Doc Talk: Vasectomy Q&A with Scott Matson, MD
Women’s Health Connecticut strives to offer a wide range of family planning services to our patients and their partners. That’s why Scott Matson, MD, a highly skilled urologic surgeon and his practice Vasectomy and Male Infertility Center of Connecticut are part of our network! If you and your partner are sure that you are done having children or do not wish to become parents, a vasectomy can be an ideal solution. Read our interview to get to know Dr. Matson and learn the basics:
Dr. Matson, tell us about your background and what drew you to this profession.
I discovered urology in medical school, and I liked that the people were pretty relaxed and treated all types of patient groups. I eventually chose to focus on reproductive surgery because first, I like it. It’s the type of surgery I'm drawn to. Second, I saw that the vasectomy patient was somewhat underserved in a waiting room full of patients with more serious urologic issues. The doctors couldn’t always give them the attention they deserved, and I felt that they could have been treated more compassionately. It's a lot for a guy to take on in a day. In my current practice, I aim to provide a comfortable, safe place where the vasectomy patient can be the center of attention.
About how many procedures have you performed?
About 6,000. I currently perform about 600 vasectomies per year.
What is the average age of patients who come to you for a vasectomy?
The average age is 35 to 40. By this age, many people are done with building a family. At age 40, it's not always recommended for a woman to stay on the pill, so many couples start looking for other long-term solutions. Yes, she could have a tubal ligation or get an IUD, and those are great for many patients, but a quick surgery for the male partner is cheaper, safer medically speaking, and more effective than a tubal ligation.
I do occasionally see people outside this age group. A man can have kids into his 70s. A guy’s fertility doesn't slow down as much as a woman’s. If you’re 60 dating a 30-year-old woman, you might consider a vasectomy. I also occasionally see much younger patients. I saw a young couple in their 20s who were planning on getting married. They did not want biological children;, they wanted to adopt kids. I spent a lot of time talking to them and I actually met with their parents and their pastor and everyone was onboard. So, I ended up doing the vasectomy for a 20-year-old with no kids. There were also other factors involved so I really felt that I served both of them and their life plan. It’s my job to help counsel them.
Are consultations available to all your patients?
Yes, I meet with every patient ahead of time to learn his story and hear his concerns. Often, they bring their partners who might have different concerns or thoughts and there’s plenty of time for both people to ask questions. I like to meet the patient, examine them, and prepare them for the surgery. I see patients from Rhode Island, Massachusetts, Connecticut, and New York. If there is a long drive involved, we can now use Telemedicine for a virtual consultation.
Are you one of the only vasectomy specialists in the area?
I would say so. There are definitely several doctors who have an interest in vasectomy and have a pretty strong practice in it. I think I am the most specialized in Connecticut. It’s a lot of fun to do what I do and help people. There’s something optimistic and nice about helping people plan their lives.
Can you tell me about the procedure itself?
The latest approach to vasectomy is the no-needle, no-scalpel. ‘No-needle’ simply means we use a spray that anesthetizes the area. It numbs the area instantly. Then the approach is pretty simple. We hold the tube and make a puncture hole through all the layers all the way down to the tube. After bringing the small tube out through the hole, we modify the tube by removing a small section, then cauterizing the tube itself. And then we put tissue that naturally lays over the tube like a sleeve. We pull that over the end and clip it, which is almost like putting it in a Ziploc bag. The clip is a tiny piece of titanium, non-ferric so you can still get an MRI if needed. It doesn't dissolve, it stays in there, but you can't feel it. It's very subtle, basically not noticeable to the patient or to his partner. The puncture hole does not cause any bleeding and doesn’t require any stitching afterward. I have 20% of my patients tell me that they had no pain at all. For the patients that do experience some pain, I recommend Tylenol because it doesn’t thin the blood.
In terms of recovery time, how long until you can get back to normal activities like going to the gym?
I like the patient to take a couple of days of couch rest, doing immobilization and icing. For the first week, I recommend sticking to light activity, as most problems that come up tend to appear in that first week. There can be some swelling. After about a week, most of the healing is done. Patients may go back to the gym, jogging, running, but should take it easy.
What is the failure rate?
The upfront failure rate of a vasectomy is similar to that of a tubal ligation but we don't stop there, we check and find the ones that have re-healed. So, then the failure rate drops to 1 in 2000 to 1 in 4000 lifelong failure, where the tubal stays at 1 in 200 to 400.
How much does a vasectomy cost, and is it typically covered by insurance?
Vasectomies are in the neighborhood of $1,000. In terms of insurance, the rules for different plans are different. It’s covered in most plans, but we do recommend that every patient call their insurance company. For some patients, insurance pays up the entire bill. Some patients pay more if they haven’t met their deductible or if their employer’s plan does not cover vasectomies.
For men who aren't 100% sure that a vasectomy is right for them, what tends to be holding them back?
We don't go forward with the surgery if the patient decides they aren’t ready. I guess you have to get to the bottom of what's making them uneasy. If they are sure they want a vasectomy but the barriers are just fear-related, we try to help them with that. When a woman has a tubal ligation, the procedure is performed while the patient is under anesthesia. For a guy, he knows the doctor’s going to do this while he's awake, so there can be some fear. I address this in more detail on my website. I want my patients to get comfortable with me and with the practice. I think that's pretty important.
If they are not sure if they want another baby or not, they are not really ready for a vasectomy until they are sure. I recommend IUDs in most circumstances like this. If the female partner is able to have an IUD, it can give them a few more years to make the decision about a vasectomy. How does a couple arrive at the decision? I think it takes communication and soul searching.
Are there any other counseling resources that you would recommend to couples?
I often say, talk with your Women’s Health Connecticut ObGyn about your options if you’re not sure that you want something permanent.
Why do couples choose vasectomy over tubal ligation?
Vasectomies are a lot simpler because of the anatomy. The vas tubes are just beneath the skin, whereas the tubes for the women are intrabdominal, so to get into the abdomen and operate the patient has to be put to sleep. They are under complete anesthesia at the hospital, and if complications arise, they can be serious. The cost of in hospital anesthesia and surgery are considerably more.
Do you see a trend in more men getting vasectomies or fewer men getting vasectomies in recent years? I feel like I see an upward trend but you’re looking at a guy who does this for a living. I feel like several social factors are affecting this. One, men are more willing to talk about it. A generation ago, I think men were less willing to be involved. In the generations that are of reproductive age right now, they are not so embarrassed. It's not just the woman’s responsibility anymore. Men are recognizing that they’re a part of this equation, and it's about time. So, I think men are more accepting, I think that the fact that the surgery has gotten easier and that the recovery is pretty short, and that it is not that expensive all make this pretty attractive to a guy or a couple who wants permanent birth control.
One last question! What do your patients get to watch on tv during their procedure?
I play “Planet Earth”. Why is that? I like the narration of David Attenborough. He's very relaxing. Nature videos can be mesmerizing, you're in a whole new world. I do get guys that ask if they can put on sports or something but I can't have someone suddenly laughing. I want the guy to be pretty relaxed and easy. You get a little mesmerized by being deep in nature and the relaxing narration.
Learn more about Dr. Matson’s practice and read what his patients are saying at VasectomyCT.com.