Sterilization in men involves the vas deferens being cut or burned via an incision on each side of the scrotum. It is common to experience tenderness and swelling in the scrotum in the first days after the operation, but most people are back to normal activity after a week.
Who can be sterilized?
As a general rule, the Sterilization Act allows all persons over the age of 25 to apply for sterilization. This is done by submitting a so-called “request for sterilization” to a doctor. The doctor is obliged to provide information about the procedure, what it entails, and the medical consequences of the procedure. If the doctor himself does not carry out such interventions, the petition is sent together with the application to a hospital or doctor who carries out such interventions. Before 2005, more than 3,000 sterilizations of men were performed annually in Norway. More recent figures are not available.
People under the age of 25, or people who have a serious mental illness, mental retardation, or are mentally impaired, must apply separately and have their application processed by a sterilization board.
Where is the sterilization performed?
Sterilization procedures are not classified as medically necessary procedures. A so-called increased deductible has therefore been introduced, and the hospitals are not obliged to offer this procedure. The waiting time is long in many places.
If you cannot have sterilization performed at a local hospital, you can contact private hospitals or private practicing surgeons for surgery. Whether you are operated on in a public hospital or a private hospital/doctor’s office, you must cover the costs yourself.
The deductible for sterilization at public hospitals in 2021 was NOK 6,079 for women and NOK 1,268 for men. Interventions at private clinics cost an estimated NOK. 6,000-10,000.
Anatomy and physiology
The sperm cells are formed in the testicles and stored in the epididymis, which are located directly behind the testicles. From the epididymis, the sperm is carried through a channel, the vas deferens, out of the scrotum, through the inguinal canal, into the abdominal cavity, and up to the prostate gland at the seminal vesicles. There, the sperm are stored in an enlarged last part of the vas deferens, the ampulla. In the ampoule, the sperm cells are mixed with the seminal fluid. During ejaculation, the sperm empties from the ampulla via a channel through the prostate, into the urethra, and out through the penis. The prostate gland also contributes to making parts of the seminal fluid.
How is the procedure performed?
Sterilization in men involves the vas deferens being cut or burned via incisions on each side of the upper part of the scrotum. In technical language, the procedure is called a vasectomy.
During the operation, a small incision is made in the skin on the upper part of the scrotum at the groin opening on both sides. Here, the vas deferens lie just under the skin, and in most cases, it is easy to find. It is then cut or burned so that the passage is broken. If the vas deferens are cut, the surgeon will sew up the two ends and usually remove a piece of the vas deferens so that the two ends cannot grow back together.
The operation is performed under local anesthetic. The treatment is over in approx. 20-30 minutes and leaves a small scar in each groin. The procedure is performed without hospital admission, and you do not need sick leave.
After one week you can usually resume normal sexual activity, but you cannot be considered sterile until after three months you have had your semen checked and found that it is free of sperm cells.
How safe is the procedure?
Sterilization is considered a very safe method of contraception, but it takes some time before there are no live sperm in the semen. Since sperm are stored throughout the vas deferens and in the seminal vesicles, vasectomy does not result in immediate sterility, and multiple ejaculations are required to remove all the sperm. It is stated by some that you should ejaculate at least 20 times before the semen is free of sperm cells.
It is therefore important to have a semen sample checked approximately three months after the procedure. This must then not contain sperm cells. The sperm cells normally make up less than five percent of the volume during ejaculation, and it is therefore not possible to see this with the naked eye. Only after this check can you trust the procedure.
On rare occasions, a new channel can be formed if the operation is not carried out satisfactorily. In various studies, it has been found that fertilization occurs in 1 in 2,000 cases where the man has been sterilized and the subsequent semen sample was empty of sperm cells. No other contraceptive method has better results.
An important aspect of sterilization is that the procedure is initially considered a permanent measure. However, some may regret the procedure, and find it psychologically burdensome to have lost their ability to conceive. It may then be possible to redo the procedure. In any case, hormone production and sexual function are not disturbed by the procedure!
In the past, it has been suggested that neutering a man increases the risk of prostate cancer and heart attacks. Recent research shows that this is not the case.
What happens to the sperm after the procedure?
The semen squirts out as usual, but the sperm cells stay inside you in the epididymis and lower part of the vas deferens. The vas deferens is closed, and there are no sperm cells in the semen. The sperm will eventually die due to lack of nutrition, but the testicles will continue to produce new sperm.
Complications
There will be tenderness and some swelling in the scrotum for the first few days. It is therefore recommended that you keep calm, especially during the first 24 hours. The vast majority are back to normal activity within a week. Complications such as swelling and bleeding are common and harmless.
Accumulations of blood (hematoma) or infection in the surgical area and surrounding tissue occur in approximately two to three percent of patients. If the wound and/or the skin in the wound area becomes inflamed with pus and/or severe redness and pain, the surgeon or other doctor should be contacted on the same day for assessment of treatment.
Life-threatening infections are very rare. However approximately 15 percent of men who are sterilized with a vasectomy experience new discomfort/pain in the scrotum in the time after the operation. Around 8 percent are affected by persistent or constantly recurring pain in the epididymis, without an infection being able to be detected as the cause (post-vasectomy pain syndrome, PVPS).
