I perform vasectomies solely under local anaesthetic. That means I don’t use general anaesthetic or IV sedation.
I can safely say that more than 99% of men tolerate vasectomy very easily.
The most painful parts of a vasectomy are:
1. Infiltration of the local anaesthesia into the scrotal skin. This is comparable to getting a needle at the dentist. I use very thin needles
2. Infiltration of local anaesthetic around each vas deferens. While not painful per se, it can give an uncomfortable feeling into the abdomen, like you may feel if kicked in the testicles. That said, the sensation is usually quite transient (less than a couple of seconds)
3. If there is any excessive tugging. Men with short scrotums may require a bit more squeezing and tugging than others and in rare situation it might be necessary to abandon the procedure and perform it under sedation of general anaesthesia. In my experience this occurs in around 1 in 200 cases.
So is a vasectomy painless? No. But I wouldn’t describe it as painful either.
Patient factors such as pain threshold, anxiety levels around needles and anatomy of the genitals all play a part. But on the whole it is usually easily performed under local anaesthetic with no major discomfort.