A 42-year-old man comes to the office seeking advice on male contraception. He and his wife have 6 children and do not want any more, and his wife wants to stop taking oral contraceptive pills. The patient's medical history is notable for an appendectomy, during which he had no complications from the procedure or the associated anesthesia. He does not smoke. On examination, the patient has a normal circumcised penis with no visible genital lesions and no palpable abnormalities in the scrotum. After appropriate discussion regarding contraceptive options, the patient elects to undergo a vasectomy. The patient should be advised to expect which of the following side effects during the first few months following the procedure?

Question

A 42-year-old man comes to the office seeking advice on male contraception.  He and his wife have 6 children and do not want any more, and his wife wants to stop taking oral contraceptive pills.  The patient's medical history is notable for an appendectomy, during which he had no complications from the procedure or the associated anesthesia.  He does not smoke.  On examination, the patient has a normal circumcised penis with no visible genital lesions and no palpable abnormalities in the scrotum.  After appropriate discussion regarding contraceptive options, the patient elects to undergo a vasectomy.  The patient should be advised to expect which of the following side effects during the first few months following the procedure?

Quizplus · Accepted Answer

11ec160b_3ccd_6ea8_9249_cd71cca6b44f_MD0001_00 The vas deferens (ductus deferens) is a long muscular duct that runs from the epididymis, via the spermatic cord, to the ejaculatory duct. In addition to transporting sperm, it functions as a reservoir to store and protect sperm following spermatogenesis. Vasectomy is a male sterilization procedure that involves transection of the vas deferens bilaterally to block the transport of new sperm. However, vasectomy has no effect on existing sperm distal to the transection; a patient can still have viable sperm in the distal vas for up to 3 months and at least 20 ejaculations following vasectomy. Sexual intercourse can typically be resumed within a week following the procedure, but pregnancy is still possible due to residual sperm in the ejaculate. Therefore, another method of birth control must be used after vasectomy until semen analysis confirms azoospermia. (Choice A) Interest in sexual activity is generally unchanged following vasectomy. Some patients report increased interest due to the reduced possibility of unplanned pregnancy; decreased interest is only occasionally reported. (Choice B) Vasectomy transects the vas deferens where it runs within the spermatic cord in the scrotum. Arterial and neuronal supplies to the erectile corpora are not at risk, and erectile impairment is not a common complication. (Choice C) Semen is composed primarily of fluid secreted from the seminal vesicles and prostate; spermatozoa make up only 2%-5% of semen by volume. Therefore, vasectomy has little effect on the volume of ejaculate. (Choice D) The endocrine function of the testes is unaffected by vasectomy, and testicular Leydig cells continue to produce testosterone at prevasectomy levels. Educational objective: Following vasectomy, viable sperm remain in the portion of the vas deferens distal to the transection. Patients can still have viable sperm in the ejaculate for up to 3 months and at least 20 ejaculations after the procedure.

A 42-Year-Old Man Comes to the Office Seeking Advice on Male