Vasectomy Specialist in London, Ontario

Dr. Goldie utilizes the ‘NO SCALPEL’ vasectomy technique. This technique has been shown in follow-up studies to have the highest success rate, the lowest incidence of side effects, and the lowest risk of subsequent failure. 

Dr. Goldie also utilizes the jet injector spray technique to provide ‘NO NEEDLE’ local anaesthesia for his procedures.

Download COPY of Vasectomy Pre and Post Info Sheet 

Download Vasectomy Consent form

BACKGROUND

Vasectomy is a minor surgical procedure that will provide men with a permanent method of birth control. The procedure will block the flow of sperm from the testicle to the penis. You and your partner would only choose to proceed with this procedure if you feel that your family is complete. Vasectomy should be considered an irreversible procedure. 

Dr. Steven Goldie

Family Physician

BSc, MD, CCFP

Technically vasectomies can be reversed but this involves a more complicated procedure performed in a hospital under general anaesthetic with less than 100 percent success rates. If there is any doubt that you may want to have more children I would recommend that you consider postponing having a vasectomy and utilize alternative methods of contraception.

If you are interested in sperm banking prior to your vasectomy please refer to the attached websites in the FAQ section for further information.

If you have decided to proceed with a vasectomy make an appointment with your primary health care provider to discuss your decision. They will then forward a consultation request to my office. On receipt of the consultation request my office staff will contact you to make a consultation appointment so that I can discuss the procedure with you prior to booking your surgery. Your consultation appointment is normally done weeks prior to your actual surgery date. Fees for your consultation visit, procedure and post vasectomy sperm test are covered by OHIP.

Saffron Health is located at 11 Base Line Rd E only minutes from Victoria Hospital Emergency Dept. Our wait times are minimal and our staff takes pride in providing high quality patient care. 

Saffron Health Centre also provides all our patients (Walk in Clinic and Family Practice) with FREE parking, Full Pharmacy on site (having your prescription ready while you are here will save another stop somewhere else).

PRIOR TO THE VASECTOMY 

Once you have decided to proceed with having a vasectomy please follow these important instructions before your vasectomy.

• If you are normally anxious prior to medical procedures I will offer to provide you with a mild tranquilizer (Lorazepam) to be taken 90 minutes prior to the procedure. This medication may cause drowsiness therefore you will need to have someone drive you both to and from the office. It is not safe to drive on the day of surgery if you have taken this medication.
• At the time of the consultation visit I will instruct you to shave off the hair from the front of the scrotum below the penis prior to the procedure. The shorter you trim the hair the better! This may be done using foam or soap and a normal razor. I would advise against using creams such as ‘Neet’ on the scrotum due to the risk of a chemical reaction.
• If your job involves heavy physical labour you may need to take some time off work after the vasectomy or request lighter duties, if these are available, for the first few days back to work.
• It’s ok to eat and drink prior to your operation unless you get nauseated with medical procedures.
• Wear clothing that you don’t mind getting mildly stained with iodine that is applied to the scrotal area prior to the surgery.

PROCEDURE

The vasectomy procedure is performed in the doctor’s office. Normally the entire time spent in the office for the procedure will be less than thirty minutes. Initially the tube that carries sperm (vas deferens) is frozen with a device called a jet injector. This device is a small metal tube that uses air pressure to inject small amounts of anaesthetic through the skin into the vas deferens. Most men describe the sensation like being lightly snapped against the skin with an elastic. This is more comfortable than having a needle block which had been the traditional method to provide anaesthesia for a vasectomy. Each testicle has a vas deferens therefore each side needs to be anaesthetized. The anaesthetic begins working almost immediately. A small number of men may not be adequately frozen using the jet injector in which case a needle block will need to be performed. While we are waiting for the freezing to work, I will be setting up the rest of my equipment and discussing postoperative care with you.

With one vas deferens pulled up under the surface of the scrotal skin beneath the penis, a small puncture hole will be created with special vasectomy instruments. Once the vas deferens is exposed a small portion of the tube will be pulled out of the scrotum. After being cut the end of the tube that goes to the penis will be cauterized (burned) with a handheld cautery instrument (NOT A LASER). Once the cauterized vas has healed this will scar the end of the tube closed. This end of the vas deferens will then be covered with a portion of the tube’s sheath or covering using a titanium clip. This will reduce the risk of the cut ends of the tubes developing a reattachment between them in the future. The end of the tube that goes to the testicle will be left open and not cauterized. This is also known as the ‘open ended vasectomy’. This will allow the sperm that are being produced by the testicle not to be blocked at the end of the tube and risk causing increased pressure to be built up in the tube and testicle. Open ended vasectomy is also felt to reduce the risk of post vasectomy pain syndrome.

Once surgery on the first tube is completed it is placed back into the scrotum. Using the same hole that was initially created in the scrotum the opposite vas deferens is delivered out of the scrotum. The same procedure is performed on the opposite vas deferens. Once both tubes have been returned to the scrotum the small puncture hole that was created is sealed closed with a special skin glue. This will prevent any oozing from the hole after the procedure. The glue will waterproof the puncture hole and normally peels off by itself in 3-4 days after surgery. You may shower the night of or following morning after your procedure. Sometimes the glue does not stick well and can fall off in 1-2 days. When this happens the small puncture hole may still be open. If this occurs do not panic. You may experience mild oozing from the wound. My advice is to place a small bandaid over the hole and it will seal up by itself in a few more days.

AFTER YOUR VASECTOMY

• Once you get home apply an ice pack or frozen vegetables onto the front of the scrotum for 10-15 minutes every hour for the next 6-8 hours after surgery. This will both reduce swelling and provide some pain relief. If you feel that icing has been helpful you can also continue icing the day after surgery.
• Wear snug fitting underwear for the first few days after the vasectomy. Some men also use an athletic support (without the cup). You will feel more comfortable with the extra scrotal support.
• It is normal to experience mild bruising in the scrotum, mild swelling and discomfort in the week after your surgery.
• The local anaesthetic will last approximately 2 hours after the operation. Once it wears off you will experience aching in the testicles and scrotum. I suggest taking advil/ibuprofen/motrin (different names for the same medication) 800 mg. or aleve/naproxen 440 mg. immediately after surgery. After this initial dose take advil/ibuprofen/motrin 400 mg. or aleve/naproxen 220 mg. every 4 hours as needed for the next 24 – 48 hours after surgery. I will have also provided you with a prescription for Tylenol #3 or an alternate potent pain medication. You may use this if you feel that the milder pain medications are not providing you with adequate pain relief after your vasectomy. My experience is that most men will obtain adequate pain relief with ibuproben/advil/motrin and icing and not require the use of stronger pain medication.
• You may shower later on the day of surgery or the following morning to wash off the iodine used during the procedure.
• The skin glue used to seal the scrotal puncture closed will take 3-4 days to peel off by itself. Don’t pick at the glue as this may cause the puncture hole to open up and take longer to heal. If the glue comes off and it looks like the puncture wound has not healed do not panic. Nothing bad is going to happen. I suggest covering the hole with a bandaid and it will heal on its own.
• It is very important that you limit your physical activities in the first few days to a week after your operation. Blood vessels around the surgery site remain weakened after surgery and any heavy exertional activities may cause these vessels to rupture forming a blood clot. Once a blood clot forms it will be painful and likely result in your activities being significantly restricted for weeks after the operation. Walking is permitted the day after surgery but not for prolonged periods of time. Overdoing it physically in the first few days after surgery can also result in swelling of the scrotum which will also delay your recovery.
• Limit lifting to less than 25 pounds (10 kg.) during the first week after surgery. Also avoid any activities that involve heavy pushing or pulling during the first week. If you participate in sports or go to the gym I recommend not participating in these activities for one week after your vasectomy.
• Do not be alarmed if you see blood in the first few ejaculations after your vasectomy. This is old blood that is being cleared out of the vas deferens that have been cauterized during the vasectomy. This can come and go for the first few weeks after the surgery.
• It is important to understand that on completion of the vasectomy operation it is not immediately successful. It is very important that you and your partner continue to use a reliable method of contraception after your vasectomy until it is known that you are sterile. It takes approximately 20 ejaculations after vasectomy for most men to clear live sperm that are stored in the seminal vesicles. If you have not had 20 ejaculations by 3 months after surgery you may also provide your sperm sample to the lab at that time. You will have been provided with specimen containers at the time of your operation and instructed as to which labs will be able to process your specimen. The sample should be taken to the lab within 1-2 hours of production for testing. The results of your test will be forwarded to my office and we will call you with the results.
• Once your tests indicate that you are sterile there is a risk that for every 2000 men that are successfully sterilized, 1 man will regain his fertility back in the future. Studies suggest that the risk of this happening is actually highest in the first few months to a year after the vasectomy. Unfortunately there are no symptoms to indicate that this is happening. I will offer to have your sperm test repeated at any time in the future but particularly within the first year after your procedure. If after one year your vasectomy has not reversed itself the future risk of failure is much less.

RISKS OF VASECTOMY

It is normal in the week after the vasectomy to experience some mild bruising and swelling of the scrotum. Significant bleeding into the scrotum after surgery causing a hematoma (blood clot) is uncommon and in my experience occurs in approximately 1 in every 500 men that I operate on. This results in increased scrotal pain after the procedure and a delay in recovery from the vasectomy. If you suspect that you are developing a hematoma after surgery you should attempt to contact your surgeon or go to the emergency department of your nearest hospital if you are unable to contact your doctor. Almost all hematomas are treated with pain medication, rest and time without the need for further surgery.

There is also a risk of epididymitis (tender swelling of the portion of the vas deferens that attaches to the testicle) in the weeks and months after the vasectomy. This may occur in up to 3% of men postoperatively in my experience. Most men will describe sudden onset of pain in one of the testicles with pain and swelling localized to behind the testicle. This will require treatment with antibiotics and anti-inflammatories.

Up to 20% of men after vasectomy may develop a small nodule, smaller than a pea size, at the end of the vas deferens attached to the testicle, where sperm are building up after vasectomy. This is called a sperm granuloma. Most men will be unaware of its presence, however in a very small percentage of men the granuloma may become painful after vasectomy and require treatment with anti-inflammatory medication. It is very uncommon to require surgical removal of the granuloma in symptomatic men. If you become aware of this swelling in the scrotum between the testicle and base of the penis after vasectomy and there is no associated discomfort, treatment is not required.

There continues to be concern that having a vasectomy will increase a man’s future risk for prostate cancer. Review of recent studies looking at this concern has shown no substantive evidence that there is a serious risk. The American Urologic Association feels that due to the lack of evidence, this topic does not need to be discussed with prospective vasectomy candidates. I suspect that this will continue to be an area of ongoing research into the future.

Uncommonly, some men may experience chronic pain/ache in their testicles after their vasectomy. Studies have difficulty stating the exact incidence of chronic testicular pain but it may affect 1-2 /1000 men after surgery. The cause is likely due to chronic inflammation in the epididymis after surgery. Performing an open ended vasectomy where the end of the vas deferens attached to the testicle is not sealed closed (procedure performed by Dr. Vladars) should theoretically partially reduce the risk of post vasectomy pain syndrome. Treatments can include medication, nerve blocks and in the most severe cases, vasectomy reversal. It has been my experience that a large number of men with lingering discomfort lasting longer than six months after surgery will eventually experience improvement in their discomfort over time.