing to have a vasectomy is a serious decision because it is carried out with the intention of creating permanent sterility.
Our experience with patients over the years has shown that some men who opt for a vasectomy later change their minds about their desire to have children after their vasectomy is done. Reasons for this include death of a spouse, death of a child, divorce, separation or just changing their minds.
Please review the questions and considerations below to ensure that you make a good decision.
Do I think that I might want to have more children?
If there is a possibility that you might want additional children in the future, you should not have a vasectomy. Your vasectomy will prevent you from conceiving a child and should be considered a permanent form of male birth control.
Vasectomy reversal surgery is not a fully effective way to restore male fertility, and no one should use surgery to temporarily suppress fertility. A vasectomy reversal may be possible but the results are not certain. A vasectomy is recommended only for men who are certain they will not want to conceive a baby.
Am I a good candidate for vasectomy surgery?
If you are certain you don’t want more children, the remaining questions are related to your current physical condition, and there are not many contra-indications for a vasectomy procedure.
The main ones are to do with any pre-existing issues affecting your scrotum (hernia in that area, scarring) and your general ability to tolerate a minor surgery (abnormal blood coagulation, other pre-existing conditions). It is also vital that you follow the doctor’s instructions on post-operative care.
Personal circumstances that men need to carefully consider before choosing to have a vasectomy:
- Age – Are you young and have no children?
- Personal Stress – Do you think you might be making a hasty decision at a stressful time?
- External Pressure – Do you feel pressured into the decision by someone or by circumstances?
- Relationship Stability – Do you frequently question the stability of your relationship?
- Permanent contraception will not likely help you resolve problems you experience in any of these areas.
If you have decided that no matter what the future brings you will not want any more children, then vasectomy is a reasonable consideration for you.
How can I be sure I want a vasectomy?
- You don’t want to father a child under any circumstances.
- You want to enjoy sex without worrying about pregnancy.
- You want to save your partner from the surgery involved in having her tubes closed, which carries a higher risk and failure rate.
If this is true in your case, then a vasectomy may be right for you.
Talk to your partner- it’s a good idea to make this decision together. Consider other kinds of birth control.
Talk to a friend or relative who has had a vasectomy.
Think about how you would feel if your partner had an unplanned pregnancy. Talk to a doctor, nurse or family planning counselor.
A vasectomy might not be right for you if:
You are very young, your current relationship is not stable, you are having the vasectomy just to please your partner, you are under a lot of stress, or you are counting on being able to reverse the procedure later.
Vasectomy reversal is a more complicated operation than the original vasectomy procedure. Reversal success rates are up to 70% and vary based on how long it has been since the original surgery. Buenafe Clinic does not offer vasectomy reversals.
Can a No-Scalpel Vasectomy be reversed?
Yes, but reversal operations are expensive and not always successful. If you are thinking about reversal, perhaps vasectomy is not right for you. We definitely recommend that you consider vasectomy a permanent form of contraception when making your decision.
Pre-vasectomy Sperm Banking (cryopreservation) is a good idea for almost anyone considering a vasectomy.
Is now the best time for my vasectomy?
You will want to be certain that you are content with the number of children you have. If you have a child under six months of age, you might want to wait because of the “Sudden Infant Death Syndrome (SIDS)”, a condition where a child can die after a few months of life for no apparent reason. Six months of age is often considered the threshold at which SIDS is least likely to occur. Although SIDS is not common (1 in 2000 infants), this might possibly affect the timing of your plans for vasectomy.
Male Sterilization – Potential Regrets
Vasectomy should be considered permanent and non-reversible as reversals are not guaranteed.
You may regret your decision one day if it is taken prematurely. Younger men, especially those in their 20s with fewer than 2 children, are most likely to seek a reversal in the future, often citing that they thought it was the right decision at the time only to be disappointed when their reversal procedure was unsuccessful.
Men change. Some men are totally convinced that they do not want kids. In our experience, some men develop a different attitude about having children as they get older and their life situation changes.
Women also change. Some women who do not want children change their minds as they grow older. Some who have had bad reactions to pregnancy feel they would never want to go through another pregnancy only to change their minds after a few years.
Relationships can end. Despite how stable our relationships may seem, there is a chance that in a few years, you may be with a different partner who may have a strong desire to have kids.
What is Post Vasectomy Pain Syndrome?
There is a well-recognized entity that can present among a small number of men after vasectomy that has become known as a post vasectomy pain syndrome. This syndrome can begin immediately after the vasectomy or many months or even years after the vasectomy has been completed. The frequency of this problem varies amongst given practitioners.
Some studies report as high as one third of men after vasectomy have some type of lingering discomfort. Other studies report that the frequency of post vasectomy pain is one case in thousands. Because of the wide variations in the incidence of post vasectomy pain in the practices of different vasectomy surgeons, it is important that each surgeon give their patients an accurate account of what the risks of post vasectomy pain syndrome would be in their specific practice.
Some of the speculative causes of post vasectomy pain are:
1. A “rough” surgery where significant amounts of tissue and nerves have been disrupted and/ or tied that have caused lingering irritation of the nerves. While this may be a frequent cause of post vasectomy pain syndrome one can imagine that it would be less common in the patients of experienced vasectomists. Treatment Option: In regards to a rough surgery, this would likely be the most difficult to treat and to identify as a cause of pain. Possible treatments could include exploration of the area to remove scarred or inflamed tissue, manual manipulation or stimulation of the painful area, or just allowing time to heal.
2. A sperm granuloma could develop post vasectomy that becomes inflamed and aggravates the surrounding nerve endings. The sperm granuloma is a build up of extravisated sperm at the end of the cut vas tube end. The reason why a sperm granuloma may develop is not well understood. Treatment Option: In the case of a sperm granuloma, injecting it with steroids or actually cutting out the inflamed granuloma has been found effective in the past. Surgery should always be viewed as a last resort.
3. Inflammation and swelling of the surrounding nerves called neuroma could develop. This could cause intermittent or constant pain. An air pressure powered jet injector, called the madajet is known to have a high rate treatment success. Treatment Option: Nerve blocks i.e. injection of various anesthetic solutions have been tried. So have injections of steroids, or excision of the neuroma.
4. A congestive state in the epididymis from back pressure to the epididymis and testes from performing a closed-ended vasectomy. Some authors believe that by blocking both the upper and lower cut ends of the vas tube the normal passage of sperm from the penis and away from the epididymis and testes causes a build up of pressure and ensuing pain. Studies have shown that this situation can be prevented to a large degree by performing an Open-ended vasectomy. In carrying out an Open-ended vasectomy, the lower or testicular end of the cut vas is left open, thereby allowing the sperm to drain out of the tube preventing a build up of pressure. Treatment Option: In regards to pain resulting from a congestive state from a closed-ended vasectomy, converting that vasectomy to an Open-ended vasectomy or considering a vasectomy reversal have been identified as being effective.
5. A vasectomy carried out too close to the epididymis can cause chronic pain and inflammation at the epididymis. Treatment Option: Surgery carried out too close to the epididymis causing chronic epididymitis may respond to medications or require an epididymectomy.
6. Some speculate that post vasectomy pain could be mediated by an immune reaction. It is known that antibodies to sperm are produced by the body after vasectomy. It is possible that these antibodies can react with testicular epididymal and or scrotal tissue to cause an inflammatory reaction. Treatment Option: Some advocate the use of a steroidal anti-inflammatory like Prednisone for 1-2 weeks. This treatment may be particularly helpful in treating an antibody/immune mediated cause of the pain. Hormone treatment with testosterone, +/- progesterone may also be effective in suppressing the production of the antigen (sperm) and therefore may help in treating an antibody-mediated immune reaction.
7. Shorter term causes of post vasectomy pain include infection and post operative inflammation which tend to resolve with the appropriate medications and rarely persist long enough to fall into the category of becoming chronic.Treatment Option: Regarding treatment of shorter post vasectomy pain like post operative inflammation or infection, the use of anti-inflammatories for inflammation and appropriate antibiotics for infection have been shown to be effective in dealing with this type of pain.
8. An undiagnosed depression that is totally unrelated to the vasectomy. In these cases the vasectomy and the perceptions of continued pain become a somatization reaction i.e. a physical expression of psychological pain. Depression can also be caused by post vasectomy pain syndrome. The depression can keep the pain perceptions ongoing even once the original cause of the pain is long gone. Treatment Option: In case of depression and somatization, counselling and anti-depressant medications can be very effective.
9. While there is no evidence that vasectomy causes prostatitis, new cases of prostatitis have been infrequently described post vasectomy. So prostatitis should be ruled out by digital exam and possibly scope. Treatment Option: Prostatitis can be treated with antibiotics like Cipro, sometimes requiring many weeks of therapy.
Potential treatments for post vasectomy pain in Winnipeg include:
Getting a second or third opinion from different practitioners with an expertise in treating post vasectomy pain is always advisable.
Time, sometimes 1-2 years, without doing anything at all, may heal the problem.
Some investigations that may help sort out the cause of post vasectomy pain include:
- Scrotal ultrasound.
- Semen culture and sensitivity and gram stain.
- Anti-sperm antibodies.
- Surgical scrotal exploration.
- Opening the testicular end of the vas.
- A careful physical examination of the scrotal contents by a qualified physician.
- A careful psychological history to rule out depression.
- Cystoscopy – scoping the urethra with observation of the prostate gland and bladder.
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