The objective was to characterize the multiple factors related to the likelihood of an opioid refill, including benzodiazepines during the procedure, nonopioid pain relievers following a vasectomy, and dispensing opioid prescriptions for pain management. This observational retrospective analysis included all patients (40,584) who had vasectomies performed in the U.S. Military Health System between January 2016 and January 2020. Primarily, researchers looked at how likely patients would receive a refill on their opioid prescriptions during the first 30 days following a vasectomy. Patient and care provider characteristics, prescription dispensing, and 30-day refill rates for opioids were analyzed using bivariate correlations. The factors influencing the need for another refill of an opioid were analyzed using a generalized additive mixed-effects model and sensitivity analyses. Dispensing patterns for benzodiazepines (32%), nonopioids (71%), and opioids (73%), all associated with a vasectomy, varied widely amongst different medical centers. About 5 % of those who were given opioids did not return for more. Although the effect of dose did not replicate in sensitivity analyses, they found that white race, younger age, a history of opioid dispensing, documentation of a mental health or pain condition, the absence of post-vasectomy nonopioid pain medication dispensing events, and a higher dispensed post-vasectomy opioid prescription dose were all associated with an increased likelihood of an opioid refill. Although there is considerable diversity in the pharmaceutical courses following a vasectomy within a comprehensive healthcare system, the vast majority of patients do not require further opioids. Inequalities based on race were seen in the wide range of prescriptions given. Intervention to reduce excessive opioid prescriptions is necessary for light of low opioid prescription refill rates, considerable heterogeneity in opioid prescription dispensing events, and recommendations for conservative opioid dosing after vasectomy by the American Urological Association.