Vasectomy and Vasovasostomy - Male Contraception

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Long-Term Complications

Vasectomy Failure and Unexpected Pregnancy. Pregnancy rates after a vasectomy are very low, about 1 in 1,000. There are two main reasons for an unexpected pregnancy:

• Residual sperm were still alive when the partners had unprotected sex. This is the most common reason for an unexpected pregnancy after a vasectomy. Men should make sure they have follow-up sperm analysis testing. They should also continue to use birth control until their doctor notifies them that the test results confirm sterility.
• Failure of the procedure and recanalization. Failure in some cases is due to a technical error, but most often it is due to recanalization -- when the cut ends of the vas spontaneously reconnect. Success rates are best when an experienced surgeon performs the vasectomy.

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Recanalization and Sperm Granulomas. The primary reason for vasectomy failure is recanalization -- when the cut ends of the vas deferens spontaneously reconnect. Recanalization in some cases may be due to sperm granulomas. These are tiny balls of debris that form from sperm, scar tissue, and white blood cells at the incision site. Cells lining the inside of the vas deferens grow through the scar tissue and form a new channel through which the sperm can now move. In general, surgeons can reduce the risk for recanalization by leaving a gap between the two cut ends.

This natural vasectomy reversal can occur after any vasectomy surgical procedure, but it is uncommon. When recanalization does occur, sperm counts are almost always very low and pregnancies are still rare. Most cases of recanalization develop within several months after the operation. In very rare cases, sperm have reappeared a year or even longer after vasectomy.

Epididymitis. Epididymitis occurs when an inflammation at the site of the vasectomy causes swelling of the epididymis. This rare condition usually occurs within the first year and is treated with heat and anti-inflammatory medications. It usually clears up within a week.

Anti-sperm Antibodies. Sperm continue to be produced after vasectomy but are disposed of in the body. In some men the immune system mistakes these sperm as foreign proteins (antigens) and produces anti-sperm antibodies that are designed to target and interfere with sperm's motility (ability to move). Infections in the genital tract, such as orchitis or sexually transmitted diseases, increase the risk for anti-sperm antibodies. The anti-sperm response itself appears to be a problem only if a man wishes to reverse the vasectomy.

Chronic Pain. Some men develop testicular pain following vasectomy. If this pain lasts longer than 3 months, it is referred to as postvasectomy pain syndrome (PVPS). The causes of PVPS are unclear. It may be due to obstruction and resulting contraction of the epididymal duct, or inflammation and formation of fibrous tissue after rupture in the duct, which can cause nerve damage. Sperm granuloma has also been discussed as a possible cause, although their role remains controversial.

PNVS is first treated conservatively, with heat or cold therapy, rest, scrotal support, and nonsteroidal anti-inflammatory drugs (NSAIDs). Most patients are successfully treated with conservative therapies. If these methods do not work, other drug therapies, (including injections of local anesthetics or steroids), may be tried. Transcutaneous electrical nerve stimulation is another method that has been used with good results. If all options fail, surgical interventions, [including removal of the epididymis (epididymectomy), granuloma excision, or vasectomy reversal surgery], may be required.

Cancer Concerns. There have been concerns that vasectomy might increase the risk of developing prostate cancer. Men with a family history of prostate cancer can discuss the risks and benefits of vasectomy with their doctors, but evidence indicates there is no link between vasectomy and prostate cancer. There have also been some concerns that vasectomy could increase the risk for testicular cancer. Studies have not identified any association between the two.

Review Date: 11/04/2010
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org).