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Sterilization Vasectomies

A vasectomy is considered a permanent method of birth control.

Vasectomy is a minor surgical procedure to block the tubes (vasa deferentia of a man) to prevent sperm from entering the seminal stream (ejaculate).

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What is vasectomy?

Vasectomy is a simple operation designed to make a man sterile, or unable to biologically father a child. Vasectomy involves blocking the tubes through which sperm pass into the semen. Sperm are produced in a man’s testis and stored in an adjacent structure known as the epididymis. During sexual climax, the sperm move from the epididymis through a tube called the vas deferens and mix with other components of semen to form the fluid that is ejaculated (ejaculate). All vasectomy techniques involve cutting or otherwise blocking both the left and right vas deferens, so that the man’s ejaculate will no longer contain sperm, and he will not be able to make a woman pregnant.

How common is vasectomy?

Vasectomy is used as a means of contraception in many parts of the world. A total of about 50 million men have had a vasectomy—a number that corresponds to roughly 5 percent of all married couples of reproductive age. In comparison, about 15 percent of couples rely on female sterilization for birth control. Approximately half a million vasectomies are performed in the United States each year. About one out of six men over age 35 has been vasectomized. The prevalence of men undergoing the procedure increases with higher levels of education and income. Among married couples in the United States, only female sterilization and oral contraception are relied upon more often for family planning. How is vasectomy done? In the conventional approach, a physician makes one or two small incisions, or cuts, in the skin of the scrotum, which has been numbed with a local anesthetic. The vas is cut, and a small piece may be removed. Next, the doctor ties the cut ends and sews up the scrotal incision. The entire procedure is then repeated on the other side. A newer method, devised by a Chinese surgeon, has been widely used in China since 1974. This so-called nonsurgical or no- scalpel vasectomy was introduced into the United States in 1988, and many doctors are now using the technique worldwide. In a no-scalpel vasectomy, the doctor feels for the vas under the skin of the scrotum and holds it in place with a small clamp. A special instrument is then used to make a tiny puncture in the skin and stretch the opening so the vas can be cut and tied. This approach produces very little bleeding, and no stitches are needed to close the punctures, which heal quickly by themselves. The newer method also causes less pain and fewer complications than conventional vasectomy How does vasectomy compare with female sterilization? Regardless of how it is performed, vasectomy offers many advantages as a method of birth control. Like female sterilization, it is a highly effective one-time procedure that

provides permanent contraception. Vasectomy, however, is medically much simpler than female sterilization, has a lower incidence of complications, and is much less expensive. What happens after vasectomy? After vasectomy, the patient will probably feel sore for a few days, and he should rest for at least one day. However, he can expect to recover completely in less than a week. Many men have the procedure on a Friday and return to work on Monday. Although complications such as swelling, bruising, inflammation, and infection may occur, they are relatively uncommon and almost never serious. Nevertheless, men who develop these symptoms at any time should inform their physician. When can a man have sex again? A man can resume sexual activity within a few days after vasectomy, but precautions should be taken against pregnancy until a test shows that his semen is free of sperm. Generally, this test is performed after the patient has had 10-20 postvasectomy ejaculations. If sperm are still present in the semen, the patient is told to return later for a repeat test. What are the side effects of vasectomy? A major study of vasectomy side effects occurring within 8 to 10 years after the procedure was published in the British Medical Journal in 1992. Investigators questioned 10,590 vasectomized men, and an equal number of nonvasectomized men, to determine if they had developed any of 99 different disorders. After a total of 182,000 person-years of follow-up, only one condition, epididymitis/orchitis (defined as painful, swollen, and tender epididymis or testis)—was found to be more common after vasectomy. This local inflammation most often occurs during the first year after surgery. Treated with heat, the condition usually clears within a week. What are the disadvantages of vasectomy? The chief advantage of vasectomy—its permanence—is also its chief disadvantage. The procedure itself is simple, but reversing it is difficult, expensive, and often unsuccessful. Researchers are studying new methods of blocking the vas that may produce less tissue damage and scarring and might thus permit more successful reversal. But these methods are all experimental, and their effectiveness has not yet been confirmed. How about storing semen in a sperm bank? It is possible to store semen in a sperm bank to preserve the possibility of producing a pregnancy at some future date. However, doing this is costly, and the sperm in stored semen do not always remain able to cause pregnancy. When should the decision about vasectomy be made? For all of the foregoing reasons, doctors advise that vasectomy be undertaken only by

men who are prepared to accept the fact that they will no longer be able to father a child. The decision should be considered along with other contraceptive options and discussed with a professional counselor. Men who are married or in a serious relationship should also discuss the issue with their partners. Does vasectomy protect against HIV and other STDs? Although the procedure is extremely effective in preventing pregnancy, vasectomy does not offer any protection whatsoever against HIV/AIDS or any other sexually transmitted diseases (STDs). Consequently, it is important that vasectomized men continue to use condoms, preferably latex, which offer considerable protection against the spread of disease, in any sexual encounter that carries the risk of contracting or transmitting infection. How does vasectomy affect masculinity and sexuality? Not at all. Vasectomy has no effect on the production or release of testosterone, the male hormone responsible for a man’s sex drive, beard, deep voice, and other masculine traits. The operation also has no effect on sexuality. Erections, climaxes, and the amount of ejaculate remain the same. Occasionally, a man may experience sexual difficulties after vasectomy, but these almost always have an emotional basis and can usually be alleviated with counseling. More often, men who have undergone the procedure, and their partners, find that sex is more spontaneous and enjoyable once they are freed from concerns about contraception and accidental pregnancy. Are there immune reactions to sperm after vasectomy? After vasectomy, the testes continue to make sperm. When the sperm cells die, they are absorbed by the body, much like unused sperm in a nonvasectomized man. Nevertheless, many vasectomized men develop immune reactions to sperm, although current evidence indicates that these reactions do not cause any harm. Ordinarily, sperm do not come in contact with immune cells, so they do not elicit an immune response. But vasectomy breaches the barriers that separate immune cells from sperm, and many men develop anti-sperm antibodies after undergoing the procedure. This has given rise to concern on the part of doctors and researchers, because immune reactions against parts of one’s own body sometimes cause disease. (Rheumatoid arthritis, juvenile diabetes, and multiple sclerosis are some of the illnesses suspected or known to be caused by immune reactions of this type.) Immune reactions can also contribute to the development of atherosclerosis, the clogging of arteries that leads to heart attacks. In the late 1970s, after a study of 10 monkeys showed an increased risk of atherosclerosis in vasectomized animals, doctors became concerned that vasectomy might increase the risk of heart disease in men.

Other, more persuasive research results, however, indicated that these concerns were not warranted. Researchers have found no evidence that vasectomized men were more likely than others to develop heart disease or any other immune illnesses. The concerns about heart disease and immune ailments following vasectomy have therefore largely subsided. Is there an increased risk of prostate cancer after vasectomy? Just as concerns about heart disease and immune ailments following vasectomy were being overcome, worries about prostate cancer were taking their place. A number of studies showed no increase in cancer among vasectomized men, even though three separate hospital-based studies published in 1990 reported a positive correlation between vasectomy and prostate cancer. However, a well-regarded 1991 study found no such relationship. In October 1991, the World Health Organization (WHO) sponsored a meeting of experts from around the world to evaluate the available evidence regarding a link between vasectomy and prostate cancer. Because additional concerns had been raised about a possible association between vasectomy and testicular cancer, evidence for such an association was also weighed at the meeting. The assembled experts concluded that a causal relationship between vasectomy and cancer of either the prostate or testis was unlikely. Following the WHO meeting, two additional studies of vasectomized men found no increased risk of either prostate cancer or all cancers combined. Subsequently, a study conducted in three regions of the United States suggested that the subgroup of men who had a vasectomy before age 35 might have a slightly increased risk of developing prostate cancer. However, the size of this subgroup was not large enough to make the result conclusive. The study did not find any increased cancer risk in men who underwent vasectomy after age 35. In 1993, a noted team of Harvard epidemiologists published findings from two large studies in the Journal of the American Medical Association (JAMA). One of these studies was retrospective while the other was prospective and followed new patients. Both found vasectomy to be associated with a moderately elevated relative risk of prostate cancer that increased with time after the procedure. After more than 20 years, a vasectomized man appeared to be twice as likely to develop prostate cancer as a nonvasectomized man of the same age. Although this conclusion may seem startling, scientists generally consider risk findings of this magnitude to be of doubtful significance. Like others before them, these scientists also noted the lack of evidence for any biological mechanism that could link vasectomy with prostate cancer. In 1993, the National Institutes of Health (NIH) convened a meeting at which an expert panel considered published data, preliminary results from studies in progress, and an analysis of eight epidemiological studies, including the two reports mentioned above. The panelists concluded that the positive associations between vasectomy and prostate cancer found in some studies might or might not be valid. Scientists agreed, however, that if any increased risk is caused by vasectomy, it is relatively small.

WHO is currently conducting a major study of vasectomy and prostate cancer in several developing countries, and three other studies are ongoing in the United States and Canada. Scientists expect these investigations to help resolve the issue. In the interim, most physicians will be guided by NIH’s expert panel of 1993. What is the official view of vasectomy? The NIH expert panel concluded there is insufficient basis for recommending any change in current clinical or public health practice. Providers should continue to offer vasectomy and to perform the procedure, the panel said. Vasectomy reversal is not warranted to prevent prostate cancer, and screening for prostate cancer should not be any different for men who have had a vasectomy than for those who have not undergone the procedure. What is the sum total of the experience with vasectomy? Vasectomy has been used for about a century as a means of sterilization. It has a long track record as a safe and effective method of contraception and is relied upon by millions of people throughout the world. On the basis of much evidence, experts believe that vasectomy can safely continue to be used as it has been in the past, while further studies are carried out to ensure its safety.
Vasectomy At A Glance

Vasectomy is a simple procedure to induce infertility in the male. Vasectomy has a long track record as a safe and effective method of contraception. The procedure blocks the tube (the vas deferens) through which sperm pass. A vasectomy can be done even without a scalpel. Reversing a vasectomy is difficult, expensive, and often unsuccessful. Vasectomy offers no protection against HIV or any other sexually transmitted diseases. Vasectomized men can develop harmless immune reactions to sperm. There has been concern about a possible increase in prostate cancer among vasectomized men. This risk (if it exists) is relatively small.

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John R. Franklin, M.D., M.A - Board Certified Urologist John R. Franklin, M.D., M.A - Board Certified Urologist
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