Common Questions

Everything you need to know about SimpleVas®

Most patients don’t want to talk with other people about their reproductive decisions. Having to discuss your personal reproductive matters could be inconvenient, as it is an intimate decision.

Dr. Guarín has chosen to handle personally those phone calls about vasectomies, for those patients trying to get a vasectomy in Cedar Rapids, IA and Naples, FL. By doing this, patients will be able to speak directly with the surgeon about their very personal decision of stopping their fertility.

Patients seen at the Newton Clinic in Newton, IA may be able to call the Newton Clinic to schedule the appointments, but if they choose not to call and register first, then Dr. Guarín will be able to call them personally and arrange the details of the surgery.

* Remember Dr. Esgar Guarín is a Maternal, Child and Reproductive Health physician. He is an strong advocate for the practice of vasectomies, but is also involved in other aspects of medicine as well (pregnancy care and child care).

Most patients don’t have to take time off from work for their recovery. Then by Monday you’re back to work without major restrictions!!

By having clinics on WEEKENDS, Dr. Guarín can spend exclusive time with his vasectomy patients. At the same time the locations are less occupied and his patients will feel more comfortable.

I understand there are some patients for whom weekends may not work in an immediate basis. I apologize for this, but you may be able to plan for a future clinic that might work. It is still a great advantage for most patients.

* Remember Dr. Esgar Guarín is a Maternal, Child and Reproductive Health physician. He is an strong advocate for the practice of vasectomies, but is also involved in other aspects of medicine as well (pregnancy care and child care).

1. Do not take Aspirin, Ibuprofen, or Naproxen within 2 days of the procedure. If you’re taking medications, please recording in the registration page.

2. Bring someone with you. Although you’re procedure will not limited your ability to drive, you may want to have some one with you who can assist you in the case of unexpected events when going back home (i.e. flat tire, mechanical issue), as you don’t want to be on the road dealing with a vehicle just after a surgery.

3. Make sure that you get a jockstrap (athletic supporter), or tight underwear. Where it when you come for your surgery (under your underwear). During the week following surgery, we suggest you use it for more scrotal support and comfort, particularly if physically active at work. We can give you one at the time of the procedure.

4. Please trim the hair of your scrotum prior to the surgery, this will allow for a quicker preparation for the procedure and an easier surgical field.

5. Take a shower prior to surgery to minimize the potential of skin infections due to limited hygiene.

* You can print these instructions from a pdf format HERE

– Reminder sperm needs to be released. About 98% of men are sperm-free after 20 ejaculations and 12 weeks

– It is important to have a semen sample checked and to use other forms of birth control until it is confirmed by microscopic examination that the semen is sperm-free.

– Sperm are still made by the testes but can no longer pass up through the vas, so white blood cells ingest and digest the retained sperm, recycling the proteins back into the system for use in other body functions.

– Men usually notice:

  • No change in the semen
  • No change in sex drive
  • No change in climax sensation
  • No change in the testes or scrotum
  • No change in erections

Bleeding can occur during or after vasectomy, but it is less common with a non-scalpel method like SimpleVas® Vasectomy.

  • If this occurs within the scrotum, drainage of a scrotal hematoma (blood clot) in a hospital operating room could be necessary. Smaller hematomas do not require surgical drainage, but tender swelling can last for 2 to 4 weeks. Both large and small hematomas are very rare. If the scrotal skin bleeds at the vasectomy access site, the scrotum can become discolored (black and blue) for about a week; this is more common than swelling, but painless.

Infection is also a rare complication.  Mild infections (swelling unresponsive to anti-inflammatory medications) respond to oral antibiotics. It is rare to require drainage of infected areas.

Sperm granuloma is a pea-sized (sometimes tender) lump on the vas tube at the vasectomy site, almost never requiring treatment.

  • They may increase the likelihood of success with vasectomy reversal. Periodic tenderness usually responds to an anti-inflammatory medication like ibuprofen.

Congestion, tender buildup of sperm and white blood cells upstream from or at the vasectomy site, can occur anytime after vasectomy, but usually goes away with use of an anti-inflammatory drug such as aspirin or ibuprofen.

  • About one in 2000 patients will experience chronic post-vasectomy discomfort (PVPS or Post-Vasectomy Pain Syndrome) severe enough that he will seek vasectomy reversal or neurolysis (division of the sensory nerves coming from the testes). A larger percentage may have milder forms of chronic pain that can affect quality of life but not severely enough to seek vasectomy reversal.

Recanalization is the development of a channel for sperm flow between the two cut ends of the vas. If this happens during the healing process (early), the semen never becomes sperm-free until the vasectomy is repeated.

  • If recanalization happens late (months or years after a man’s semen has been examined and declared sperm-free), an unplanned pregnancy could result; but the odds of this occurring is far less after vasectomy than the odds of pregnancy with any other form of birth control including birth control pills and tubal ligation (female sterilization).
  • Failure rates of vasectomy vary with the technique used to obstruct sperm flow through the vas tubes. The early failure rate is about one in 2500 and the late failure rate is one in 3500.

Vasectomy is NOT 100% reversible *

Patient must use other forms of birth-control UNTIL sperm-free

Vasectomy DOES NOT prevent transmission of sexually transmitted infections (STI’s).

*  Since reversal attempts often do not lead to pregnancy, vasectomy should be considered an IRREVERSIBLE form of contraception.

Before choosing vasectomy, couples, especially couples in their 20’s with fewer than 3 children, should consider all other forms of reversible contraception including birth control pills, shots, patches, and implants; the IUD (intrauterine device); and barrier methods such as the condom and diaphragm. Couples using barrier methods (ie. condoms) should also be aware that emergency contraception(“the morning after pill”) is readily available.

Low one-time expense often covered by insurance companies, and by federal grant money through state programs for low-income men with no insurance (check your benefits).

Vasectomy is more dependable than any other form of contraception including female sterilization.

It eliminates risks associated with birth control pills or shots and the IUD.

Vasectomy reversals are less costly and more successful than tubal ligation reversals

No need for inconvenient and less dependable methods

Dr. Guarín’s SimpleVas® Vasectomy technique follows the no-needle/no-scalpel technique technique learned under Dr. Doug Stein, a renown urologist and full-time vasectomist from Tampa, Florida.

  • During the SimpleVas® Dr. Guarín exposes each vas through a tiny opening in the front scrotal wall under local anesthesia. Since the opening is so small, it is easy to apply anesthesia without the use of needles.
  • A spray applicator (MadaJet®) delivers a stream of anesthetic so fine that it penetrates the skin and diffuses to a depth of about 3/16 of an inch, enough to surround and anesthetize each vas tube in turn as it is lifted into position beneath the skin.
  • Most, about 99%, of patients require no more anesthetic than this for completion of the procedure itself without pain.
  • Some, about 1%, of patients do require injection of a little more anesthetic, but since the skin and vas are already partially numb, injection of more anesthetic with a fine needle rarely causes more than the slightest sensation.
  • The tiny opening in the dime-sized area of numb skin is made with a pointy hemostat. One tip makes a pinpoint opening, then the two tips are used to spread and enlarge the opening to about 1/4 of an inch.
  • Since blood vessels in the skin are spread apart rather than cut, bleeding is less than when a scalpel is used, no stitches are required, and the opening is usually sealed closed (often barely visible) by the next day.
  • Once each vas tube is lifted through the small skin opening, it is divided under direct vision with fine surgical scissors.
  • Nothing is removed; the ends of the divided vas are placed out of alignment and kept from rejoining by applying a tiny clip to the sheath surrounding the vas so that one end stays inside the sheath, the other outside.
  • While extremely effective (failure rate less than 1 in 2000), the technique provides for easier reversal (less scarring than when sutures are used) in men who choose reversal later in life.
  • Procedure time is about 20 minutes. Most men say it hurts less than having a blood sample drawn. Many have called it painless.

A scrotal support (jockstrap) is applied and should be worn overnight and reapplied, after a next-morning shower, when up and around for the next 2 days.

Ice-packs are not necessary, but is used make sure the surgical area is DRY AT ALL TIMES.

Men are advised to recline on the evening of the vasectomy, light activity the next day, and full activity 2 days after the vasectomy. May resume sex within 5-7 days from the procedure.

After vasectomy about half of men will take non-prescription pain pills (Tylenol or ibuprofen), often just to prevent expected discomfort; the other half don’t take any pain pills. About 1 in 1000 men will have enough discomfort to request a prescription pain medication.

* Remember that THIS IS A SURGERY, so some discomfort (although very minimal) should be expected the following day. 

Semen samples should be brought to the office twelve (12) weeks after the procedure to see if all stored sperm have been passed. 98% of men are sperm-free after 12 weeks and 20 ejaculations, some sooner, and a few men will not be sperm-free for 5 or 6 months.

* Initial evaluation of semen samples is included in the price.

No-scalpel vasectomy instruments, used in China since the mid-70’s and introduced into the United States in 1989, are simply a very pointy hemostat, used initially to make a tiny opening into anesthetized skin of the scrotal wall, and a ring clamp, used initially to secure each vas tube in turn beneath this opening.

Using a spray applicator (MadaJet®), a fine stream of liquid anesthetic is delivered at a pressure great enough to penetrate the skin to a depth of about 3/16″, deep enough to envelop the vas tube held snugly beneath the skin.

Each vas is positioned in turn beneath the very middle of the front of the scrotum and given 3-5 squirts. That numbs the skin and both vas tubes adequately for 99% of men. The other 1% (usually men who have thick skin or scarring due to prior surgical procedures in the area) will require additional anesthetic delivered with a fine needle (30 gauge), usually with no pain at all because of the partial anesthesia achieved with the MadaJet®.

After the vas is divided, the lower end is allowed to slide back down into the sheath, while the upper end is held outside the sheath. A tiny hemoclip (the size of a grain of rice) is then used to close the empty portion of the sheath between the 2 ends.

Most hemoclips are made of titanium, a non-ferromagnetic metal used for many types of implanted medical devices such as dental implants, heart valves, and joint replacement. Surgeons have used hemoclips for many years to occlude bleeding blood vessels during many operations in the abdomen and chest, sometimes over 50 clips in a single procedure. Titanium will not interfere with MRI studies and the small amounts used in hemoclips and dental implants do not set off metal detector alarms.

Some men may request the use a suture rather than a hemoclip out of preference to avoid having any metal implanted in their bodies. Please let us know if this is your choice, as by default hemoclips will be used.

Removal of a small section of the vas directed towards the testicle is optional; it does not influence the effectiveness of the technique.

Considering the minimally invasive nature of the SimpleVas® Vasectomy technique, the expected discomfort is minimal. Remember, you will have had a surgery; so some discomfort should be expected.

If present, the discomfort can be easily alleviated by using acetaminophen or ibuprofen. Most men require either no medications or only 1 dose of over the counter analgesics.

* Click HERE for postoperative instructions

Because of the technique used for SimpleVas® Vasectomy, failure outcomes are expected to be a reflection of the technique acquired by training with Dr. Doug Stein, so with the use of hemoclips to divert the vas ends out of alignment the rates of early failure (never cleared sperm after procedure) are 1 in 3000.

Delayed failure  (return of live sperm to the semen at some time after the semen has been confirmed to be sperm-free) resulting in pregnancy is possible but rare, with rates of about 1 in 4000, a rate of failure much lower than with any other form of contraception.

The World Health Organization convened a 1991 meeting of 23 international experts to review all research regarding vasectomy and prostate cancer. They concluded that there was no plausible biologic mechanism for a relationship between vasectomy and prostate cancer. All available research data to date showed no association of vasectomy with prostate cancer, which is supported by the American Urological Association.

The question of an association between vasectomy and subsequent cardiovascular disease was raised back in 1978 and 1980 by 2 studies, but recent data comparing 24,773 vasectomized men with 159,480 non-vasectomized men showed evidence that vasectomy is not followed by an increased risk of coronary heart disease, or stroke. 

There are no laws forbidding vasectomy for certain age groups, though individuals under 18 require parental consent for any elective surgery.

I will not provide vasectomy for a man less than 21 years old without children, unless there are profound extenuating circumstances such as a hereditary disease or obvious inability to care for a child, as might be the case in someone with a cognitive disability.

If you are less than 30 years old and you have had fewer than 2 children, please consider the following points before having a vasectomy:

1– You may regret it. Men who have vasectomies when they are in their 20’s, especially if they have had fewer than two children, may be the ones most likely to seek vasectomy reversal at a later date, often regretting their vasectomy decisions if their reversals are not successful.

2– You may change. Many men who think they will never want children when they are in their early 20’s are delighted with fatherhood when they are in their 30’s. You may be totally convinced now that you will never want children, but people change and you may have a much different outlook 10 years from now.

3– Women change. Similarly, women who have no desire for children when they are in their early 20’s may have a much stronger desire when they are in their 30’s and when many of their friends are having children of their own.

4– Relationships end. Since more than 50% of American marriages end in divorce, you may not be with the same partner ten years from now and a new partner may have a much stronger desire for children than your present partner does. So just because your present partner claims that she will never want children, her tune may change 10 years from now, or she may not even be your partner 10 years from now.

5– Your thoughts and your partner’s with respect to abortion should be considered. If you are both not philosophically opposed to abortion, you have some back-up should other forms of contraception fail, and having a vasectomy now may not seem as critical to avoid an unintended pregnancy. But keep in mind that if she gets pregnant, the choice is hers.

 6– Vasectomy should be considered a permanent and non-reversible procedure because vasectomy reversals are not always successful. So before having a vasectomy, know all of the other options.

7– Young men should consider sperm storage. The companies who provide the service will send what you need directly to your home, you can collect the semen specimens in the privacy of your home, and you can mail them back to the company in the storage container provided.

8– Have you discussed your decision with your parents? Having a vasectomy is absolutely your decision, but if you consider talking with them; at least you will have granted them the respect of letting them render an opinion. If they succeed in discouraging you, because they know you better than any doctor does, you may one day thank them. If they don’t succeed in discouraging you, they may split with you the cost of sperm storage and feel much better about your vasectomy in doing so.

1. Plan to spend a quiet evening at home, reclining in bed or a lounge chair. Minimize activity.

2. You may take acetaminophen (Tylenol or generic) or ibuprofen (Motrin, Nuprin, Advil or generic) if you have any discomfort. Avoid aspirin for 2 days after the vasectomy.

3. No need for ice packs.

4. On the day after the procedure, you may walk and drive as much as you like, but no sports, yard work, swimming, or heavy lifting. If you job is sedentary (office work or supervisor), you may return to work.

5. You may take a daily shower starting the morning after the procedure. Replace the scrotal support and wear it whenever you are up and around for the next 2 days, during sports for the next 7 days.

6. Two days after the procedure, you may return to more strenuous work and regular activities wearing your scrotal support. Wait 3 days for aggressive sports like basketball and tennis.

7. You may have sex 5-7 days after the procedure. It is common to have some blood in the semen for the first few ejaculations. Use other forms of contraception until you are told that your semen is sperm-free.

8. Since no incision is made, a follow-up visit is not required; but if you have undue discomfort or any concerns, please call me at the office (see numbers of locations at SimpleVas.net)

* Expect a follow up phone call from Dr. Guarin 24-48 hours after your procedure

9. It is normal to have some discoloration of the skin around the puncture site. Some men will develop considerable discoloration of the scrotum about 4 days after the vasectomy. Blood from the deep vasectomy site comes to the surface as a purplish-blue mark, gets darker and spreads out like an oil slick, then gradually dissipates.

10. Some men (about one in 20) will develop swelling and discomfort on one or both sides, starting anytime from 3 days to 3 months following vasectomy. This usually represents an exaggerated form of the normal inflammatory response necessary for sperm absorption and recycling. It is best managed with a 5-7 day course of ibuprofen 600 mg 3 times per day.

11. At least twelve (12) weeks and 20 ejaculations after your vasectomy, bring a semen sample to our office. This should be produced after a 2 day period of no ejaculation.

Samples will not be checked early. When you bring the sample, it should be in a small container with a lid, such as a pill bottle, baby food jar, 35mm film canister, etc. Please do not bring the sample in a condom or baggie as we will be unable to retrieve a specimen adequate to be checked and you will be asked to return with another sample in a container with a lid.

The sample should be produced the day of the examination, but can be 3-4 hours old. If sperm are seen you will be asked to continue other means of birth control and return with a second specimen in 2-3 weeks.

* Patients from outside of Newton, IA, will receive a mailer with instructions for submission of their samples

* You can print these instructions from a pdf format HERE

Why do I do vasectomies?

For me it has been very simple: because of the FAMILY

#1, We owe it to women, but also to ourselves!!

It is very clear that it has been easier, from the medical standpoint, to control the release of a single egg from an ovary every month than it is to try to control millions of spermatozoa being produced on a daily basis in the testicles. Thus, women have had to deal with a BIGGER burden when it comes to contraception; as the vast majority of available options are targeted to them. Even reproductive campaigns are almost always directed to females with little participation of men.

When the time comes for a PERMANENT DECISION, men can certainly step up to the plate and choose to participate responsibly with a vasectomy; a procedure that is definitely less invasive and slightly more effective than a tubal ligation.

We owe it to women, we owe them being active participants in permanent reproductive decisions. We owe them this, as they have already a fair share bearing children and giving birth, for them now to have to carry a heavier weight with permanent contraception. We also owe it to ourselves, as we can demonstrate that we care and are responsible as well.

#2, We owe it to our children!!

About half of pregnancies that occur in the US are unplanned, which means that many will be caught off guard and ill prepared to assume the demands of paternity/maternity. When we become parents, we are entrusted with a major responsibility: forming a human being that inspires and improves our society while pursuing her/his happiness. Not everyone is up for the challenge ahead of being a parent.

Many people choose to take the challenge and, even learning from the mistakes we make along the way, decide to do our best educating our children in the most nurturing environment possible.

Families are the center of society, intimate social laboratories where people grow either affect-rich or affect-deprived. The classical or traditional definition of family has morphed into a very enriching plurality, demonstrating that the number or gender of its members matter less than their efforts and intentions. Despite that plurality, still making poor or untimely decisions regarding contraception can seriously affect the integrity of families and their members.

Poor contraceptive decisions could greatly affect CHILDREN. Many individuals will accept and adapt to unplanned pregnancies by adjusting their resources, and welcoming the new addition to their lives. They create their own plural concept of family (single vs. multiple parents, etc), but ultimately strive for a nurturing environment for their children. Unfortunately many others will struggle and will not adapt, leaving children behind; not being responsible for them and leading to dysfunctional environments that in the end will affect the growth and development of the unattended offspring.

#3, Empowerment of men, women, and families!!

By choosing permanent sterilization, we are giving up a very important function of the human being: reproduction. Making such decision demonstrates that we care and are up for the challenge ahead of supporting a family with the appropriate resources (emotional, social and financial).

A vasectomy empowers men because it shows the WE CARE and are willing to be active participants in reproductive decisions. A vasectomy empowers women because it relieves them from the heavy burden of contraception at the time of a permanent decision. Finally, A vasectomy empowers families because it allows them to allocate time, effort and resources more efficiently for its growth and continued pursuit of happiness.

Esgar Guarin MD Vasectomy Iowa Naples