Guy's Guide to a Vasectomy

(Publisher's Note: the following post contains graphic detail of the vasectomy procedure, graphic language, and may not be suitable reading material for everyone. Continue forward at your own risk.)

This blog is generally intended to be about our kids and, maybe on a broader scale, the twists and turns of parenthood in general. I’ve never wanted this to be so much about us or me. But there are exceptions, and I think the following tale touches on family planning and what many parents must face at one point or another.
Thursday I got a vasectomy, and I think it’s worth a blog entry since I found nothing of my suiting around the web that properly prepared me for what I went through. I’ll try to keep the language clean and clinical and hope that this may serve as some sort of helpful guide for someone.

Taking one for the team
During our pregnancy with Karissa we knew that two was enough, especially with Kathy 37 and me about to turn 40. Kathy’s options of birth control are limited, for various reasons. The condom and I have never got along. After the birth it was time for someone other than Kathy to take one for the team. A urologist I had been to before, Dr. Aaron Amos of Mansifield, was first visited with a consultation, essentially to confirm in eye to eye with the doctor that – yes – I know this means being sterile and my wife agrees to it, too. The day of the procedure Kathy actually had the option to sign a “Spousal consent” document, which she did.
I started an antibiotic (Levaquin) the day before. The doctor said no grooming was required on my part, that it would be done in prep of the procedure. When I was called in, I was told by a nurse (?? PA? some assistant of the doctor; too many titles for too many people in a doctor’s office these days – an African-American woman about my age) to disrobe completely from the waist down, but that I could keep my socks on. I could then sit on the chair and drape a sheet over my lap. When I say “chair” I mean like a regular examining table/bed that every doctor’s office has, but cut in half – a little slab to sit on, then an adjustable back. My legs dangled off the edge at the knees. I sat on surgical blankets, gauze, whatever the heck that stuff is, wearing only socks and a t-shirt. I had to be quite a sight. I had my iPhone with me and ear buds. I was told to bring a book, headphones, even a portable DVD player if I wanted to. This was a local anesthetic procedure where I’d be wide awake, not unlike many dental or dermatological procedures. I chose my phone, loaded up with tunes, and a good set of ear buds that drown out all airplane noises on a flight. The woman returned and told me to lean back.

Clinical basics of a Vasectomy
A vasectomy is the snipping and partial removal of the vas deferens, a small vein-like tube which carries sperm from the testicles to its mixing station with other seminal fluids. Sperm seemingly has a short path to travel from the testicles to the penis, but in fact sperm actually travels through the vas deferens back into the body, behind and over the bladder, where it then joins with the prostate gland just above the penis. This is where ejaculate fluids are produced and stored – only about 5% of which is sperm. I have no idea what comprises the other 95%, but after a vasectomy it becomes 100% of an ejaculate. There is obviously very little that changes, outside of its potency around a pregnant woman. We are told that there will be no noticeable distinction between a former ejaculation and future one – in color, consistency and volume. For what that’s worth. They thought enough of those details to add it to the FAQs. We are also told that it will not affect any sensation that brings on an ejaculation. That’s still to be seen and will not be blogged about. Anyways, right near the testicle, the vas deferens is snipped at two points, removing about a 1/8-inch segment of it. The ends are then burnt shut. In a vasectomy reversal the two burnt ends are simply reattached.

The Prep
The first thing the nurse did was attach a piece of tape to one side of my thigh, brought it across my waist, pulled my penis upward towards my belly, taped it down then attached the tape on my other thigh. At this point, modesty and embarrassment were out the window. She made no eye contact or attempted any other chit-chat beyond what was necessary (“this might be cold”, etc.) She then took an object that I did not see and began what felt like brushing of my scrotum. Soft, gentle strokes with an object that did not feel sharp or metallic, but was obviously shaving the area. This took a couple of minutes and she was thorough. Next came another blanket that was put over my nether regions, but for a large hollow square in the middle. My taped penis remained under this sheet and only my scrotum was exposed through the sheet. Another wonderful sight this had to have been. She then scrubbed my scrotum with iodine, then wiped up and deemed me ready to be cut. Instruments were laid out on a tray with sterile sheets.
So if an aerial photo was taken all that would be seen is me looking quite normal from the torso upwards, then a white sterile sheet with nothing but a set of bald testicles protruding from it, then my black socks. Wonderful.

The Procedure
Dr. Amos arrived with cordial small talk as he scrubbed his hands and put on sterile gloves, verbally walking through the procedure as he had done before. First up was to find the vas deferens. This is done manually, and it might be the most painful part of the entire process. It was not an eventful opening act. He gashed his fingers into my scrotum and dug and pulled. He eventually found it and gave it a few tugs. On a pain scale of 1-10 I eventually told the doctor that I probably don’t know what Level 10 pain is and hope I never do, but this was a solid 9. This was the pain associated with when a man is racked in the testicles, but I’d call the pain at least twice as intense, it was not restrained to just my testicles but as far back as to my spine, and lasted nearly 60 seconds. I don't know that I can properly relay the the origin of the pain. Just imagine your testicles have roots, like a plant, and the roots go deep into your body and tie around your spine. Now imagine pulling your nuts and jerking on those roots. The pain comes not from your testicular sack, but from the roots and the innards where the pulling is taking place. Maybe the angriness of the metal playing through my ear buds wasn’t helping, so I made a quick mental note to go with happier, cheesier music when it was the other testicle’s turn. I writhed in agony, but kept my lower torso still and was commended afterwards. I never knew how I’d show pain in such a situation, but apparently it’s by intensely rubbing my head and forehead. I grunted loudly once or twice, and finally on a particularly sharp prod – approaching 9.9 on that pain scale – I did spontaneously produce a profanity. Not only was it the f-word, but with “er” on the end, making it a sort of proper noun that could be perceived as being directed at the doctor personally. I apologized when things cooled down and luckily he was in good humor about it. I weakly tried to explain that profanity is an actual dialect of live television production that is used by dainty little girls and Godly men and everyone in between. He understood and said that eventually he would have to go through that process again to find the vas deferens on my right side, and I was free to say what I needed to say. So, giving my potty mouth a green light was somewhat of a truce.
So, once 9.9-pain had been reached, he grabbed the needle and stuck me in the scrotum and deadened the area. That wasn’t so bad. From then on, I felt nothing on the exterior of my procedure. Never felt cuts, tugging, all of that. But so much pain was internal, and seemingly from the roots of my testicles. There was no anesthetic that could reach that pain, and that’s the pain that sticks out in my mind.
I spent most of the time texting Kathy out in the lobby, keeping my hands and mind busy as the tunes played. Eventually, smoke was seen and the smell of burnt skin (very much like singed hair) filled the room. That was jarring. But, all I felt – again – was the slight, lingering sensation of being racked in my testicles. Soon enough it was time to do the right testicle, the whole procedure all over. First with the prodding and finding of the vas, and a 9 on the pain scale was quickly reached. The Go-Gos “Turn to You” was not cheery enough and I let three f-bombs fly, along with an s-word. Things finally cooled down when he found the vas, pulled some slack, and made one last stick to deaden the area. I kept texting with Kathy and eventually was helping with her crossword puzzle clues (Milton Bearle’s title? 5 letters? “Uncle!”). While I had the phone hovering above me I also snuck a couple of pictures. More smoke and stench of burnt flesh filled the room. Then it was over. Only one incision was needed, just below the base of my penis. The paperwork warns that two incisions may be needed. He said it was about the size of a pencil eraser. A simple Band-Aid was placed on it. I felt it and realized there was no hair around to pull once it was ready to come off, so that was a relief. Once I thought the pain was over, the tape that was holding my penis up was removed from my thighs. One last little piece of joy.

Post-Procedure
Post-procedure instructions came while I was dressing – and these were the same instructions I was told on the initial consult: no sexual activity for 7-10 days (more specifically – “no ejaculating”); do not get the affected area wet (I’m allowed to shower, but with my back to the water); no baths or hot tubs, no submersion of the testicles. I was given Hydrocodone and told to put a cold compress on my testicles every two hours. A bag of frozen peas works fine, I was told. Into the next day, I can attest that the cold on my swollen sack actually feels really good.
For the rest of the night after the procedure, into today, it still feels like the lingering discomfort that comes after being kicked in the groin. It’s not the intense initial pain that can bring a man to his knees, but the ensuing cramping discomfort that keeps him from walking straight for several minutes. Again, it’s all more internal discomfort that external pain around my scrotum. It’s hard to describe. It’s like the roots of my testicles, wherever they originate in my body cavity, that’s where it hurts. It hurts to sit and get up from a seat, when pressure is put directly on the scrotum. Getting in and out of my car is probably the worst.
The 9.9-level pain of the procedure has been quickly forgotten. It sucked, but did not permanently scar me. Now in about 8 weeks I’ll send in a sample of my new fluids to check my potency. Right now, sperm still live in the larger section of my vas deferens and it will take time to clear the pipes. According to the paperwork, approximately 20-30 ejaculations. After the first sample is tested, I will then give another sample within two weeks. When I have given two samples within 2 weeks of one another, and both show no sperm, I am awarded the green flag of being sterile.