Interview with No Scalpel Vasectomy Specialist Dr. James Gottesman – No-Scalpel, No-Needle Vasectomys

Interview with No Scalpel Vasectomy Specialist Dr. James Gottesman – No-Scalpel, No-Needle Vasectomys. This interview is one in a series of expert interviews on the blog. We add new interviews on a regular basis. Please see our complete list of insightful interviews

1. Have you noticed an increase in the demand for vasectomies within the past 10 or so years, or has the demand remained pretty consistent? If there has been an increase, to what would you attribute this change?

500 – 600,000 vasectomies are performed each year in the US. The number of vasectomies increase each year. About one out of every six men over the age of 35 has now had a vasectomy. Higher vasectomy rates are associated with higher levels of education and income. I think the Internet has helped considerably. Both men and women can now easily research vasectomy and vasectomy providers and other forms of permanent contraception. When they learn that vasectomy is faster, cheaper and safer than other forms of permanent birth control the decision becomes easier.

Almost all insurance companies now pay for vasectomy. It is considerably cheaper to pay for a vasectomy than to pay for another pregnancy and child to cover. Also, the perception that birth control is a female-only issue is eroding and more and more men are ‘stepping up to the plate’. The No-Scalpel and the No-Needle techniques that we use are faster, safer and more comfortable than standard techniques and take away some the psychological fears.

2. You offer a no-scalpel, no-needle approach to vasectomies. Can you explain how this technique varies from a “standard” vasectomy and why it might be more beneficial?

Vasectomy ( or more correctly ‘Partial Vasectomy’) simply means removing a small portion of vas which transports sperm from the testicle to the prostate gland. In the end, all vasectomies get to the same place. A considerable number of variations of doing the vasectomy exist which make the procedure easier and safer to do, including the No-Scalpel and the No-Needle techniques. What does “no-scalpel” mean? The No-scalpel vasectomy is a procedure first introduced to the United States in 1985. The scrotal skin is uniquely elastic compared to other parts of the body. For example most men will note the difference in scrotal size coming out of the cold ocean as opposed to a hot tub. The no-scalpel technique takes advantage of the elasticity. Instead of cutting the scrotal skin with a scalpel or scissors, a small hole or puncture is created with a special tool that then allows the skin to be stretched open. The opening size created is the same as an incision but the elasticity allows the no-scalpel technique to close more rapidly without sutures and with less bleeding. What does “no-needle” mean? “No-needle” refers to the way anesthesia is given. The doctor uses a special device or ‘air-gun’ rather than needle injections to numb the skin and vas, which causes less discomfort. There is just something about needles and testicles that don’t go together for many men.

3. What is the recovery time for the no-scalpel, no-needle vasectomy?

Recovery is a bit of a moving target and all men are different. I do all my vasectomies on Saturday morning. If the men, stay off their feet for the rest of the weekend and keep ice-packs on the scrotum intermittently, almost all are walking, driving and working on Monday morning with little or no discomfort. I encourage men to do nothing athletic or sexual until the following weekend. At that time, they have no restrictions.

4. Will having a vasectomy affect the man’s sex life in any way?

This is the easiest question to answer. NO, NO, and NO. All the studies done suggest an improvement in sexual desire and performance in most men. Vasectomy has no effect on male hormone levels. The amount, quality, look, touch and feel of the semen or ejaculate produced is the same. The one and only change is that there are no sperm in the semen which is a very small fraction of the volume. Where’s the condom? Did you remember to take your pill?. Are you sure your IUD is in place? When one takes away the fear of pregnancy with every sexual event, the freedom becomes empowering. If you are of the mindset that you need to be able to get someone pregnant to make sex worthwhile don’t have a vasectomy. Thankfully, most men don’t fall into this category.

5. Are vasectomies reversible?

Yes, but……….. In most cases the vasectomy can be surgically reversed. The success rate depends on the number of years that have passed from the time of the vasectomy to the time of the reversal. The procedure is expensive and not covered by insurance, requires several hours of micro-surgery and a week of recovery. I instruct men that they really need to see the vasectomy as permanent sterilization. If the thought of never being able to have more children is a hurdle, cryo-preservation of sperm is an option. Obviously, this needs to be done before the vasectomy.

About Dr. Gottesman:

Dr. Gottesman and his partner, Wayne D. Weissman, M.D., were among the first of a growing number of physicians in Washington who offer no-scalpel, no-needle vasectomies. Combined, they have more than 50 years of experience in the practice of medicine and have performed more than 12,000 vasectomies.

A board-certified urologist, Dr. Gottesman attended the University of California at Berkeley and graduated from the University of California, San Francisco Medical School (UCSF) in 1970 with honors. He was also a member of the Alpha Omega Alpha Honorary Society. He completed his general surgical training at UCSF and served his residency in urology at the University of California at Los Angeles under the prestigious Drs. Joseph Kaufman and Willard Goodwin. From 1972 to 1976, Dr Gottesman performed vasectomies at the Planned Parenthood Vasectomy Clinic. In 1978, after two years on the faculty at Rush Medical School in Chicago, he and his family moved to Seattle and began practice at Swedish Medical Center. Dr. Gottesman is clinical professor of urology at the University of Washington and has authored more than 65 papers and five book chapters.

He is past chief of the department of urology at Swedish. He has two patents on urological devices and has written many medical educational software programs, including the original program of Dialog Medical, called DISCussion. He has been selected on multiple occasions by the physicians of King County as one of region’s ‘Top Doctors in Seattle Magazine, and in the Fall 2003 issue of Puget Sound Consumers’ Checkbook. Besides his clinical interest vasectomy, Dr. Gottesman was active in the treatment of all genitourinary malignancies, (kidney, ureter, bladder, prostate and testes) and was a principal investigator for the National Prostate Cancer Prevention Study and multiple investigational drug studies.

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