Weighing the Pros and Cons of Vasectomy
When it comes to vasectomy, the most important decision a man will make is not how it will be done—it's a safe, relatively painless, and straightforward procedure—but why it should be done. The choice may seem uncomplicated, but it's tied to ego and lifestyle, perceptions, and values. One thing, though, is clear: If you have a vasectomy, say doctors, you'll probably never father another child, no matter what those highway billboards and newspaper ads may say about vasectomy reversal.
After John's wife gave birth to his third child, John did not run out to buy diapers or open a mutual fund for his new offspring's college education. Instead, he called his doctor and scheduled his own trip to the hospital. John, a Dallas newspaperman, figured that his wife had done her job. Now it was time for him to do his.
Making the Decision
John (not his real name) is one of the half million American men who get a vasectomy every year. Most are like John—men in their late thirties or early forties who have fathered all of the children they intend to father. But a significant minority, say doctors, are men in their twenties who haven't yet had children and have decided they don't want to.
"Those are the people that we try to talk out of vasectomy," says Peter Nieh, MD, a urologist at the Lahey-Hitchcock Medical Center in Burlington, Massachusetts. "The thing we stress is that vasectomy is a permanent form of birth control, no matter what you hear about vasectomy reversal. Just because you think you don't want children now doesn't mean you'll think that way later."
In fact, making the decision for the best reasons is the most difficult part about undergoing a vasectomy. As medical procedures go, it's relatively uncomplicated. Literally, the procedure is just a cut, a snip, and a twist that can take as little as 20 minutes in your doctor's office. Vasectomy is more than 99% effective, and in almost every case leaves you functioning as well sexually as you did before.
What isn't as simple is deciding why you should have a vasectomy, says Michael Warren, MD, the chief of the division of urology at the University of Texas-Galveston Medical Branch. There are almost no medical reasons (save for a tiny number of men who have a chronic infection of the testicles) why a man should have a vasectomy. Contrast this with the plight of many middle-aged women who must undergo a hysterectomy for a variety of health concerns and who must undergo a more complicated and riskier surgery in which their fallopian tubes are tied.
What Happens During a Vasectomy?
Sperm are the reproductive cells in men and are formed in the seminiferous tubules of the testes. During sexual climax, sperm emerge from the testes through two narrow tubes called the vas deferens and mix with semen to form ejaculate. The purpose of vasectomy is to cut and tie the vas deferens, so that sperm cannot get through. Instead, the sperm are harmlessly absorbed by the body. You will still ejaculate semen (and it will still feel the same) during a post-vasectomy orgasm. It just won't be fertile.
In a conventional vasectomy, local anesthetic is injected and an incision made on each side of the scrotum, which is the sac containing the testes. Each of the two vas deferens tubes is cut and tied off. It is a very simple, 15-20 minute procedure. No-scalpel vasectomy, in which a special tool is used to make an opening in the scrotum instead of a scalpel incision, is even simpler. You will most likely be awake throughout either procedure.
Have a vasectomy on a Friday, and you'll be back at work on Monday to endure the odd wisecrack from your colleagues (which is what happened to John). The only catch is that there will probably still be some sperm present in your ejaculate for a couple of months after the operation, so you'll be asked to have two sperm counts done after approximately 20 to 25 ejaculations. Use some form of birth control until these two semen analyses have shown that all is clear.
How About Recovery Time?
Swelling, bruising, and pain are the most common complaints immediately after the procedure. However these usually subside quickly and respond well to ice packs, mild pain relievers, scrotal support, and rest. Don't plan on doing any heavy work or physical activity for at least 72 hours after surgery.
You should note no change in your libido or sex drive, because vasectomy prevents only the escape of sperm, not the release of testosterone, which drives your libido.
Is It Safe?
In the l970s, studies on vasectomized animals showed an increase in hardening of the arteries, which is a precursor to heart disease. Researchers speculated that sperm antibodies, produced by many men following vasectomy, could be responsible for this increased risk. However, a multimillion dollar program of research since that time reveals that there do not appear to be any increased health risks in men who undergo vasectomy. As a matter of fact, there is some evidence showing that vasectomized men had 1/3 fewer deaths from all causes, with the exception of accidents and violence.
Can the Surgery Be Reversed?
All vasectomies should be considered permanent. A reverse vasectomy is a risky and expensive proposition, with no better than a 50% chance of success. The very effectiveness of a vasectomy makes the reversal that much chancier. Once the doctor snips the vas deferens in two and ties the ends off (or coagulates them with electrical current from a battery-operated device that resembles a soldering iron), they tend to stay apart, reversal or not.
In a reversal, the doctor must untie the vas deferens (or cut them apart if they have been coagulated) and stitch them back together. This is a tedious, laborious, and time-consuming process that can take as long as four hours and cost up to 10 times as much as a vasectomy. Most importantly, there is no guarantee it will work. The reconnected vas deferens, say doctors, may not stay together or may not remain sperm-tight.
Says Dr. Warren, "Perhaps if men knew how difficult a reverse vasectomy was and how often it didn't work, they'd think twice about getting a vasectomy."
For John, the only pain in his decision were the cracks from his colleagues and a soreness in his groin for a couple of days. He doesn't have any regrets. "Sometimes," he says, "a man's got to do what a man's got to do."
Planned Parenthood Federation of America
Men's Health Centre
Barone, MA, Nazerali, H, Cortes, M, et al. A prospective study of time and number of ejaculations to azoospermia after vasectomy by ligation and excision. J Urol. 2003;170:892.
Hendry, WF. Vasectomy and vasectomy reversal. Br J Urol. 1994;73:337.
The patient's guide to vasectomy reversal. Columbia Presbyterian Medical Center website. Available at: http://cpmcnet.columbia.edu/dept/urology/infertility/vasectomy/vasr0000.html. Accessed November 13, 2007.
Schwingl PJ, Guess HA. Safety and effectiveness of vasectomy. Fertil Steril. 2000;73:923.
Last reviewed November 2007 by Marcin Chwistek, MD
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