Non-scalpel vasectomy is a minimally invasive approach that does not require the ‘classic incision’ with its associated potential complications but performed only via a small puncture at the scrotum and with minimal and very rare potential complications.

Vasectomy as a general principal blocks sperm from reaching the semen that is ejaculated from the penis. However, NSV is different from the conventional form, since no major incision is made. The procedure is done during a "regular clinic visit”.

Dr. Tewodros Fesseha, a US trained Urologist desires to transfer this skill set to providers of service in Rwanda as part of the Family Planning Program and hopes it will be made available, at some point, to all families all over Rwanda.

Dr. Fesseha says, due to "myths” around vasectomy, many men shy away from participating in Family Planning, and relegate the issue purely as the responsibility of women adding to their societal burden, a fact he says is unacceptably unfair and unwise.

The medic notes that one thing people should know is that this form of vasectomy is the easiest permanent sterilisation procedure.

"It can take 10-20 minutes, whereas if a woman was to have tubal ligation, she would have to go under general anaesthesia. It is difficult and extremely costly compared to the resources necessary to perform a NSV” he adds.

The procedure

Dr Fesseha recommends this procedure to be done after having consulted with your partner and have really decided that you don’t want to have any more children. The procedure is considered permanent though it is reversible.

One thing to note though is, reversing a vasectomy is possible. The reversal procedure is dubbed "vasovasostomy” and has a good success rate, although it is expensive, the medic says.

"The key point however, is that the procedure is simple. It is an outpatient procedure; we try to have the room relatively warm and comfortable. We then sterilise the area and have one small opening through which you will be able to access the Vas Deference (tube through which the sperm passes). You pull them out, tie upstream, downstream, incise the tube structure, cauterise the tunnel which will create a scar tissue that will actually plug the tubes,” he explains.

Even after the procedure, Dr Fesseha explains, sperm will continue to be made in the testicle though when it travels to the point where there is blockage, it can’t go any further. When this happens, the sperms just break down and are reabsorbed back into the body. A process that normally happens if a person has not been sexually active for a couple of weeks.

Possible complications

Infection rates are very low with this procedure and in some very rare cases, 1 out of 2000 people can develop mild pain but that is very rare.

Dr Fesseha notes that there might be bleeding but this tends to be at the skin level (which stops by putting pressure like as with a ‘nosebleed’); whereas with open vasectomy one could have bleeding on the inside that may require an involved procedure to evacuate clots that would have formed inside the scrotum with a trip to the operating room.

It’s important to note that one has to continue using protection or other forms of birth control a short period after the procedure to confirm sterility as the sperm downstream from the blockage can still cause pregnancy and have to have been totally evacuated with subsequent ejaculations.

In regards to the period of recovery and when one can get back to being sexually active, the surgeon notes that it doesn’t take long though healing also depends on the kind of work that you do.

 "If you do heavy lifting or a very strenuous activity, in order to protect yourself the doctor may ask you to wait for a week or two but in my experience, if I did the procedure say on Friday I recommend my patient to take that weekend easy and if everything is okay, by Sunday they can get back to normal activities.”

Busting myths

- Dr Fesseha observes that a lot of men believe if they have a vasectomy is done, that it would stop ejaculations. "In other words, they think they will not be able to ejaculate during sexual intercourse. The truth is the sperm is in less than one percent of the fluid that comes out of the ejaculate.” Neither they nor their partners would notice a change.

- The other myth is that once a person has a vasectomy, they will stop making sperm, in other words they will be "permanently sterile” … there is the opportunity at reversal; hence this is not true.

- He also notes that some people think that family planning is generally easier for women to do than men and that this is further from the truth, extremely easier for men than for women, hands down!

- The other myth is fear of cancer”. In fact, going for this procedure exposes you to a "urologist” and eventually likely to get screened for prostate cancer than another person who might actually have cancer but does not get screened. Which means persons who might have prostate cancer are likely to be identified versus persons who have never been to a urologist because they are less likely to be "screened” for ‘prostate cancer’.

- Most importantly, men erroneously may also feel that after they have had a vasectomy their ability to "perform sexually would be diminished’. Actually free from worry of unwanted pregnancy, their libido and performance may be enhanced.

Plans for a clinic

Dr Fesseha reveals that King Faisal Hospital will develop a platform where a team of urologists led by Dr. Edouard Ngendahayo, and obstetrician/gynaecologist Dr. Balkachew Nigatu from King Faisal Hospital, shall discuss NSV availability for Family Planning; and make a list of patients who want to have this procedure done.

"The key thing is, I want to transfer the skill set off the NSV procedure to local urologists so that this becomes part of the services that are provided to all patients on a regular basis.” he says.

"I have already done three procedures here at KFH. These services are available. What we want is to set a clinic strictly focused on NSV and train physicians across Rwanda to conduct the procedure. I will train "trainer physicians” which can then transfer their skills to other healthcare providers. We will also be available to travel to outlying hospitals/clinics and provide training but also ongoing support as needed.

The main objective is to inform and educate men as to the role they can play in this responsibility of Family Planning and give them the opportunity to decrease the burden on the women they love and decrease the burden imposed on the healthcare system which can then better meet the needs of the society at large.