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Sep 2025
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Vasectomy: Common Questions and Answers

This is a corrected version of the article that appeared in print.

James J. Arnold, DO
David Villanueva, DO
Melissa Jane Puntkattalee, MD

American Family Physician. 2025;112(3):264-269.

Author disclosure: No relevant financial relationships.

This clinical content conforms to AAFP criteria for CME.

Vasectomy is a highly effective form of permanent contraception. It is as effective as tubal sterilization and is safer, less costly, and associated with quicker recovery. In the United States, only 4% of men ages 18 to 45 years have had a vasectomy, indicating that it is underused despite the benefits. Vasectomy is typically performed in the outpatient setting, and most patients return to regular physical and sexual activity after 1 week. Opioids and antibiotics are not routinely needed. The no-scalpel vasectomy and other minimally invasive techniques for approaching and isolating the vas deferens have the lowest occurrence of adverse events such as hematoma, infection, sperm granuloma, recanalization, and chronic scrotal pain. After the vas deferens is isolated and segment is removed, mucosal cautery alone or facial interposition with mucosal cautery of both ends or abdominal end have occlusion failure rates of less than 1%. The addition of fascial interposition improves rates and decreases the time to azoospermia on semen analysis without a significant increase in adverse outcomes. Sterility is confirmed 3 months after vasectomy with a semen analysis that shows rare, nonmotile sperm (100,000/mL or fewer) on microscopy. Although vasectomy should be considered permanent, up to 6% of patients seek reversal. Successful reversal rates (return of sperm to semen) are high; however, pregnancy rates are variable.

JAMES J. ARNOLD, DO, FACOFP, FAAFP, is the director of osteopathic education at the Gadsden Regional Family Medicine Residency, Gadsden, Alabama, and associate clinical professor in the Family Medicine Department at the University of Alabama at Birmingham. At the time this article was written, he was director of osteopathic education at St. Vincent's East Family Medicine Residency, Birmingham, Alabama.

DAVID VILLANUEVA, DO, is associate program director at St. Vincent's East Family Medicine Residency.

MELISSA JANE PUNTKATTALEE, MD, is family medicine with obstetrics faculty at St. Vincent's East Family Medicine Residency.

Address correspondence to James J. Arnold, DO, FACOFP, FAAFP, at drarnolddo@me.com.

Author disclosure: No relevant financial relationships.

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