There are few medical procedures that elicit more of a reflexive groan or hearty chuckle from men than the vasectomy . But for all the reliable comedy routines it’s inspired, the vasectomy has earned a reputation as an emasculating, fear inducing, and possibly life threatening surgery.

So let’s go ahead and dispel some of these concerns by shining a light on the inner workings of the vasectomy.

Nuts And Bolts

The titular “vas” stands for the vas deferens, the tube that winds around the testiscle and connects it to its corresponding ejacuatory duct on either side of the prostate. If I were to compare semen to a friend’s potluck dinner, the vas deferens would be responsible for bringing the sperm produced by the testes.

A vasectomy is the equivalent of padlocking Mr. Deferens’ front door so he can’t make it to the party — not tonight and not ever again. The vasa deferentia are cut in half and either one or both ends are sealed up, usually with a heated needle. Though sperm is still produced by the testes, it’s eventually absorbed into the body, rarely causing the epididymis, the tightly packed tube that helps store sperm in the testes, to enlarge in size. This wasted production, for whatever reason, tends to reduce the quality of the sperm itself after some time.

Though the vasectomy has been around since the turn of the 20th century, the basic approach hasn’t changed much.

According to Dr. David Weiner, assistant professor of urology at Columbia University Medical Center, there are two types of vasectomy procedures, depending on how you choose to get to the vas deferens from the scrotum. The traditional method involves a scalpel incision, while a newer no-scalpel method, invented in the 1970s, uses a small puncture to gain access. “The no-scalpel technique is slightly less invasive and I suspect the more common method used by urologists,” said Weiner.

Whatever brand you opt for, there’s little to worry about. Vasectomy is one of the safest procedures available, taking as few as 15 minutes at your local urologist’s office. The risk of greater complications, such as bleeding and longer bouts of pain, ranges from 1 to 2 percent, according to guidelines issued by the American Urological Association. Similarly, the chances of outright failure are minimal — the need for a second vasectomy is less than 1 percent. According to the association, there has only been one documented death via vasectomy in the academic literature, which occurred in 1992 in Europe.

Once the operation is over, recovery means a few days of soreness, a week or less of avoiding normal sexual activities, and about two to three months of sticking to conventional contraception until your doctor can confirm the lack of Olympic-level swimmers in your semen.

Myths and Misconceptions

Benign as it may be, the procedure suffers from plenty of misconceptions that Weiner says he often has to debunk for his patients.

“I make sure to speak with my patients and reassure them that the vasectomy will not affect any of the nerves that allow erections. If erectile dysfunction presents after a vasectomy, it is most commonly due to anxiety and typically will resolve with time and reassurance,” he said. “The testosterone level and masculinity will not be impacted by a vasectomy as the testosterone flows through the vasculature attached to the testis which is not disturbed during a vasectomy.”

A minority of researchers have also shakily linked vasectomy to more serious health concerns such as prostate cancer and even dementia.

“The whole question of prostate cancer had been dispelled in the 1980s and has now gotten revisited again,” Dr. Ajay Nangia, an Associate Professor of Urology at the University of Kansas Medical Center, told Medical Daily. Indeed, a 2014 study in the Journal of Clinical Urology followed up on 24-year-old research and found a slightly elevated risk of prostate cancer among those who underwent vasectomy and a more significant risk of higher grade tumors.

As Nangia explains, though, there’s no plausible biological explanation for such a direct cause-and-effect link. He suggests a much simpler reason for their findings: “Those men who had a vasectomy might be followed more closely by their urologists and had their prostates checked more often,” he explained. This increased scrutiny in turn may have led to the discovery of more tumors in the vasectomy patients. While a few studies have also found a link, many more, including a 2015 review in Scientific Reports, have concluded the opposite.

Meanwhile, a 2006 study found that a group of older men with a rare neurological disorder called primary progressive aphasia were more likely to have gotten a vasectomy than those without cognitive impairment. The study, however, looked at only 47 patients and has never been replicated by anyone else. Dr. Sandra Weintraub, the study’s lead author and a cognitive researcher at Northwestern University, told Medical Daily that there were no plans to pursue further research on the link from her end. When asked why, she stated it wasn’t in her field and that the original study was an “observed association.”

An Unfortunate History

That isn’t to say vasectomy hasn’t had some unfortunate consequences. “The history of it is not very good, having been tied to the eugenics movement,” Nangia said. “It was very much used as a means of preventing the progression of any disability [in the early 20th century] and then of course, during the Nazi period, it got used on a much broader population.” Forced sterilization is a trend that, while more pronounced in women, has continued on in many regions of the world, including the U.S.

In 2014, a 27-year-old Virginia man named Jessie Lee Herald who had fled the scene of a car accident agreed to a particularly bizarre plea deal offered by prosecutors. In exchange for reduced jail time, he would obtain a vasectomy on his own dime soon after he returned home. Herald had a long criminal history and was the father of seven children by six different women. In 2013, the family of a mentally disabled British man was allowed to go forward with their plans to sterilize him after a court ruled it was in his best interest. The man, though legally unable to consent to the procedure, was a father and reportedly expressed a desire to have no more children. These troubling cases aside, the vast majority of vasectomy patients, approximately half a million men annually, have little to no regret.

Odds And Ends

Safe and effective as vasectomies are, they aren’t foolproof. The chances of a man getting someone pregnant after the operation are about one in 2,000, even after his semen appears to have no functional sperm. This failure rate is about the same for women given tubal ligations, which are oftentimes more expensive and more prone to side effects than vasectomies.

Lastly, for those wondering, you can indeed reverse a vasectomy, usually by reconnecting the ends of the vas deferens together again. Reversals are more expensive and less effective, only restoring fertility in about 80 to 90 percent of men. For that reason, prospective patients should always consider their sterilization permanent and might want to store their semen in case they ever change their minds about children in the future.

“I believe that a patient should always keep an open mind when selecting an elective sterilization procedure,” Weiner replied when we asked what someone thinking about getting a vasectomy should know beforehand. “They should seek to obtain a thorough understanding of the risks, benefits, and alternatives that exist for contraception. This is a very personal choice and it is of paramount importance that a patient gives strong consideration before pursuing a vasectomy.”