How common is vasectomy in Singapore? Is it reversible? Here’s what men should know

Gentlemen, your plans for a romantic night with your lady on Valentine’s Day might already be one-upped by what a Taiwanese plastic surgeon did for his wife. And no, it wasn’t a boob job (that would be self-gratuitous).

Rather, he performed a vasectomy on himself. In an Instagram video posted on Jan 9, Dr Chen Weinong, a father of three, was seen cutting, cauterising and suturing himself in a seated position – all while describing how each step felt.

“Extremely sore” and “strange” were his words when he reached his vas deferens, the tube that transports sperm from each testicle. “It is really painful when you touch the sperm duct, and it feels strange to sew yourself up,” he said in the video.

As Dr Chen performed the vasectomy on himself in the presence of three doctors, including a urologist, he shared his thoughts on why he opted to sterilise himself.

“Female sterilisation is more complex but male procedures are simpler. We just locate the duct which carries the sperm externally and tie it off,” he said. He called the vasectomy a “gift to my wife”.

Well, no one should be cutting and suturing himself down there, unless you’re a licensed surgeon who feels strongly about operating on yourself.

But if you and the missus have made the executive decision to shut down the baby-making factory – and don’t want to fiddle with condoms and birth control pills any more – it would seem getting the snip might be an alternative.

We ask medical experts for the lowdown on getting the gentleman’s cut and what it entails.

HOW COMMON ARE VASECTOMIES IN SINGAPORE?

“While there are no precise public statistics on the number or percentage of men in Singapore who have had vasectomies, the procedure is generally less popular in Asia compared to western countries,” said Dr James Tan, a urologist with Mount Elizabeth Hospital.

“Studies suggest that sterilisation as a male contraceptive method remains uncommon, with less than 1 per cent of men opting for it in Singapore. In my clinic, I see between two and three cases per month,” said Dr Tan.

The number is pretty low at the other hospitals, too. The National University Health System cluster collectively attends to an average of 15 to 20 vasectomies per month, according to consultant Dr Chia Jun Yang from National University Hospital's Department of Urology. 

Over at Raffles Hospital’s Raffles Urology Centre, Dr Darren Goh, a specialist in urology and a senior consultant said he sees a monthly average of five to 10 such patients. “There has been a gradual increase in the number of men asking for vasectomy, approximately by about 10 per cent to 20 per cent,” he said.

“This may be due to an increased awareness of vasectomy and understanding its benefits,” said Dr Goh, which primarily, is a permanent and one-time procedure for couples who are certain they do not want any more children.

“Men, in general, may be more open nowadays to be the one to go through the procedure, to ‘take one for the team’,” added Dr Goh.

Dr Tan has also noticed “an increase in the number of local men seeking vasectomy as a form of family planning”. “This is likely due to improved awareness and education about the procedure’s safety and effectiveness.”

WHAT HAPPENS DURING A VASECTOMY?

Essentially, a vasectomy involves severing both sperm ducts (also known as the epididymides or vas deferentia) by cutting, then tying or cauterising the severed ends to prevent them from joining up again, said Dr Chia.

To access the tubes, “one or two incisions are made in the scrotum or skin sac that holds the testes”, said Dr Chia. These initial cuts can be made with a scalpel in what is known as scalpel vasectomy.

In non-scalpel vasectomy, “a pair of sharp, pointed instruments is used to make a small puncture on each side of the scrotal skin” instead, said Dr Tan.

“The vas deferens is then brought out of the skin puncture,” said Dr Tan, before it is cut, cauterised, buried and the scrotal skin sewn back up with a single stitch on each side. “This method is less invasive, results in less bleeding, and typically has a faster recovery.”

A vasectomy can be performed under general or localised anaesthesia, said Dr Chia, making it possible as day surgery or as an outpatient procedure. The whole process is usually completed within half an hour.

Dr Tan noted that performing the procedure under local anaesthesia is technically more challenging as it requires “operating with the surrounding swelling”. Some patients may also feel some ways about being conscious and aware of what’s going on during the procedure with local anaesthesia.

WHAT CAN ONE EXPECT AFTER THE OPERATION?

As with any surgical procedure, you may experience mild pain, bruising and swelling post-operatively, said Dr Chia. These signs should resolve with pain and anti-inflammatory medications after a few days. “Chronic pain is not common but can occur in up to 5 per cent of patients,” he said

The most common side effects are bleeding and infection. “Thankfully, these occur in less than 5 per cent to 10 per cent of patients and are easily treated,” said Dr Chia. “Most bleeding is minor and can be stopped with compression dressing.” Most infections are treated conservatively with a course of antibiotics, he added.

What can also occur in some men after a vasectomy is the development of a sperm granuloma in the vas deferens. It is a small mass caused by leaked sperm from the cut end of the vas deferens.

A sperm granuloma may be painful but it generally heals by itself. In the meantime, over-the-counter anti-inflammatory and pain medication can help. If the discomfort is unbearable, it may need to be surgically removed.

HOW LONG MUST ONE WAIT AFTER A VASECTOMY TO HAVE SEX?

The testes aren’t going to shut down after a vasectomy, meaning they will continue to produce sperm, according to Dr Goh. And you will still be able to ejaculate without noticing a change in the quantity and appearance of your semen.

The difference is, those swimmers won’t reach the outside of your body as the vas deferentia are cut. Instead, the sperm “will remain in the body and get broken down and absorbed by the body”, said Dr Goh.

While you are typically cleared to resume sexual activities one week after a vasectomy, said Dr Tan, it’s best to still use contraception in the meantime. That’s because sperm may take “up to three months or 25 ejaculations” to clear from the semen, he said.

To be very certain, Dr Goh said that patients will need “a seminal analysis after three months to confirm the absence of sperm in the semen”.

You should also stay away from the gym and strenuous physical activities such as heavy lifting for at least a week, said Dr Tan, to reduce the risk of swelling or complications.

CAN YOU SUCCESSFULLY REVERSE A VASECTOMY?

“There are no strict age limits specific to vasectomy in Singapore,” said Dr Chia. But think carefully, he cautioned, because “while vasectomy reversal can be done, there is a chance that it may not be successful”.

The reversal procedure is called a vasovasostomy, said Dr Tan, where the severed ends of each vas deferens are surgically reconnected. “The success rates depend on the time passed since the original vasectomy,” he said:

• Less than 10 years: 70 to 90 per cent success rate
• More than 10 years: 30 to 60 per cent success rate

The longer the time lapse, the more prevalent the obstacles, said Dr Tan. For instance, your “body may produce antibodies against sperm, reducing fertility”. “The longer the gap, the higher the likelihood of permanent damage to the vas deferens.”

There are also the technical difficulty as well as the surgeon’s experience to consider. “We use sutures as thin as the human hair to stitch the ends together in two layers,” said Dr Tan. And while surgeons may perform two or three vasectomies a month, they may only perform about one vasovasostomy per year, according to him.