Condition & Treatments
/ Vasectomy
Vasectomy, done with the same microsurgical care as fertility surgery
Vasectomy is a permanent, highly reliable form of contraception for men who are sure their family is complete. Prof Raheem performs it using a microsurgical technique he developed, designed to reduce the risk of long-term pain.
I N S H O R T
Vasectomy blocks the tubes (vas deferens) that carry sperm, so the semen no longer contains sperm.
It is a short procedure, usually under local anaesthetic, and you go home the same day. Some men are better suited to a general anaesthetic, and Prof Raheem will advise on this when he examines you.
You are not sterile straight away. Sperm left beyond the cut can still cause a pregnancy until a semen test, at least 12 weeks later, confirms you are clear.
A modified, nerve-sparing technique
Prof Raheem has created a modification to the standard vasectomy technique, with the aim of reducing the risk of long-term pain after vasectomy.
Denervation. The small nerves around the vas are gently slid off it under magnification and left intact, so they are not caught in the cut or tie, aiming to reduce the risk of long-term pain after vasectomy.
Vessel-sparing. The small blood vessels that run with the vas are slid off in the same way and preserved.
No implant or device. It is a refinement of technique, with no implant or device involved.
Before you decide
Be sure. Vasectomy should be seen as permanent. Reversal is possible but not guaranteed.
Consider freezing sperm beforehand, if there is any chance you might want children later.
Consultation, to discuss the procedure, risks and your medical history. A vasectomy consultation costs £250. Prof Raheem prefers to see you in clinic, because the examination tells him whether a local anaesthetic will be comfortable for you or whether a general anaesthetic is better.
Local or general anaesthetic?
A vasectomy should never be a traumatic experience. Research across surgery shows that fear and anxiety around an operation are linked to a higher risk of pain that lasts long afterwards [5, 6]. So Prof Raheem would rather a nervous man be asleep than endure the procedure awake. Together with his modified technique, which protects the nerves around the tube, the aim is to lower the risk of long-term pain from both sides: the body and the mind.
Local anaesthetic. Most vasectomies are done this way. An injection numbs the skin and the tubes. You are awake, and after the injection you feel pressure or tugging but not sharp pain. There is no need to fast, and most men are back to normal quickly.
General anaesthetic. You are asleep throughout. Prof Raheem recommends it for some men [3], for example:
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A low pain threshold, or real anxiety about being awake during the procedure.
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A tight scrotum that draws up when touched, making the tubes hard to hold steady.
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Difficult anatomy, such as tubes that are hard to feel, thickened tissue, or previous surgery in the scrotum or groin.
With a general anaesthetic it is still a day case, but you will need to stop eating and drinking for some hours beforehand, have someone take you home and stay with you overnight, and avoid driving for 24 to 48 hours [3]. Anaesthetist and hospital fees are added, and are quoted after your consultation.
How the choice is made. At your consultation, Prof Raheem examines you to see how easily the tubes can be reached, and talks through how you feel about being awake. Together you agree the option that will be safest and most comfortable for you. If you are nervous, say so: it is a good reason to choose a general anaesthetic.
Why an expert assessment matters
Vasectomy is often presented as a quick, routine procedure, and for many men it is. But it is still surgery on a sensitive area, and it is meant to be permanent. Seeing a specialist first means:
Problems are found before surgery, not during it. The examination can pick up a varicocele, hydrocele, hernia, cyst or scarring from previous surgery that would change how the procedure is done.
The right anaesthetic is chosen for you. Not everyone is comfortable awake, and a difficult procedure under local anaesthetic is exactly the kind of experience that should be avoided.
The technique protects the nerves. Prof Raheem's modified technique is designed to leave the nerves around the tube intact, aiming to reduce the risk of long-term pain.
You have time to decide. You can discuss the permanence of vasectomy, freezing sperm beforehand, and what would happen if you changed your mind, rather than deciding on the day.
Follow-up is with an expert in what comes after. If you ever need help with ongoing pain or a reversal, you are already under the care of a specialist in both.
After the vasectomy
You are not sterile straight away. Cutting the tubes stops new sperm getting through, but sperm already stored beyond the cut, in the upper part of the tubes and the seminal vesicles, can still be ejaculated for several weeks or even months [2, 3]. Until a semen test confirms you are clear, a pregnancy is still possible, so keep using contraception.
Your semen test. UK guidelines from BAUS, the British Andrology Society and the Association of Biomedical Andrologists say:
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Test at least 12 weeks after the vasectomy, and after at least 20 ejaculations to flush out the remaining sperm [1].
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One sample with no sperm is enough for clearance, if the guidelines have been followed [1].
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About 1 in 10 men still have a few non-moving sperm at six months [2]. If two samples show fewer than 100,000 non-moving sperm per millilitre, “special clearance” can be given, usually after 7 months and 24 ejaculations [1, 2].
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Clearance is never given if any moving sperm are seen [1].
Recovery. Most men rest for a day or two, and avoid heavy lifting, sport and strenuous exercise for 1 to 2 weeks. Bruising and swelling usually settle within 2 to 3 weeks, and there may be blood in the semen the first few times you ejaculate [3].
Risks. In a UK audit of more than 70,000 vasectomies [4]:
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Early failure (sperm still present at the semen test): 0.5%, about 1 in 200.
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Late failure (the tubes rejoining after clearance, even years later): 0.014%, about 1 in 7,000.
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Long-term pain (post-vasectomy pain syndrome): 0.12%, about 1 in 800. The BAUS leaflet quotes troublesome chronic pain in up to 5% of men [4].
Common questions
Am I sterile straight after my vasectomy?
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No. Sperm already beyond the cut can still be ejaculated for weeks or months. You are only considered sterile once your semen test gives clearance, at least 12 weeks and 20 ejaculations after the vasectomy [1].
Does it affect sex or testosterone?
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No. Hormones, erections and orgasm are unchanged, and the semen looks the same.
Is it painful?
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You'll feel the local anaesthetic, then pressure but not pain. Most men need only simple painkillers afterwards. A general anaesthetic is recommended for some men, for example those with a low pain threshold, a tight scrotum or anatomy that makes the tubes harder to reach [3]. Prof Raheem assesses this when he examines you, so you'll know which is right for you before booking.
How is Prof Raheem's technique different from a standard no-scalpel vasectomy?
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In a standard no-scalpel vasectomy, the tube is lifted out through a tiny opening, then cut and sealed together with the tissue wrapped around it. That tissue carries fine nerves and small blood vessels, which are caught up in the cut. In his modified technique, Prof Raheem works under magnification to gently slide the fine nerves and small blood vessels off the tube before it is cut. They are left intact, not cut, tied or damaged, aiming to reduce the risk of long-term pain and to keep the area's blood supply healthy. The tube itself is divided and sealed as in any vasectomy, so the semen test and clearance afterwards are exactly the same.
Prof Raheem's published work on this topic
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Microsurgical denervation of the spermatic cord for chronic scrotal pain: a prospective pilot study. African Journal of Urology, 2026. Link
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Microsurgical denervation of the spermatic cord for chronic scrotal pain: results from a prospective case series. Journal of Sexual Medicine, 2024 (congress abstract). Link
References
1. Hancock P, Woodward BJ, Muneer A, Kirkman-Brown JC. 2016 Laboratory guidelines for postvasectomy semen analysis: Association of Biomedical Andrologists, the British Andrology Society and the British Association of Urological Surgeons. Journal of Clinical Pathology, 2016;69(7):655–660. Link
2. Gloucestershire Hospitals NHS Foundation Trust. Semen post vasectomy check: guidance based on the 2016 ABA, BAS and BAUS guidelines. Link
3. British Association of Urological Surgeons. Vasectomy: information about your procedure. Leaflet A24/049, October 2024. Link
4. Peacock J, Henderson J, James G. Complications of vasectomy: results from a prospective audit of 94,000 procedures. European Urology (EAU Congress abstract), 2023. Link
5. Theunissen M, et al. Preoperative anxiety and catastrophizing: a systematic review and meta-analysis of the association with chronic postsurgical pain. Clinical Journal of Pain, 2012;28(9). Link
6. The association between preoperative anxiety and chronic post-surgical pain after general anaesthesia: a systematic review and meta-analysis. Link