Data regarding the efficacy of vasectomy are limited, but the procedure appears to be highly effective. Efficacy may vary by the method of vas occlusion. Death attributable to vasectomy in the United States is exceedingly rare, and major perioperative morbidity is quite uncommon. No long-term adverse health effects have been documented, and much evidence supports the conclusion that vasectomy does not increase the risk of subsequent atherosclerosis. Vasectomy, like tubal sterilization, should be considered a permanent decision, because reversal surgery is expensive and requires substantial surgical expertise. Although vasectomy reversal is often successful, it cannot be guaranteed even in the best of circumstances, and when the vasectomy has caused epididymal obstruction, reversal is often unsuccessful. Vasectomy represents a safe and effective alternative to tubal sterilization for couples who decide that the male should be sterilized.