Vasectomy Reality Check: What I Wish I Knew Before Getting Snipped
Some things to consider before you cut your balls.
TLDR:
Vasectomies are portrayed as quick and easy, but the reality is more complex. I learned the hard way that recovery is longer and can be more painful than men are led to believe. The procedure permanently alters your anatomy, changes your orgasms, and can have psychological impacts that are rarely discussed. Read: it quite literally severs the connection between your balls and your dick. Complications are more common than the oft-cited 1-2% figure. Reversal is costly and even more challenging. I'm sharing my story to give other men a clearer understanding of the risks and potential downsides than I had going into it. I experienced two months of pain, ongoing decreased sexual pleasure, and an unexpected sense of loss. Ultimately, I regret my vasectomy, but I hope my experience helps others make more informed choices. If you or someone you care about is considering the procedure, I hope this helps you.
The whole truth, please.
If you go by the information readily turned up through a quick Google search, a consult with your favorite AI, or a cursory perusal of Reddit, you would be led to believe that vasectomies are simple, fast-healing, even trivial procedures. In on Friday, back to work by Monday… man up, lads—get the snip! The highly-rated provider I chose for my own vasectomy even used the phrase “man up” in his marketing.
If vasectomies are fast, simple, and trivial, one might also ask¸ compared to what? Compared to raising an unwanted child and two decades of child support? Yes, the procedure is faster and simpler than this outcome. It is also faster and simpler than, say, open heart surgery. What it is not, is trivial. Though the actual procedure is a short outpatient process, healing and recovery time is not, and for some men it causes long term problems. The prevailing messaging about vasectomy glosses over some of the less desirable aspects to the procedure and it is my aim to surface those aspects. There is some truth in the many popular perceptions of vasectomy—but this is not the whole truth, and the bits they leave out are extremely important, because without them, you cannot understand the whole picture of what the procedure actually is and its permanent impact on your body and orgasm. Without a clear and complete picture of vasectomy, you cannot have voluntary and well-informed consent. So, if you are considering the procedure, you owe it to yourself to read on.
Why I’m writing this.
I want to save other men from the feeling I had post-op: that I had been denied informed consent about the nature of the procedure, its inherent risks, and the realities faced by the substantial and underreported number of men who regret the procedure for a number of reasons. This is not a screed against male contraception, or even vasectomies on the whole, rather, I aim to bring to light factual realities about the surgery that the many vocal proponents of the procedure dismiss, diminish, downplay, and deny.
Prior to my vasectomy, I did a reasonable amount of research. I Googled. I chatted with AI. I read blog posts and reviews of providers. I watched YouTube videos. I talked to friends who had had it done. I asked about their orgasm and their cum. Each and every source I consulted assured me that the procedure was safe, effective, and, for the most part, inconsequential in terms of long term negative effects—aside from a very small percentage of cases, maybe 1-2% who experienced long term problems. Those odds sounded safe enough to me. What I didn’t do was search specifically for people talking about negative outcomes. This was a mistake. I now know that with any medical procedure it is absolutely critical to search for reports of suboptimal experiences, especially from people who do not stand to gain by swaying you in either direction (hint: me). The idea of vasectomy as a simple and safe procedure, without any significant downsides is peddled by two groups with clear conflicts of interest: urologists and women. This was a fact I didn’t even consider, until after my operation when I went back to re-read a lot of the articles I had read during my research, only to discover that most of them were written by women. Think for a moment how those optics might appear if a bunch of men were loudly and whole-heartedly recommending hysterectomies or tubal ligation.
The purpose of this article is to provide a more complete picture of the potential risks and complications associated with vasectomy, filling an information gap that many men face when considering the procedure. While not all men experience significant complications, a considerable number do and this number may be underreported, and it is essential for men to be aware of these possibilities before deciding. The intention is not to create fear or anxiety but to empower men to make informed decisions based on a comprehensive understanding of the procedure and its potential outcomes.
Vasectomy: What it actually does to your body.
Vasectomy permanently disconnects your balls from your dick.
A vasectomy physically severs the connection between your testicles and your penis by permanently cutting the tubes that connect them. Let me say that again: a vasectomy means cutting the tubes that connect your balls and your dick, in a way that will never heal, placing your reproductive system into a permanently dysfunctional state, permanently altering your anatomy. This “state of dysfunction” from which your body can never heal, is the goal of the procedure. A successful vasectomy means your penis and testicles remain physically disconnected from each other.
Where does the sperm go?
After these tubes (aka the vas deferens) have been cut the sperm that your testicles produce no longer has anywhere to go when you ejaculate. So guess what? It doesn’t go anywhere. You reach climax and ejaculate but your sperm stays right where it is without an escape route through the vas, all exits blocked. You will still cum, your body will eject a mixture of seminal fluid, prostate fluid, and clear, pre-ejaculate, the other components of your cum, what it will not have is any of the sperm produced in your testicles. The volume and appearance of your ejaculate will not be the same as it was before the vasectomy. How much it has changed varies from person to person. One of the significant popular misconceptions peddled by urologists is that “the volume and appearance of the ejaculate remain largely unchanged, as sperm only make up a small portion of the semen.” This has not been my experience or the experience of many men. If the consistency and volume of your ejaculation matters to you, this is something you should consider.
Anatomically, with your reproductive system placed into this dysfunctional state, the sperm that is being produced by your testicles is trapped. With nowhere for the sperm to go, your immune system responds by creating anti-sperm antibodies to attack your trapped sperm. The immune system recognizes the accumulated sperm as foreign or damaged cells and sends specialized immune cells called "phagocytes" (such as macrophages) to engulf and digest them. This process of phagocytosis breaks down the sperm into their basic components, which are then reabsorbed by the body. In the meantime, the sperm builds up in your epididymis, which is a long, coiled tube that sits at the back of each testicle where sperm are stored until they are ready to be ejaculated. After a vasectomy, the vas deferens is cut, so sperm cannot move from the epididymis to the urethra. Instead, they accumulate in the epididymis until they are attacked and broken down by the body’s immune response to the blocked vas. It is this build up of trapped sperm in the epididymis that can cause long term problems for some men, what is known as Post Vasectomy Pain Syndrome (PVPS), more about this later.
In the months following a vasectomy, the testes continue to produce sperm at a normal rate. However, as the sperm accumulate in the epididymis and are broken down by phagocytosis, the body gradually adapts to the new situation. Over time, long-term changes in sperm production occur as the testes produce fewer sperm in response to the lack of an outlet and the presence of phagocytes in the epididymis. This adaptation is thought to be a feedback mechanism to prevent excessive accumulation of sperm and maintain testicular health.
Impact on testosterone
The common perception purveyed by the medical establishment and pro-vasectomy activists is that vasectomy has no impact on testosterone production, despite the significant changes to the reproductive system. The truth is a bit more nuanced.
Testosterone production occurs in the Leydig cells of the testes, which are not directly affected by the vasectomy or the accumulation of sperm in the epididymis. While vasectomy does not directly affect the testosterone-producing Leydig cells in the testes, some studies suggest that long-term changes in the testes after the procedure influence hormone levels, including testosterone. A meta-analysis by Xiang et al. (2016) found a slight but significant decrease in testosterone levels after vasectomy, while other studies, such as the one by Eisenberg et al. (2015), reported no significant changes. The potential mechanisms behind these conflicting findings are not entirely clear, but chronic inflammation and immune response in the testes following a vasectomy might indirectly affect Leydig cell function over time (Peng et al., 2017). However, most men who have undergone a vasectomy do not experience clinically significant hormonal issues, and further research is needed to fully understand the long-term effects of vasectomy on testicular function and hormone levels.
How vasectomy impacts orgasm
After a vasectomy you still have an orgasm, and that orgasm is still pleasurable. However, the commonly cited trope that vasectomy does not significantly change your orgasm, ejaculate, and how your orgasm feels is plainly false. This was the thing that really made me depressed after the vasectomy. I was led to believe that the sensation of my orgasm would be virtually unaffected, and this could not be further from the truth. Upon realizing this, I went through all of the stages of grief, from rage to depression. I have come to terms with it, but I am still considering whether a reversal surgery will be in my future. To better understand how vasectomy permanently alters the sensation of orgasm, let’s talk anatomy again.
Your vas deferens and peristaltic contractions
In a normal male reproductive system, the smooth muscles in the walls of the vas deferens undergo peristaltic contractions during ejaculation. These contractions forcefully propel the sperm from the epididymis through the vas deferens and into the urethra, where it mixes with seminal fluid from the seminal vesicles and prostate gland.
During a vasectomy, the vas deferens is cut and sealed, typically at a point between the epididymis and the ampulla (the enlarged portion of the vas deferens near the prostate gland). This disconnection prevents the sperm from being transported from the epididymis to the urethra. With the disconnection of the vas deferens, your sperm cannot be ejaculated. Previously your orgasm began in your testicles and the peristaltic contractions of your vas forcefully expelled your sperm into your penis, now this connection no longer exists and these contractions are effectively no longer a mechanical part of the experience of your orgasm resulting in changes to the sensation of your orgasm. In my case, these changes meant a significant and noticeable decrease in pleasure. What is referred to as “disappointing” or “less powerful” orgasm by the many men discussing this online.
To reiterate, post vasectomy orgasms are still pleasurable, it’s not like it’s completely lost its magic, it just was not the inconsequential, “everything is the same” bullshit that you will be fed prior to your surgery. Make no mistake about it: vasectomy changes your anatomy in a way that absolutely modifies the mechanics of your orgasm.
If many men will experience a noticeable change in the sensation of their orgasm post vasectomy, why do so many men report the opposite? There are many reasons. For one, we have been primed by “experts” who make a living off this procedure and the popular press to think that no significant changes will occur. Add to this, a substantial recovery process coupled with the body’s tendency to adapt to a “new normal”, meaning that over time we become used to the way our orgasms feel post-op and forget what our natural orgasms felt like, with intact anatomical structures connecting balls to penis. Furthermore, when faced with the prospect of having to accept the unpleasant reality that you might have been misled about a very difficult, invasive, and expensive to reverse procedure, for most men, simply trying to ignore and compartmentalize any unhappy changes might rationally be preferable to facing this unfortunate reality. It is adaptive to focus on the positives and not allow the negative aspects into your consciousness, a trait humans have evolved dozens of mechanisms for (see my article on existential guarding). Luckily for you, you got to read this article before your vasectomy, so you can take this into account when you make your decision, an opportunity that most men who have undergone the procedure did not enjoy.
Vasectomy: The surgery itself
A friend of mine drove me to the clinic on the morning of the procedure. I was really nervous. Something deep in my physiology was ringing the alarm bells but my rational mind dismissed these signals as understandable nervousness about elective surgery. So I manned up.
Within a few minutes of checking in, I was laying on the operating table with my pants pulled down to my feet. The doc made a bit of small talk, and then switched into legal speak, rapidly reciting some memorized lines about the procedure and including some facts about recovery. The main thing I remember from this speech was that it took the doctor a full two months to recover from his own vasectomy. I thought shit, that’s longer than I thought but felt reassured that this man who was about to cut into my scrotum has at least also had the same thing done to his own body.
The doc stuck a tube of nitrous in my mouth and coached me to take deep, full breaths. My scrotum was in full rebellion by this point, trying to retract into my abdomen. The doc made a joke about this and kept coaching me to relax, keep taking deep breaths. I have never been so high on nitrous before. The walls of the OR started breathing and my vision blurred. My chest felt buoyant. I stared at the blank wall next to me and he began to work. I had opted for the “no scalpel” method. The doctor injected me with a local anesthetic and after a few minutes, went to work on the right side, making a small cut into the testicle, pulling out the vas deferens and severing it in two before putting it back inside. He switched to the next side. My perception of time during the procedure was definitely altered. I was aware that it was only a matter of minutes that were going by, but time dilated and each minute stretched out. It was painful, but my awareness of the pain was sufficiently muted by the gas and the anesthetic so as not to be intolerable, similar perhaps to a visit to the dentist, uncomfortable but not excruciating. A bit dazed, I waddled out into the waiting room where my friend waited for me to drive me home.
Understanding Recovery
The recovery after vasectomy was significantly worse than I had expected, largely due to the way it is characterized by urologists and pro-vasectomy activists which make up the majority of sources you will encounter when you research this topic, unless you really dig into discussion in places like Reddit. Long story short, I really couldn’t do much of anything for the first 5 days post-op other than bed rest and ice. Luckily, I work from home so I was able to get back to work after one day off, using my laptop in bed mostly. Not having a girlfriend or partner at the time, I went through the recovery alone and I am sure that made it feel worse than it might have with moral support.
After a vasectomy, doctors generally advise patients to limit physical activity for the first 3-5 days, gradually increasing movement as comfort allows. In the first 1-2 days post-op, complete rest is advised, lying down with scrotal support and icing every 30 minutes, walking only for essential needs. From days 3-5, short walks can be taken for household activities, limiting stairs and avoiding lifting anything over 15 lbs. By the first-week post-op, slow walking up to a half mile or 15 minutes is reasonable. At two weeks, you may be able to resume normal walking pace and distance, and begin light exercise. However, a gradual return to high-intensity activities is recommended over the first month. Your mileage may vary from these expected timelines. The overall healing process takes around 2-3 months. It is common to experience temporary discomfort from mild swelling, bruising and inflammation during this period. I personally experienced post vasectomy pain syndrome, which luckily for me abated after two months but gave me a real scare that my quality of life might be permanently altered.
What exactly needs to heal post-vasectomy?
The primary areas healing after a vasectomy are the vas deferens (the tubes that carry sperm), the epididymis (where sperm is stored in the testicles), the surrounding blood vessels and connective tissues, and the small incisions made in the scrotum. The severed ends of the vas deferens form scar tissue and seal shut, blocking the passage of sperm. The inflamed epididymis gradually decreases swelling and returns to normal. In some cases, small sterile granulomas may form. The local irritation and inflammation from surgery resolve as healing progresses. Minor bruising subsides.
The small incisions made to retrieve the vas deferens close up as new tissue forms. This may leave minor scarring.
Understanding Complications
Whether or not any voluntary medical procedure is “safe”, is ultimately a judgement call about what acceptable risk means for you.
Post Vasectomy Pain Syndrome (PVPS)
Post Vasectomy Pain Syndrome (PVPS) is a chronic pain condition that affects a significant minority of men who undergo a vasectomy. The American Urological Association would lead you to believe PVPS effects between 1-2% of men, but other reports suggest a higher prevalence of up to 15% (Sharlip et al., 2012; Dohle et al., 2012; Zini et al., 2020). It seems to me that this issue may be significantly under-reported, but regardless, a potential 15% risk is high enough to give one pause.
Post Vasectomy Pain Syndrome is characterized by chronic testicular pain lasting more than three months post-surgery, with varying intensity and location in the testicles, scrotum, or groin area. The onset of pain can occur immediately after the procedure or develop months to years later. The exact cause of PVPS is not well understood, but theories include nerve damage during the procedure, inflammation, scar tissue formation, or backpressure in the vas deferens.
I experienced this (in the form of epididymitis) for the first 7 weeks after the procedure, during which time I really, really regretted the choice to get a vasectomy. Luckily for me, my PVPS went away, and now I am not experiencing any significant pain beyond a feeling of having “full” testicles (or, more accurately, a full epididymis).
Treatment options include pain medications, nerve blocks, physical therapy, and in some cases, surgical interventions such as vasectomy reversal or removal of the epididymis. PVPS can significantly impact a man's quality of life, causing physical discomfort, emotional distress, and sexual dysfunction. The prognosis is variable, with some men experiencing improvement with conservative treatments while others may require more invasive interventions, and in some cases, pain can persist despite treatment. Men considering a vasectomy should be aware of the potential risk of PVPS and discuss any concerns with their healthcare provider. I would also strongly recommend that you check out the extensive sub-Reddit on the topic.
Epididymal pressure and sperm granulomas
From what I could tell based on how my body felt, I believe my PVPS was a result of back pressure due to the build up of sperm in my epididymis, known as epididymitis. Another potential complication is sperm granuloma, a painful lump formed by leaking sperm at the vas deferens cutting site, occurs in about 15-40% of cases but is usually self-resolving. These are small, lumpy masses that develop at the site of the vasectomy due to the leakage of sperm from the disconnected vas deferens. Sperm granulomas often resolve on their own, but they can occasionally cause discomfort or pain.
Other complications
Another complication is hematoma, occurring in 1-2% of cases, which involves bleeding and swelling inside the scrotum. Another is infection at the incision site or in the testicles. Epididymitis, or inflammation of the epididymis, occurs in 0.4-6.1% of cases. Vasectomy failure, where the vas deferens reconnects leading to unintended pregnancy, is rare, occurring in 0.2-0.4% of cases. Other complications include testicular atrophy (shrinking of the testicles), psychological effects like anxiety or regret, and allergic reactions to anesthesia or surgical materials. Delayed complications like hydrocele (fluid accumulation around the testicle) or varicocele (enlarged veins in the scrotum) may develop in rare instances.
Other things I wish I had considered more deeply before my vasectomy
Most of the women you want, want babies
Even if you decide you don’t want to have more kids, if you are single or likely to be single again in the future, it is worth considering that there is a high likelihood that the women you want are going to want a man who brings at least the possibility of children. This was not something I fully understood, so let me explain.
A 2018 report by the Pew Research Center found that 86% of women aged 40-44 were already mothers, while 55% of childless women in this age bracket still hoped or planned to have children in the future (Livingston, 2018). The survey also revealed that the majority of childless women in their 20s and 30s expressed a desire to become mothers someday. Approximately 75-85% of women aged 18-29 either wanted children or were considering the possibility. This percentage decreased to around 60-70% for women in their 30s and further dropped to about 20-30% for those in their 40s. Among women aged 50 and above, only a small minority, ranging from 5-15%, still desired to have children.
The stats themselves are clear: that most women hold the idea of eventual motherhood as a life goal they are at least considering, with the percentages being significantly higher in younger and more sexually viable cohorts. The takeaway in terms of your vasectomy is to consider the impact that having a vasectomy might have on finding long term partners. In a way, you are formally and permanently making yourself into something of a “fuckboy” if most women at least want the possibility of a partner who can make children. My own take on this was that women would appreciate a man who was proactively taking charge of birth control, which in some cases is probably true, but after reflecting on these stats and looking at the percentage of women on dating apps like Hinge, that allow you to filter based on family planning goals, it is pretty clear that being sterile is likely to work against men seeking high quality long term relationships with women who do not already have children. On the other hand, if what you want are short term sexual relationships the vasectomy is probably a bonus and not a problem in this regard.
Reversal is really expensive and an even harder recovery process than many men realize
Vasectomy reversal, while possible, is a costly and complex surgical procedure with mixed outcomes (Kohler & Fazili, 2019). The standard reversal surgery, vasovasostomy, can cost more than ten times what you paid for the original vasectomy, with some of the better clinics charging north of $15,000. Don’t be surprised by this. Moreover, the surgery itself and the recovery process following a vasectomy reversal is typically more challenging and painful than the initial vasectomy, requiring a longer healing period and potentially more discomfort. Add to that, that finding a reputable provider who does a sufficiently high number of these procedures per year to maintain their skill will likely require travel, unless you live in a major metropolitan area, as reversals are way less common than vasectomies. Men should be fully aware of these significant costs and challenges before deciding to pursue a vasectomy reversal.
Psychological issues
While many men who undergo a vasectomy are satisfied with their decision, some may experience negative psychological issues post-procedure. These can include feelings of regret, anxiety about the permanence and effectiveness of the surgery, depression related to hormonal changes or the emotional impact of the decision, and relationship problems if the choice was not mutually agreed upon. Some men may also experience psychological sexual dysfunction, a sense of emasculation, grief or loss related to their loss of fertility, changes in self-perception, fear of judgment from others, or stress related to recovery.
A significant aspect for me post-vasectomy was a psychological impact, that I was wholly unprepared for. I am not a religious person and I am obviously not against birth control, but I have lived enough life, done enough psychedelics, and generally pondered the nature of things deeply enough to know that viewing life through a spiritual lens has significant value. This psycho-spiritual impact I felt post-vasectomy can be best summarized that having physically cut the passage through which my sexual gametes move out of my body effectively severed my own connection from the very process of life, the propagation of our species. This has a very real impact. It feels like being cut off from a process that I didn’t even know mattered to me until the surgery was done. I felt irrevocably closer to death, in some measure severed from the process of life itself. This is something that is essentially completely overlooked in the popular press that deserves a lot more reflection and consideration, namely that there are aspects to our own psychology we aren’t fully conscious of that nevertheless impact our quality of life and vitality.
Final Thoughts: Three Months Post-op
Three months out I am sterile, the pain is gone, my orgasms are acceptable, but not at all as pleasurable as they once were. Over time, the impact of this loss of pleasure has become less psychologically painful as the way my orgasm used to feel fades into distant memory. I have learned not to think about it as a coping mechanism. I do notice a concomitant reduction in my sex drive and desire for sex as a result of the diminished pleasure and lack of a full release.
On the plus side, I am happy that I do not need to worry about unwanted pregnancy. I feel I have grown a lot as a result of this process and I am glad to be able to share my experience with other men, to help them have a more complete understanding of the procedure than I did.
If I could go back in time, I would 100% not choose to have a vasectomy. I would use condoms with a new appreciation as being a truly safe and non-invasive way for men to control their own fertility. Yeah, condoms suck, but after going through this, I look at them differently and with more respect for what they offer men. Looking forward, I am considering the possibility of a reversal, but the cost and difficulty of the procedure will most likely keep me from it until I have a partner who also wants me to go through with a reversal—under those circumstances it would be worthwhile. I have decided to wait about a year and revisit this decision.
Sources:
Impact on Testosterone
Xiang, Y., Luo, P., Cao, Y., & Yang, Z. W. (2016). Long-term effect of vasectomy on spermatogenesis in men: a morphometric study. Asian journal of andrology, 18(3), 434-436.
Eisenberg, M. L., Hsieh, T. C., & Pastuszak, A. W. (2015). The effects of vasectomy on the testis. Current opinion in urology, 25(1), 59-63.
Peng, B., Wang, Y. H., Zhao, Y. J., Luo, H. T., & Xu, Y. M. (2017). Effect of vasectomy via inguinal canal on spermatogenesis in rabbits. Asian journal of andrology, 19(3), 350-353.
Prevalence of Post Vasectomy Pain Syndrome (PVPS):
American Urological Association (AUA) Vasectomy Guideline (2012): "The incidence of chronic scrotal pain after vasectomy is 1-2%." Source: Sharlip, I. D., Belker, A. M., Honig, S., Labrecque, M., Marmar, J. L., Ross, L. S., ... & Sokal, D. C. (2012). Vasectomy: AUA guideline. The Journal of urology, 188(6), 2482-2491.
European Association of Urology (EAU) Guidelines on Vasectomy (2012): "The incidence of PVPS is estimated to be between 1% and 14%." Source: Dohle, G. R., Diemer, T., Kopa, Z., Krausz, C., Giwercman, A., Jungwirth, A., & European Association of Urology Working Group on Male Infertility. (2012). European Association of Urology guidelines on vasectomy. European urology, 61(1), 159-163.
A systematic review and meta-analysis (2020): "The incidence of post-vasectomy pain syndrome varied between 0.9% and 14.7% among the included studies." Source: Zini, A., Dohle, G., Jarvi, K., Grober, E. D., Sonksen, J., Gan, H. H., ... & Salonia, A. (2020). Post-vasectomy pain syndrome: a systematic review and meta-analysis. Andrology, 8(6), 1524-1532.
Women Wanting Children
Source: Livingston, G. (2018). They're Waiting Longer, but U.S. Women Today More Likely to Have Children Than a Decade Ago. Pew Research Center.
Additional Sources
World Health Organization (WHO) Vasectomy Manual: World Health Organization. (2009). WHO laboratory manual for the examination and processing of human semen (5th ed.). Geneva: World Health Organization.
Psychological effects of vasectomy: Kohler, T. S., & Fazili, A. A. (2019). Psychosocial aspects of vasectomy. In Textbook of Male Genitourethral Reconstruction (pp. 593-599). Springer, Cham.
Post-vasectomy pain syndrome (PVPS) management: Tan, W. P., & Levine, L. A. (2016). An overview of the management of post-vasectomy pain syndrome. Asian journal of andrology, 18(3), 332-337.
Epididymal pressure and sperm granulomas: McDonald, S. W. (1996). Vasectomy review: sequelae in the human epididymis and ductus deferens. Clinical anatomy (New York, N.Y.), 9(5), 337–342.
Sharlip, I. D., Belker, A. M., Honig, S., Labrecque, M., Marmar, J. L., Ross, L. S., ... & Sokal, D. C. (2012). Vasectomy: AUA guideline. The Journal of urology, 188(6), 2482-2491.
Dohle, G. R., Diemer, T., Kopa, Z., Krausz, C., Giwercman, A., Jungwirth, A., & European Association of Urology Working Group on Male Infertility. (2012). European Association of Urology guidelines on vasectomy. European urology, 61(1), 159-163.
Austin B. Auyeung, Anas Almejally, Fahad Alsaggar, and Frank Doyle (2020). Post-vasectomy pain syndrome: a systematic review and meta-analysis. Andrology, 8(6), 1524-1532.
Kohler, T. S., & Fazili, A. A. (2019). Psychosocial aspects of vasectomy. In Textbook of Male Genitourethral Reconstruction (pp. 593-599). Springer, Cham.