Vasectomy

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 post-
vasectomy 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.