Vasectomy – frequently asked questions

Vasectomy is undoubtedly one of the most effective methods of preventing pregnancy and the most reliable method of contraception under the man’s control. It is also considered one of the safest surgical procedures with the fewest complications.

The failure rate of the so-called “open-ended (Canadian) method” ranges from 0 to 0.5%, depending on the clinic and the doctor’s experience. This means that statistically, at most one in 200 men after a vasectomy needs the procedure repeated due to the persistent presence of motile sperm.

With other no-scalpel vasectomy methods, scientific publications show that 5% to 13% of procedures need to be repeated because of so-called “early recanalisation” – a situation in which 5 to 13 men out of 100 must undergo the procedure again.

Vasectomy effectiveness depending on the method used
The American Urological Association carried out an analysis of all available scientific publications published in reputable medical journals between 1949 and 2011. Around 70 scientists reviewed the results of several thousand papers.
It turned out that the discrepancies in reports on the effectiveness and complications of vasectomy stem mainly from the method used to perform the procedure. The oldest techniques, involving cutting and tying both ends of the vas deferens, carry the highest failure rates. In some centres, the need to correct the procedure due to the persistent presence of sperm in the ejaculate reached as much as 13%.
It should be stressed, however, that even in those cases the pregnancy rate remains very low.
The American Urological Association recommends the open-ended method, with the testicular end of the vas brought outside the sheath of the spermatic cord (FI – fascial interposition), and cauterisation of the segment leading to the penis (thermal cautery).
Source: Original text in English

The most common cause of fertility returning or persisting after a vasectomy is “searching” sperm finding alternative routes, an error in identifying the vas, or the presence of a duplicate vas on one side.

If the first semen analysis shows no sperm, the risk of fertility returning in the future is extremely low – around 1 in 2,000 cases.

Everyone is different and reacts differently to pain stimuli. In some patients, the very fear of the scalpel can create resistance to having a vasectomy. That is why in our practice we try to eliminate stress-inducing elements, such as the use of a scalpel, so that the whole procedure takes place in the most pleasant atmosphere possible.

Of course, we cannot guarantee a completely painless vasectomy, although in most cases that is exactly how it is. The patient feels only the doctor’s manipulations in the intimate area. Occasionally there may be slight tenderness of the operated area.

We hope positively! A vasectomy does not affect libido, erections or the ejaculate. It merely blocks the sperm, preventing them from reaching the semen. Male sex hormone levels do not change either.

However, if the man or his partner has a negative emotional attitude towards the procedure, it may affect the satisfaction of one of them with intercourse. That is why the decision about a vasectomy is worth thinking through together.

In most cases, however, a feeling of relief appears – you can enjoy greater freedom, and both partners derive more pleasure from intimacy.

Yes, of course. The volume of the ejaculate after a vasectomy decreases by only 2 to 5%, which is imperceptible to the naked eye.

The appearance, smell, consistency and viscosity of the semen remain unchanged. Without a microscopic examination, it is impossible to tell whether sperm are present in the ejaculate.

The body continues to produce sperm just as before the vasectomy. Because the testicular end of the vas is left open, the sperm exit the testicles outside the sheath of the spermatic cord into the scrotum.

The scrotum naturally secretes a small amount of fluid, which is reabsorbed in the same quantity. This allows the testicles to move freely.

The absorption system easily copes with eliminating the sperm – they are removed by immune system cells, just like old, worn-out or abnormal cells in other parts of the body.

Indeed, you have to wait a little for the final effect. This is because after being produced in the testicles, sperm travel to several “storage sites” near the bladder, including the prostate, the ampullae of the vas deferens and the seminal vesicles, where they are stored together with the other components of the ejaculate until ejaculation.

The body needs many ejaculations to get rid of the remaining sperm reserves – some patients may only clear them completely after 40-50 ejaculations. In some men sperm may be present for up to 6 months.

As with all surgical procedures, a vasectomy carries a risk of complications. Of course, the risk is small – around 99% of any complications can be managed with rest or over-the-counter anti-inflammatory medication.

In rare cases a medical consultation may be needed, and in extreme cases an additional procedure.

There are many variants of vasectomy methods. Since tens of millions of these procedures have already been performed worldwide, their effectiveness and complication risks have been analysed in detail.

The method currently considered the most effective and safest is the so-called electrocautery, open ended, fascial interposition – No Scalpel Vasectomy.

It involves cutting the vas deferens and bringing its open (unblocked) testicular end outside the sheath of the spermatic cord, while blocking the prostatic end (leading to the penis) and leaving it inside that sheath.

The opening in the sheath is closed with sutures or titanium clips. As a result, neither end of the vas is tied or clamped. The end towards the penis is thermally sealed along about 10-15 mm, while the end on the testicular side freely releases the sperm produced throughout the rest of the patient’s life.

The online questionnaire and the questions it contains are a modern form of medical interview – an example of so-called telemedicine.

Some patients find the questions irritating, unnecessary, intrusive or unclear. Nevertheless, each of them has a specific justification – the answers help establish the indications and rule out contraindications for performing a vasectomy.

Every medical intervention carries a greater or lesser risk of complications. That is why every procedure, especially a surgical one – whether therapeutic or preventive – must be justified.

A principle universally accepted in medicine for thousands of years is that the benefits of treatment should outweigh the risks (primum non nocere – first, do no harm).

This means that before starting any treatment, the doctor has a legal obligation not only to assess the indications for the procedure but also to rule out contraindications.

The answers given in the questionnaire guide the further course of action – including the consultation, which currently takes the form of a phone call before the procedure.

Only on the basis of the questionnaire and that conversation can the doctor assess whether there are indications and whether there are no contraindications for carrying out a procedure with such serious consequences as a vasectomy.

How many openings need to be made, and where, to perform a vasectomy?

Usually only one small opening is made in the scrotum, by spreading the skin apart without using a scalpel (is that possible? YES).

It is the vasectomy method described in Quebec, Canada (top left corner of the figure).

The advantage of this method is that the failure rate (the need for a repeat procedure) is in the range of 0-0.5%. With no-scalpel vasectomy variants in which both ends of the vas are closed with sutures or clips (tying, clamping), the failure rate can reach as much as 13.5% (see: Table 5, American Urological Association Guideline on Vasectomy). The internet is teeming with posts by frustrated patients describing how they still have sperm after their vasectomy.

Following the American Urological Association’s recommendations, many experienced surgeons – even those who have performed many thousands of procedures using older methods – are learning this variant from scratch and switching to it.

The difficulty is that the spermatic cord contains a very complex venous plexus that must not be damaged. That is why the operator’s experience (the number of procedures performed with this method) is so important.

During charity missions with No Scalpel Vasectomy International we train doctors even from the United Kingdom, where vasectomy is very popular. Since no centre in Europe teaches this variant, Dr Kulik travelled to the USA specifically to learn it. Over the past 9 years he has performed over 5,000 procedures and has also trained several doctors.

The scrotum contains a great many blood vessels. This makes it harder to bring the open end of the vas outside the spermatic cord. An open end outside the spermatic cord reduces the risk of pain complications.

70% of patients feel nothing after a vasectomy, or only mild discomfort. 30% of patients feel some discomfort in one testicle, in both testicles, sometimes in the groin or above the pubic bone. Such discomfort may last from 7 to 28 days. The vast majority of patients in this group do not need any painkillers. They often say “it’s not the kind of pain that would make me take medication”.

On the day of the procedure, about 10% of patients take ibuprofen. The next day – only 2-3%. Fewer than 1% of patients take painkillers for several days. Which group a given patient will fall into is unpredictable. However, discomfort or pain after a vasectomy is more common in physically active people (heavy work, sport), and how it is felt depends largely on individual tolerance of discomfort and the pain threshold.

In summary: after about 7-14 days, over 90% of patients feel no symptoms at all related to their vasectomy.

Usually yes. After the vasectomy, wait about 30 minutes before your journey home. You can spend this time having a meal, for example. People prone to fainting – e.g. when having blood drawn or at the sight of it – should arrange return transport (e.g. come with a driver, return by taxi) or wait about an hour.

Yes.

Yes! The presence of a loved one is beneficial and an accompanying person is welcome. In addition, having a driver lets you set off home sooner after the procedure.

PLN 2,000

The procedure can be paid for in cash or by payment card.

Everything happens during a single visit lasting about 40-90 minutes.

The procedure itself usually takes 10-20 minutes.

Most of the time is spent on formalities – so please arrive about 10 minutes before your scheduled appointment.

• Shave your genitals thoroughly (ideally everything, including above the penis). If you have never done this before, it is best done 4-5 days before the scheduled date.

• Wear snug briefs (this is not strictly necessary, as you will receive a so-called athletic supporter from us – the protective garment used by wrestlers).

• Fast for 3 hours (after a light meal without meat, fish, vegetables or fruit) or for 6 hours before the procedure in the case of a heavier meal.

• Bring a physical (plastic or paper) photo ID (identity card, driving licence, passport) – needed to set up your medical records.

• You must have had the telephone consultation, preceded by completing the questionnaire (medical interview). Without the telephone consultation the procedure cannot take place. Without completing the questionnaire, the telephone consultation cannot be held.

No, but your activity should be limited. You can drive (allowing for the post-procedure break), but it is better to avoid walking too much. For a long journey home, it is a good idea to bring provisions (sandwiches, a thermos) and eat in the car. If you plan to travel by train, it is worth buying a seat reservation to guarantee a seat.

Immediately after the procedure, limit your activity. Go home and spend the day in a comfortable armchair or on a couch. Walk as little as possible – only to the toilet and to the table. The next day, if your work is light (even physical), you can do it, provided you protect the perineum against possible injury (athletic supporter). Certain occupations, e.g. miners working underground, should not go down even if they only operate a joystick, because of the high temperatures and dust. Dirty sweat would run down towards the wound and could cause an infection. Patients whose work is inadvisable for a time can receive a sick note (L4)

Heavy physical work (pickaxe, axe, shovel, any lifting or heaving of large weights) is best postponed for at least 7 days. Dynamic training (football, tennis, martial arts etc.) is best resumed after 2-3 weeks due to the risk of discomfort. Static exercise (e.g. the gym), where you can choose muscle groups and loads, can be resumed from day 8 after the procedure (but really carefully, without “abdominal straining“, i.e. without grunting).

Failure to follow these recommendations usually results in discomfort or pain (which typically resolves on its own). Rarely, a haematoma may form. The appearance of pain often makes the patient worry that something has gone wrong. By way of example: during charity vasectomy missions in the Philippines, our patients (often very poor) usually return to physical work the very next day. They are advised not to wrestle with loads, especially those over 30 kg. Their complication rate (e.g. haematomas) is about 0.5% (one in 200 patients).

It is worth waiting 7-10 days after the procedure before resuming an intensive sex life. Very gentle intimacy (e.g. in the “spooning” position, i.e. “from behind and on your side”, as with a wife in advanced pregnancy) is possible as early as 2-3 days after the procedure.

Additional contraceptive methods must be used until a semen analysis confirms that there are no more sperm, or that only a very small number of dead sperm “mummies” remain.

A sperm granuloma is a vascularised lump appearing near the vas deferens or the epididymis. It is spherical or irregular in shape and measures from a few to a dozen or so millimetres. It consists of immune system cells (macrophages, connective tissue cells) and is often richly vascularised. It forms around sperm that have escaped from the vas deferens – usually within the spermatic cord.

It is the body’s autoimmune reaction against sperm that have crossed the blood-testis barrier. This barrier protects sperm from the immune system, which perceives them as genetically foreign and potentially dangerous. Each sperm cell carries a unique set of genes different from the host’s genetic code.

A sperm granuloma usually causes no symptoms. Sometimes, however, it can cause pain and lead to chronic testicular complaints.

No. The most common cause of a sperm granuloma is scrotal trauma (even many years later) or epididymitis – e.g. as a complication of a genital infection (usually caused by harmless environmental microbes or sexually transmitted diseases). The vasectomy procedure itself (especially in its older versions – without bringing the open end of the vas outside the spermatic cord) comes only third among the causes of chronic testicular pain.

Such pain occurs mainly when the procedure was performed using a method that completely closes the cut testicular end of the vas. In that situation the sperm, which continue to be produced, have no outlet, leading to increased pressure in the epididymides and the closed segments of the vas.

The solution is a method that leaves the testicular end open and brings it outside the sheath of the spermatic cord – the so-called Canadian variant.

A sperm granuloma can also be difficult to diagnose. On ultrasound it can sometimes resemble a testicular tumour, which may lead to unnecessary amputation of the organ.

An explanation can be found in many scientific and popular science articles on the causes of testicular pain in men who have never had a vasectomy.

Dr Wojciech Ejchman, for example, explains it in his article on the causes of testicular pain in men.

In as many as 25-50% of patients attending urology clinics, chronic genital pain, especially testicular pain, occurs without a clear anatomical cause and without any detectable abnormalities.

The list of causes of chronic male genital pain is long. Previous operations on the testicles and spermatic cords (including vasectomy) come only in 9th place. Here is the list of causes of chronic pain:

1.) Pain radiating to the testicle (e.g. a stone in the ureter, nerve root inflammation in the lumbosacral region).

2.) Chronic prostatitis.

3.) Chronic urethritis.

4.) Epididymal cyst.

5.) Hydrocele.

6.) Chronic epididymitis.

7.) Repeated testicular microtrauma (e.g. intensive cycling training).

8.) Testicular cancer.

9.) Previous operations on the testicles and spermatic cords. This includes varicocele surgery, hydrocele surgery and vasectomy. With vasectomy, this can occur quite often when a method is used that closes the sperm outlet from the testicle. These are older methods, which often lead to congestive epididymitis. Fortunately, this condition (after older methods) is transient, and the discomfort usually resolves on its own after a few weeks or months.

10.) Inguinal hernia.

With vasectomy, remember that it does not protect against other diseases – just as wearing glasses does not prevent all future food poisoning.

I don’t know. If the criticism concerns the method itself, the proper addressee of that criticism should be the American Urological Association.

The AUA (American Urological Association) has since 2012 recommended to all doctors performing vasectomies the method:

open ended, fascial interposition, thermal cautery.

In plain terms: it is a technique with an open end on the testicular side (brought outside the sheath), while the end on the prostate side is sealed thermally.

This method is somewhat more technically demanding, as it involves several additional steps.

Dr Kulik is not the author of this method – he simply performs procedures strictly according to the recommended protocol.

A vasectomy is a microsurgical contraceptive procedure for men, involving cutting the vasa deferentia – two thin tubes (about 3 mm in diameter) through which sperm travel from the testicles to the urethra.

After the procedure, the man still has normal ejaculations and orgasms – the only difference is that there are no longer any sperm in the semen. The ejaculate volume decreases by just 2-5%, which is completely unnoticeable. The appearance, smell and consistency of the semen remain unchanged.

The procedure takes just 10-20 minutes and is performed under local anaesthesia. In our practice we additionally use needle-free anaesthesia – the anaesthetic is delivered with a special pressure device, which eliminates the needle prick and greatly reduces the patient’s stress.

More information: home page

Absolutely not! This is one of the most common misunderstandings about vasectomy and it deserves a firm explanation.

Castration is the surgical removal of the testicles – an irreversible procedure that completely eliminates testosterone and sperm production. After castration a man loses his libido, may have erection problems, and his metabolism and muscle mass change.

Vasectomy is something entirely different – it merely interrupts the patency of the vas deferens, the “tubes” transporting sperm. The testicles remain completely intact and continue to produce testosterone in unchanged amounts, produce sperm (which are naturally absorbed by the body) and perform all their hormonal functions.

After a vasectomy, male hormone levels do not change one iota. Libido, erections, orgasms, muscle mass, body hair – everything stays exactly the same. The only change is the absence of sperm in the semen.

More information: incorrect names for vasectomy

Yes, vasectomy is fully legal. There is no provision in Polish law prohibiting this procedure.

It is worth emphasising that a vasectomy is a potentially reversible procedure – a reversal (reconnecting the vas deferens) is possible. This means the procedure does not permanently “deprive” a man of the ability to father children, but only temporarily blocks it. From a legal point of view this is an important distinction.

Vasectomies have been performed in Poland for many years in numerous medical facilities. No special permits or consents are required (apart from the patient’s standard consent to the procedure).

Vasectomy is the ideal solution for men who are certain they do not want more children. It is one of the most effective contraceptive methods available – more effective even than tubal ligation in women.

A good candidate for a vasectomy is a man who already has children and is not planning more, is in a stable relationship where the partners have made the decision together, wants to free his partner from hormonal contraception, is looking for a permanent, reliable contraceptive solution, and understands that the procedure should be treated as permanent (reversal does not always succeed).

Important: Although reversal (restoring fertility) is technically possible, it does not guarantee success. That is why the decision about a vasectomy should be well thought through and treated as final.

More information: qualification for the procedure

These are two innovations that make vasectomy a far less invasive and less stressful procedure than traditional surgical methods.

“No Scalpel” (No-Scalpel Vasectomy) means that the opening in the scrotal skin (just 4-8 mm) is made with special dissecting forceps rather than a scalpel incision. The forceps gently spread the skin fibres apart instead of cutting them. As a result there is no skin bleeding, the wound heals faster, no stitches are needed, and the risk of infection is lower.

“No Needle” (No-Needle Anesthesia) means the local anaesthetic is delivered by a high-pressure pneumatic device that pushes the anaesthetic through the skin without a traditional needle. The patient feels only a brief “snap” – many compare it to being flicked with a rubber band. It is far less stressful than a traditional injection.

More information: history of the no-scalpel method | needle-free anaesthesia

This is a key technical difference that has a huge impact on the patient’s comfort after the procedure and on the risk of complications.

Traditional (older) methods closed both ends of the cut vas deferens – the end leading to the testicle as well as the end leading to the prostate. The problem is that the testicles keep producing sperm, which then have nowhere to drain. This leads to increased pressure in the testicle and epididymis, stretching of delicate structures, irritation of nerve endings and the risk of chronic pain (so-called PVPS – Post-Vasectomy Pain Syndrome).

The open-ended method leaves the testicular end of the vas open and brought outside the sheath of the spermatic cord. This allows the sperm to flow freely into the scrotum, where they are naturally absorbed by the immune system – exactly as the body deals with old, worn-out cells in other parts of the body.

The result: no congestion, no increased pressure, minimal risk of chronic pain.

More information: article on chronic pain

The booking process is simple and consists of a few steps:

1. Phone contact – Call +48 607 776 777 and arrange the date of your visit. You can also send a text message or a WhatsApp message.

2. Completing the online health questionnaire – After scheduling, you will receive a link to the questionnaire. It is a form of medical interview (telemedicine) that allows the doctor to assess the indications and rule out possible contraindications.

3. Telephone consultation with the doctor – 1-3 days before the procedure, the doctor will call to discuss the questionnaire, answer questions and make sure you are properly prepared.

4. Visit to the practice – You arrive on the scheduled date. The consultation and procedure take place during a single visit – you do not have to come twice.

More information: how to book

Contraindications to vasectomy are rare, but they exist. That is why before every procedure we carry out a thorough qualification – a questionnaire, a phone call and a physical examination.

Absolute contraindications (the procedure cannot be performed): active genital infections, acute inflammation, untreated blood clotting disorders.

Relative contraindications (requiring individual assessment): hydroceles (fluid accumulation), large varicoceles of the spermatic cord, previous scrotal surgery with scarring, tumours or abnormal masses in the scrotum, inguinal hernia (which may require prior treatment).

That is why the physical examination on the day of the procedure is so important – the doctor assesses the anatomy and makes the final decision.

More information: qualification for the procedure

Formally – no. From a legal point of view, a vasectomy is your personal medical decision and does not require anyone else’s consent.

In practice, however, we strongly recommend discussing the decision with your partner. A vasectomy concerns your shared sexual life and family planning – it is a decision that should be made consciously by both partners.

A joint decision also has a psychological aspect. If your partner has a negative attitude towards the procedure, it may affect satisfaction with intimacy. But when both partners agree, a vasectomy often leads to an improved sex life – the stress associated with the risk of an unplanned pregnancy disappears.

More information: qualification for the procedure

Yes, vasectomy in younger men is possible, but it requires a particularly well-thought-out decision.

Statistics show that younger men more often regret the decision – life can surprise you: a new relationship, changed priorities, a family tragedy. That is why, with patients under 30, we discuss all aspects of the decision especially thoroughly before the procedure.

What to consider: semen cryopreservation – freezing a sample “just in case” (a relatively inexpensive “insurance policy”); talking to your partner and family – make sure the decision is fully thought through; awareness that reversal does not always succeed – its effectiveness depends on many factors and decreases over time.

We do not refuse younger men, but we want to be sure the decision is fully informed.

More information: vasectomy in young men

The semen analysis after a vasectomy is an absolutely crucial element of the whole process. Only a result with no sperm confirms the effectiveness of the procedure – until then, other contraceptive methods must be used!

When to do the test? At the earliest 8-12 weeks after the procedure and after at least 20-30 ejaculations. Some patients need as many as 40-50 ejaculations, and sometimes up to 6 months.

Why the wait? After a vasectomy, the body’s “storage sites” (seminal vesicles, ampullae of the vas, prostate) still contain reserves of sperm produced before the procedure. The body has to “flush them out” through subsequent ejaculations.

What does the result mean? No sperm (azoospermia) – success! You can stop other contraceptive methods. The presence of a few dead sperm – usually acceptable, but worth discussing with the doctor. The presence of motile sperm – requires further observation or an assessment of whether recanalisation has occurred.

More information: semen analysis after vasectomy

Chronic scrotal pain (in medical terminology also called orchialgia or testicular pain syndrome) is pain or discomfort in the scrotum that persists for at least 3 months and affects the patient’s daily functioning.

The pain may be located in various structures: in the testicle, in the epididymis (the structure adjacent to the testicle responsible for sperm maturation) or in the spermatic cord (the structure connecting the testicle with the abdominal cavity).

Important: Chronic scrotal pain is a common medical problem – it accounts for 2-5% of all visits to urology clinics. In around 35-45% of patients no clear cause can be established (so-called idiopathic pain), which does not, however, mean it cannot be treated.

More information: article on chronic pain

Yes, some patients may experience chronic discomfort after a vasectomy – this condition is called PVPS (Post-Vasectomy Pain Syndrome).

How common is it? Over 15% of men after a vasectomy experience some degree of prolonged discomfort. Severe pain requiring treatment affects around 1-2% of patients. The risk is significantly lower with the open-ended (Canadian) method.

Why does the method matter? With older methods (closing both ends of the vas), the sperm have no outlet, leading to increased pressure in the testicle and epididymis. This irritates nerve endings and can cause chronic pain. The open-ended method minimises this risk, because the sperm can flow out freely and be absorbed.

More information: article on chronic pain

Pain after a vasectomy can have several causes:

1. Obstruction (blocked outflow) and swelling – This is the most common cause of post-vasectomy pain syndrome. When both ends of the vas are closed, the sperm still being produced in the testicle have nowhere to drain. This leads to increased pressure throughout the system – from the testicle, through the epididymis, up to the cut site. This pressure irritates the nerve fibres and causes pain.

2. Sperm granuloma – A lump that forms where sperm leak out of the cut vas. The body reacts to the sperm as a foreign body, surrounding them with immune cells. If the granuloma forms in direct contact with nerve fibres (in the absence of fascial interposition), it can be painful.

3. Haematoma – A compact “ball” of blood that forms when internal bleeding occurred during the procedure. It usually forms within the first hours after the procedure. Small haematomas resolve on their own, larger ones may persist longer.

More information: article on chronic pain

Fascial interposition (FI) is a key element of vasectomy technique that significantly reduces the risk of pain complications.

What does it involve? After cutting the vas, the surgeon places a layer of fascia between its ends – the natural membrane (sheath) surrounding the spermatic cord. This creates a physical barrier between the ends of the vas.

Why is this so important? When a sperm granuloma (a natural process in sperm absorption) forms outside the spermatic cord – away from the nerve fibres – it usually causes no pain. Without fascial interposition, the granuloma forms inside the cord, in direct contact with the numerous nerve fibres running through it – and can be very painful.

In short: Fascial interposition = granuloma away from the nerves = no pain.

More information: article on chronic pain

This is very important information: the most common cause of pain radiating to the scrotum is compression of the spinal nerves in the lower spine!

All the main nerves supplying the scrotum originate from the lower spine – from the lumbar level (L1-L2) and the sacral level (S2-S4). This means that any problem in the lumbosacral spine can cause pain felt in the scrotum – even if the testicles themselves are perfectly healthy!

The most common causes: a herniated or bulging intervertebral disc, spinal canal stenosis, degenerative changes of the spine, tense paraspinal muscles, sciatica.

Note: The pain may be felt exclusively in the scrotum, without accompanying back pain! This often misleads patients.

Good news: Many cases can be treated effectively with simple methods – posture correction, weight reduction, strengthening exercises and physiotherapy.

More information: article on chronic pain

The list of causes of chronic scrotal pain is long, and vasectomy comes only well down the list:

Causes related to the testicle and epididymis: epididymitis and orchitis (bacterial or viral), epididymal cysts (spermatoceles) – benign, fluid-filled formations, varicoceles – dilated veins, more common on the left side, testicular tumours – always to be ruled out.

Extrascrotal causes (referred pain): urinary stones – a stone in the ureter can cause severe pain radiating to the scrotum, inguinal hernia – pain on exertion, spinal disorders – disc disease, sciatica (the most common cause!), pelvic floor muscle tension – a common but underestimated cause.

Important: In around 35-45% of patients no clear cause can be established. However, that does not mean the pain is not real or cannot be treated!

More information: article on chronic pain

Central sensitisation is the phenomenon that explains why chronic pain is so hard to treat and why it sometimes persists even after the original cause has been removed.

How does it work? With prolonged irritation, the nervous system can become hypersensitive. It starts reacting with: allodynia – pain in response to stimuli that should not normally hurt (e.g. touch), and hyperalgesia – excessive pain in response to ordinary painful stimuli.

An analogy: It is a bit like a car alarm that has become so sensitive it goes off at the slightest gust of wind.

What does this mean for treatment? If central sensitisation has occurred, removing the original cause of the pain alone may not be enough. Sometimes additional treatment is needed to “reset” the hypersensitive nervous system – e.g. drugs acting on the central nervous system (gabapentin, amitriptyline) or specialised physiotherapy.

More information: article on chronic pain

Proper diagnosis is the key to effective treatment. It involves several stages:

1. A detailed medical history – The doctor will ask about: the location of the pain, its character (sharp, dull, burning), duration, aggravating and relieving factors, its relation to exertion, urination and ejaculation. Questions about the spine are very important – back pain, sedentary work, heavy lifting.

2. Physical examination – Includes: inspection of the scrotum, palpation (testicle, epididymis, cord), examination of the groin for hernia, rectal examination (assessment of the prostate and pelvic floor muscle tension).

3. Additional tests – Urinalysis (to rule out infection), scrotal ultrasound (the basic imaging test), CT/MRI (if urinary stones or abdominal causes are suspected), spinal imaging (often overlooked, yet very important!).

4. Diagnostic spermatic cord block – Injection of anaesthetic: if the pain subsides for >4 hours, this confirms that the source of the pain lies in the cord’s nerves.

More information: article on chronic pain

A spermatic cord block is both a diagnostic tool and a treatment method for chronic scrotal pain.

What does it involve? The doctor isolates the spermatic cord near the pubic tubercle and injects about 20 ml of anaesthetic solution (similar to what a dentist uses) with a thin needle. The procedure is done on an outpatient basis and takes a few minutes.

How to interpret the result? A positive response (pain reduced by >50%, lasting >4 hours) suggests the pain comes from the cord’s nerves and the patient may benefit from surgical treatment. A negative response (no improvement) suggests the source of the pain is elsewhere or that central sensitisation has occurred.

Therapeutic effect: The block is not just a test – a series of blocks (4-5 at 2-week intervals) can “break the pain cycle” and bring lasting relief, especially in patients whose pain has lasted less than 6 months.

More information: article on chronic pain

Treatment should be tailored individually to each patient. It often requires the cooperation of several specialists.

Conservative (non-surgical) treatment: basic measures (warm baths, supportive snug underwear, avoiding activities that aggravate the pain), anti-inflammatory drugs (NSAIDs) – ibuprofen, naproxen, neuropathic pain medication – gabapentin, amitriptyline (prescription only!), pelvic floor physiotherapy – very effective for muscle tension, a series of cord blocks – can “break the pain cycle”.

Surgical treatment: removing a specific cause (hydrocele, cyst, varicocele), microsurgical denervation of the cord (MDSC) – the preferred method, 50-100% effective, vasectomy reversal – if the cause is obstruction (50-69% effective), removal of the testicle (orchiectomy) – a last resort, 20-70% effective.

More information: article on chronic pain

Microsurgical Denervation of the Spermatic Cord (MDSC) is currently the preferred surgical method for patients with chronic scrotal pain whom conservative treatment has not helped.

For whom? The pain is diffuse (not confined to one spot), no specific anatomical cause has been identified, and a spermatic cord block brought relief lasting >4 hours.

What does the operation involve? The surgeon makes a small (3-5 cm) incision in the groin, isolates the spermatic cord and, under an operating microscope, cuts all the nerves, while preserving: the arteries (supplying the testicle with blood), the lymphatic vessels (preventing hydrocele formation), the vas deferens (if the patient has not had a vasectomy).

Effectiveness: Complete resolution of pain: 50-100% of patients. Partial improvement: an additional 3-24%. The complication risk is low (hydrocele <1%, testicular atrophy ~1%).

More information: article on chronic pain

Yes, in some patients a vasectomy reversal can help treat the pain, especially when the cause is obstruction.

How does it work? If the pain is caused by blocked sperm outflow and increased pressure in the testicle/epididymis, reconnecting the vas restores patency and removes the cause of the pain.

Effectiveness in treating pain: 50-69%

Drawbacks of this method: it restores fertility – which is not always desirable (the patient had the vasectomy precisely to be infertile), it is an expensive procedure – a reversal costs much more than a vasectomy and is usually not reimbursed, and it does not guarantee success – either in restoring fertility or in relieving pain.

For patients who do not want to restore fertility, MDSC (microsurgical denervation) may be a better option.

More information: article on chronic pain

A vasectomy is not just the man’s decision – it is a gift for the whole family, especially for his partner.

Freedom from hormones: Hormonal contraception (pills, patches, implants) can cause numerous side effects: reduced libido, mood swings and depressive states, weight gain, increased risk of thrombosis, and with long-term use, an increased risk of certain cancers. After a vasectomy, your partner can give up hormones entirely.

No more other methods: An end to condoms (which reduce sensation and spontaneity), the coil (which can cause pain and heavy periods) or withdrawal (which is stressful and unreliable).

Sex without stress: Research shows that many couples experience an improved sex life after a vasectomy – the constant stress associated with the risk of an unplanned pregnancy disappears, allowing greater freedom and pleasure.

More information: benefits of vasectomy

Semen cryopreservation is a “just in case” option, particularly worth considering for younger men.

Arguments FOR: a relatively inexpensive “insurance policy” (a one-off cost + annual storage fees), peace of mind – you know you have a “plan B” if your life situation changes, especially sensible before the age of 35.

Arguments AGAINST / to consider: frozen semen is about 50% less valuable than fresh (lower sperm motility after thawing), fertilisation will require IVF – a costly procedure that is burdensome for your partner, alternatives: reversal or retrieval of fresh sperm directly from the epididymis (PESA/MESA).

In short: If you are under 35 and have no children yet, or only a few, it is worth seriously considering cryopreservation.

More information: vasectomy in young men

There are two main ways to regain fertility after a vasectomy:

1. Reversal (vasovasostomy) – Microsurgical reconnection of the cut vas deferens. Its effectiveness depends on: time since the vasectomy (the shorter, the better), the partner’s age, the technique of the original vasectomy, the surgeon’s experience. Overall effectiveness in restoring the presence of sperm: 70-95%. Effectiveness in achieving pregnancy: 30-70%.

2. Sperm retrieval for IVF – PESA, MESA, TESE methods – retrieving sperm directly from the epididymis or testicle, without restoring the patency of the vas. Requires an IVF procedure, which is costly and burdensome for the partner.

Important: No method guarantees success. That is why a vasectomy should be treated as a permanent decision – “forever” – and not as “temporary contraception”.

More information: vasectomy reversal

A vasectomy reversal is an operation to restore the patency of the vas deferens after a previous vasectomy. The aim is to allow the sperm to reach the semen again, and thus to restore fertility.

When do men decide on a reversal? A new relationship and the desire for children with a new partner, the death of a child and the desire for another, a change in life priorities, treatment of chronic pain after a vasectomy (when the cause is obstruction).

Reversal outcomes depend on time: Up to 3 years from the vasectomy: ~95% patency, ~75% pregnancies. 3-8 years: ~90% patency, ~55% pregnancies. 9-14 years: ~80% patency, ~45% pregnancies. Over 15 years: ~70% patency, ~30% pregnancies.

Important: A reversal is a much more complicated procedure than a vasectomy; it takes longer (2-4 hours) and requires microsurgical precision. It is also much more expensive and is not reimbursed by the National Health Fund (NFZ).

More information: vasectomy reversal

There are two main surgical techniques for restoring the patency of the vas:

1. Vasovasostomy (VV) – A direct end-to-end connection of the two ends of the cut vas. Used when: clear fluid flows from the epididymal side during the operation, sperm (even fragments) are visible in the fluid, the epididymis is not blocked.

2. Vasoepididymostomy (VE) – Connecting the vas directly to the epididymis (bypassing the blocked segment). Used when: thick, pasty fluid flows from the epididymal side, there are no sperm in the fluid, a blockage in the epididymis is suspected.

Which method is better? The surgeon decides during the operation, after assessing the anatomy. Vasovasostomy is simpler and more effective, but not always possible. Vasoepididymostomy is technically more difficult.

More information: reversal methods

We perform procedures at two locations:

WARSAW: ul. Floriańska 6, unit U-4 (entrance from ul. Jagiellońska 32), 03-707 Warszawa

KATOWICE: ul. Obroki 68 (NL-Clinic), 40-833 Katowice

Contact: Phone: +48 607 776 777 (calls, SMS, WhatsApp)

Dr Kulik rotates between the two locations (2-3 days every two weeks at each). When booking, you will be told the nearest available dates in both cities.

Patients come to us from all over Poland and even from abroad. Here are some practical tips:

Everything in a single visit: The consultation and the procedure take place on the same day – you do not have to come twice.

Driving: Most patients can drive as soon as 30 minutes after the procedure. If you are prone to fainting, consider coming with a driver.

Travelling by train: Buy a seat reservation to guarantee a seat. You don’t want to stand for hours after the procedure.

Provisions: Bring sandwiches and something to drink. After the procedure it is good to eat before setting off home.

Plan your day: Plan it so that you can rest after getting home – ideally in a comfortable armchair or on a sofa, with minimal walking.

More information: information for those coming from far away

Yes, if needed you can receive a sick note.

When is it worth taking sick leave? You do heavy physical work (lifting, trench work, working at heights), you work in conditions that hinder healing (high temperatures, dust, dirt – e.g. miners), you cannot afford discomfort at work (e.g. work requiring concentration), you have a long commute.

How long? Usually 2-7 days, depending on the nature of your work and your individual recovery.

Remember: With light office work, you can often work normally the very next day. It is an individual matter.

The procedures are performed by Dr Robert Kulik – one of the pioneers of the Canadian vasectomy method in Poland.

Experience: 12 years of vasectomy practice, over 10,000 procedures performed independently, clinical andrologist and gynaecologist.

Training and missions: Training in the USA in the Canadian method (open-ended, fascial interposition), participant in international No Scalpel Vasectomy International charity missions, World Vasectomy Day in Bali (2015), missions to the Philippines (2015, 2016), training doctors from all over Europe, including the United Kingdom.

Dr Kulik is one of the few doctors in Poland who perform vasectomy using the method recommended by the American Urological Association.

More information: about the doctor

Experience that matters: Over 10,000 procedures – one of the largest bodies of experience in Poland. The Canadian method (open-ended, fascial interposition, thermal cautery) – recommended by the American Urological Association, with the lowest complication rate. Needle-free anaesthesia – minimising stress and discomfort. No scalpel – faster healing, no stitches.

Patient convenience: Consultation + procedure in a single visit – you do not have to come twice. Two locations – Warsaw and Katowice. Telemedicine – an online questionnaire and a telephone consultation before your visit.

International experience: Training in the USA, charity missions in the Philippines and Bali, training doctors from all over Europe.

“Tying the testicles” is an incorrect, colloquial term for vasectomy. Unfortunately, it is misleading and suggests something entirely different from the actual procedure.

Vasectomy: Cuts the vas deferens (the thin “tubes” transporting sperm). It does not touch the testicles – they remain completely intact. The testicles continue to produce hormones and sperm.

Other incorrect terms to avoid: “Male sterilisation” – sounds drastic and suggests something irreversible. “Castration” – a completely different procedure (removal of the testicles). “Cutting out the testicles” – entirely wrong. “Tying the testicles” – the testicles are not tied.

The correct name is simply “vasectomy” (from Latin vas deferens + ectomy – excision/cutting).

More information: incorrect names for vasectomy