Most vasectomy articles are either clinical (“Here’s what happens step by step”) or overly reassuring (“It’s quick and simple!”). But this isn’t going to be most vasectomy articles. Curious, medically grounded, and willing to explore the lesser-discussed realities, this is intended for those who want the real scoop.
We’ve gotten a few of these questions in the office, and we also scanned online forums and patient discussions to see what men (and their partners) are really asking. Here are a few of the most common – and most misunderstood – questions about vasectomy.
Does it hurt?
Mild discomfort or soreness is normal after a vasectomy, but severe pain is not. The procedure is typically done with local anesthesia, and most men describe a brief pinch or tug rather than sharp pain. Some swelling or bruising may occur for a few days afterward, and ice packs, supportive underwear, and over-the-counter pain relievers help ease recovery. A small percentage of men may develop post-vasectomy pain syndrome, characterized by persistent discomfort in the testicles or groin. While this is rare, it can usually be managed with medication or, in some cases, a minor corrective procedure.
Can you still get someone pregnant?
Maybe. Sperm can remain in the vas deferens and seminal fluid for weeks or sometimes even months after the procedure. That’s why we recommend continuing contraception until a semen analysis confirms a zero sperm count. Even after clearance, pregnancy is still possible in very rare cases due to spontaneous recanalization, when the severed vas deferens reconnects. In most cases, though, vasectomy is one of the most effective forms of birth control, with success rates comparable to female sterilization, but with far fewer complications.
Will it affect sex drive or erections?
No. A vasectomy blocks sperm, not testosterone. Your hormone levels, libido, and erectile function remain the same because the procedure doesn’t touch the testicles’ ability to produce testosterone or the nerves and blood vessels that enable erection. Many men report no difference, or even improved sexual confidence afterward, since anxiety about unintended pregnancy is gone. Erections and ejaculation all occur normally. If issues like decreased libido or erectile difficulty arise, it’s often due to unrelated factors such as stress, aging, unrelated health issues, or performance anxiety rather than the vasectomy itself.
Can a vasectomy influence the sensation of orgasm?
Most men notice no difference in how orgasm feels. The pleasure of climax comes from nerve signals and muscle contractions in the pelvic floor and prostate, not from the presence of sperm. A small number of men say orgasms feel subtly different (sometimes more intense, sometimes less), usually because of psychological factors or reduced anxiety. Physical changes, like altered ejaculate pressure, are minimal and rarely affect sensation. If anything, the absence of pregnancy worries can help some men feel more relaxed and present during intimacy, which can enhance perceived pleasure.
Does it cause health problems down the road?
There’s no proven link between vasectomy and long-term health problems such as prostate or testicular cancer, cardiovascular disease, or hormonal imbalance. Earlier studies raised concern about possible immune or inflammatory effects, but large-scale follow-ups found no causal relationships.1 The most common long-term issue is occasional tenderness at the surgical site, often linked to sperm granulomas or mild nerve irritation, which are typically manageable. With modern technological advances in medicine, vasectomy is one of the safest surgical procedures available, with an excellent safety record and extremely low risk of major complications.
Circumcised vs. uncircumcised – any differences?
Not really. Circumcision affects the foreskin, while vasectomy involves the vas deferens inside the scrotum – entirely different anatomy. Being circumcised or uncircumcised doesn’t influence how the vasectomy is performed or how it heals. However, uncircumcised men should take extra care with hygiene during recovery to minimize infection risk. But in terms of outcomes and effectiveness, circumcision status makes no meaningful difference.
Can you still get a penile implant after a vasectomy?
Yes – a vasectomy doesn’t interfere with future penile implant procedures. The two surgeries involve different parts of the anatomy: the vas deferens for sperm transport versus the corpora cavernosa for erections. However, a urologist planning an implant will review your surgical history to avoid scar tissue or prior incision sites. The combination is common in men addressing both fertility and erectile function issues, and when done by an experienced surgeon, outcomes are safe and effective.
What is post-vasectomy sex like?
Once cleared by your doctor, sex after a vasectomy should feel the same – or sometimes even better. Ejaculate volume is nearly unchanged because sperm make up less than 5% of semen. Some men experience temporary tenderness or mild apprehension the first few times, but these sensations fade as healing completes. Many couples describe sex as more relaxed and spontaneous afterward, without the mental load of contraception concerns or pregnancy anxiety.
Can sperm build up and cause discomfort after a vasectomy?
Normally, no. After a vasectomy, sperm are still produced in the testicles, but can’t travel through the vas deferens. Instead, they break down naturally and are reabsorbed by the body. Occasionally, some sperm may leak into surrounding tissue, forming a tiny, harmless lump called a sperm granuloma. Sometimes it can occur after a vasectomy, but it can also happen after trauma to the epididymis (coiled tubes at the back of each testicle) or other reproductive structures and after an infection that causes significant inflammation. Sperm granulomas can cause mild tenderness, but it’s usually temporary. Larger granulomas or those located in more sensitive areas could result in more pronounced pain.
What happens to sperm production after “the snip?”
Your testicles don’t get the memo – they keep producing sperm just as before. The difference is that sperm can no longer exit the body. Instead, they’re broken down by immune cells and absorbed, a completely natural and harmless process. Over time, the body may slightly reduce sperm production because the system finds its new equilibrium. So, while your sperm don’t make it to the finish line anymore, the testicular “factory” keeps running without any negative health consequences.
Can ejaculate change in volume or texture?
No, not typically. Sperm account for only a small fraction of semen volume, so most men see little to no difference. Some may notice a slightly thinner or less opaque appearance, but texture and sensation are virtually identical to before the procedure. Any substantial change in ejaculate color, volume, or consistency months later is more likely due to hydration, diet, or prostate changes than to the vasectomy itself. Your body still produces seminal fluid as before, just without the sperm component.
Is there a “best age” for a vasectomy?
It depends more on life circumstances than biology. Most men who choose a vasectomy are in their 30s or 40s and confident they don’t want (more) children. Age doesn’t affect success or recovery, but younger men may have a higher chance of regret if their family plans change later. That’s why counseling before the procedure is important. Discussing sperm banking or reversible options gives you an “out” in case your long-term goals change. Ultimately, the best age is when you’re certain about your choice.
Can a vasectomy affect testosterone replacement therapy?
No. Vasectomy doesn’t influence testosterone levels, absorption, or the effectiveness of hormone replacement. Testosterone replacement therapy (TRT) acts on the bloodstream and tissues, not on the vas deferens or sperm production. Vasectomy and TRT can coexist safely – many men with prior vasectomies later start testosterone therapy without issues. The only consideration is that TRT can temporarily suppress sperm production, so fertility restoration after vasectomy reversal may take longer. Otherwise, there’s no conflict between the two, and your hormonal health remains completely intact.
Will insurance cover a vasectomy?
It could. Some private insurance plans and employer-sponsored policies cover vasectomy as a form of “permanent” birth control. (It isn’t permanent in a strict sense as reversal procedures are available.) Coverage may include the procedure, anesthesia, and follow-up semen testing, though deductibles or copays can still apply. Federal law doesn’t require private insurers to cover male sterilization, so benefits vary by plan. It’s best to verify benefits with your insurer before scheduling the procedure.
“Doctors are curious people – that’s partly why I became one! If you have questions, no matter how “weird,” I genuinely appreciate you asking. To learn more about any of the topics we covered here or to talk through your own, don’t hesitate to schedule a visit.” ~ Dr. Kapadia
Based in the Atlanta area with Georgia Urology, Dr. Kapadia focuses on men’s health, including fertility, vasectomy reversal, erectile dysfunction, and penile implants. He’s also active in the field of reproductive urology and sexual medicine, publishing and presenting his research at both national and international levels.
Resources:
- Goldacre, M. J., Wotton, C. J., Seagroatt, V., & Yeates, D. (2007). Immune-related disease before and after vasectomy: an epidemiological database study. Human reproduction (Oxford, England), 22(5), 1273–1278. https://doi.org/10.1093/humrep/dem010.
