Previous article
Correction
Sep 2025
Next article
Cardiac Rehabilitation: Indications, Benefits, and New Approaches

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.

Vasectomy is an elective, office-based procedure performed in men who do not want to conceive future children. During this procedure, a segment of the vas deferens is removed and/or cauterized, preventing sperm from entering the semen.1,2 Vasectomy has no impact on sexual experience or drive.1,2 It is more than 99% effective in preventing future pregnancies after a semen analysis confirms sterility 3 months after the procedure.1,2 In the United States, 13% of vasectomies are performed by family physicians.1–3

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingComments
Use of no-scalpel or other minimally invasive techniques for approaching and isolating the vas deferens reduces the rates of perioperative bleeding and postoperative hematoma, sperm granuloma, recanalization, chronic scrotal pain, and infection.21 ACochrane review (meta-analysis of two RCTs)
When occluding the vas deferens, adding fascial interposition decreases failure rates by one-half and shortens time to azoospermia on semen analysis compared with segment removal only.24 CRCT, disease-oriented outcome
Irrigating the distal end of the vas deferens during vasectomy does not speed the clearance of sperm.27 CRCT, disease-oriented outcome
Opioids are not routinely needed before or after vasectomy, and their use increases the risk of chronic opioid use.15 BCohort study

RCT = randomized controlled trial.

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

Vasectomy rates in the 1980s and 1990s were steady but declined across all age groups and areas of the country from 2002 to 2017.4,5 In the United States, only 4% of men ages 18 to 45 years have had a vasectomy, indicating it is underused despite the benefits.4 Typical characteristics of men who pursue vasectomy include age older than 30 years and being in a stable relationship with two or more children.6,7 Lower education and income are associated with lower utilization of vasectomy.4,8

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.

  1. 1.Sharlip ID, Belker AM, Honig S, et al. Vasectomy: AUA guideline. J Urol. 2012;188(6 suppl):2482-2491.
  2. 2.Zini A, Grantmyre J, Chan P. CUA guideline: vasectomy. Can Urol Assoc J. 2016;10(7–8):E274-E278.
  3. 3.Zeitler M, Rayala B. Outpatient vasectomy: safe, reliable, and cost-effective. Prim Care. 2021;48(4):613-625.
  4. 4.Zhang X, Eisenberg ML. Vasectomy utilization in men aged 18–45 declined between 2002 and 2017: results from the United States National Survey for Family Growth data. Andrology. 2022;10(1):137-142.
  5. 5.Ostrowski KA, Holt SK, Haynes B, et al. Evaluation of vasectomy trends in the United States. Urology. 2018;118:76-79.
  6. 6.Anderson JE, Jamieson DJ, Warner L, et al. Contraceptive sterilization among married adults: national data on who chooses vasectomy and tubal sterilization. Contraception. 2012;85(6):552-557.
  7. 7.Huang Z, Hyman MJ, Raheem OA. Trends in the vasectomy rate among privately insured men aged 18–64 in the United States between 2014–2021. Urology. 2023;179:80-86.
  8. 8.Eisenberg ML, Henderson JT, Amory JK, et al. Racial differences in vasectomy utilization in the United States: data from the national survey of family growth. Urology. 2009;74(5):1020-1024.
  9. 9.American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Gynecology. ACOG practice bulletin no. 208: benefits and risks of sterilization. Obstet Gynecol. 2019;133(3):e194-e207.
  10. 10.Medicare.org. Does Medicare cover vasectomy? April 28, 2019. Accessed July 22, 2024. https://www.medicare.org/articles/does-medicare-cover-vasectomy/
  11. 11.Planned Parenthood. How do I get a tubal ligation? Accessed July 22, 2024. https://www.plannedparenthood.org/learn/birth-control/sterilization/how-do-i-get-tubal-ligation-procedure
  12. 12.Jamieson DJ, Costello C, Trussell J, et al.; US Collaborative Review of Sterilization Working Group. The risk of pregnancy after vasectomy. Obstet Gynecol. 2004;103(5 pt 1):848-850.
  13. 13.Edwards IS. Earlier testing after vasectomy, based on the absence of motile sperm. Fertil Steril. 1993;59(2):431-436.
  14. 14.Korthorst RA, Consten D, van Roijen JH. Clearance after vasectomy with a single semen sample containing < than 100000 immotile sperm/mL: analysis of 1073 patients. BJU Int. 2010;105(11):1572-1575.
  15. 15.Barham DW, McMann LP, Musser JE, et al. Routine prescription of opioids for post-vasectomy pain control associated with persistent use. J Urol. 2019;202(4):806-810.
  16. 16.Shih G, Turok DK, Parker WJ. Vasectomy: the other (better) form of sterilization. Contraception. 2011;83(4):310-315.
  17. 17.Griffin T, Tooher R, Nowakowski K, et al. How little is enough? The evidence for post-vasectomy testing. J Urol. 2005;174(1):29-36.
  18. 18.White MA, Maatman TJ. Comparative analysis of effectiveness of two local anesthetic techniques in men undergoing no-scalpel vasectomy. Urology. 2007;70(6):1187-1189.
  19. 19.Shih G, Njoya M, Lessard M, et al. Minimizing pain during vasectomy: the mini-needle anesthetic technique. J Urol. 2010;183(5):1959-1963.
  20. 20.Sokal D, McMullen S, Gates D, et al.; Male Sterilization Investigator Team. A comparative study of the no scalpel and standard incision approaches to vasectomy in 5 countries. J Urol. 1999;162(5):1621-1625.
  21. 21.Cook LA, Pun A, Gallo MF, et al. Scalpel versus no-scalpel incision for vasectomy. Cochrane Database Syst Rev. 2014(3):CD004112.
  22. 22.Moss WM. A comparison of open-end versus closed-end vasectomies: a report on 6220 cases. Contraception. 1992;46(6):521-525.
  23. 23.Labrecque M, Nazerali H, Mondor M, et al. Effectiveness and complications associated with 2 vasectomy occlusion techniques. J Urol. 2002;168(6):2495-2498.
  24. 24.Sokal D, Irsula B, Hays M, et al. Vasectomy by ligation and excision, with or without fascial interposition: a randomized controlled trial. BMC Med. 2004;2:6.
  25. 25.Dassow P, Bennett JM. Vasectomy: an update. Am Fam Physician. 2006;74(12):2069-2077.
  26. 26.Black T, Francome C. The evolution of the Marie Stopes electrocautery no-scalpel vasectomy procedure. J Fam Plann Reprod Health Care. 2002;28(3):137-138.
  27. 27.Mason RG, Dodds L, Swami SK. Sterile water irrigation of the distal vas deferens at vasectomy: does it accelerate clearance of sperm? A prospective randomized trial. Urology. 2002;59(3):424-427.
  28. 28.Yang F, Li J, Dong L, et al. Review of vasectomy complications and safety concerns. World J Mens Health. 2021;39(3):406-418.
  29. 29.Coady SA, Sharrett AR, Zheng ZJ, et al. Vasectomy, inflammation, atherosclerosis and long-term followup for cardiovascular diseases: no associations in the atherosclerosis risk in communities study. J Urol. 2002;167(1):204-207.
  30. 30.Velez D, Pagani R, Mima M, et al. Vasectomy: a guidelines-based approach to male surgical contraception. Fertil Steril. 2021;115(6):1365-1368.
  31. 31.Adams CE, Wald M. Risks and complications of vasectomy. Urol Clin North Am. 2009;36(3):331-336.
  32. 32.Meng MV, Greene KL, Turek PJ. Surgery or assisted reproduction? A decision analysis of treatment costs in male infertility. J Urol. 2005;174(5):1926-1931.
  33. 33.Belker AM, Thomas AJ, Fuchs EF, et al. Results of 1,469 microsurgical vasectomy reversals by the Vasovasostomy Study Group. J Urol. 1991;145(3):505-511.
  34. 34.Nagler HM, Jung H. Factors predicting successful microsurgical vasectomy reversal. Urol Clin North Am. 2009;36(3):383-390.
  35. 35.Marinaro J, Hayden RP, Shin P, et al. The utility of sperm cryopreservation at the time of vasectomy reversal. J Urol. 2021;205(1):236-240.
  36. 36.Schwarzer JU, Steinfatt H. Current status of vasectomy reversal. Nat Rev Urol. 2013;10(4):195-205.
  37. 37.Hinz S, Rais-Bahrami S, Kempkensteffen C, et al. Fertility rates following vasectomy reversal: importance of age of the female partner. Urol Int. 2008;81(4):416-420.
  38. 38.Hernandez J, Sabanegh ES. Repeat vasectomy reversal after initial failure: overall results and predictors for success. J Urol. 1999;161(4):1153-1156.
  39. 39.Potts JM, Pasqualotto FF, Nelson D, et al. Patient characteristics associated with vasectomy reversal. J Urol. 1999;161(6):1835-1839.
  40. 40.Trussell J, Guilbert E, Hedley A. Sterilization failure, sterilization reversal, and pregnancy after sterilization reversal in Quebec. Obstet Gynecol. 2003;101(4):677-684.
  41. 41.Rayala BZ, Viera AJ. Common questions about vasectomy. Am Fam Physician. 2013;88(11):757-761.
Previous article
Correction
Sep 2025
Next article
Cardiac Rehabilitation: Indications, Benefits, and New Approaches

Current issue

July 2026

July 2026

Copyright © 2026 by the American Academy of Family Physicians.

This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. See permissions for copyright questions and/or permission requests.