Vasectomy And Family Planning

Vasectomy is, at the moment, the only reliable method of male sterilization. The operation has gained popularity since the 1950s, not least because it is simpler and safer than female sterilization (this was especially true when female sterilization was still a major operation).

Method

Vasectomy involves blocking or severing the two vas deferens, the tubes which transport the sperm inside the man’s scrotum. The operation is a very straightforward surgical procedure, and is done under local anaesthetic. All the hairs on the scrotum and penis are cut very short, and the area is washed thoroughly. Two small incisions are made in the scrotum, one at each side. Through each incision the vas on that side is drawn and cut and tied; for extra surety the cut ends can be electrocoagulated. The vas is replaced and the incision is stitched with an absorbable suture. Recovery generally takes fifteen to thirty minutes, and then the patient can go home.

If you are planning a vasectomy, arrange for a friend or your wife to be available to drive you home; this helps to decrease complications. Plan to rest for forty-eight hours after the operation; if you put an ice pack on the scrotum for about four hours after the operation, this will reduce any swelling, bleeding or discomfort. Aspirin should be powerful enough to deal with any pain experienced. Avoid strenuous physical exercise for a week, and wear a scrotal support if it gives you extra comfort. Do not shower or bathe for forty-eight hours, and do not have sex for two to three days. After forty-eight hours, plain warm baths several times a day are ideal. The clinic should arrange for a check-up several weeks after the operation, and this should always be attended.

After a vasectomy you will still ejaculate normally, as sperm form only a small proportion of the seminal fluid. However, you will not immediately be sterile. Estimates vary as to just how long it takes to flush out any sperm that remain in the system; certainly a minimum of ten ejaculations, and some clinics say twenty. They will ask you to go back with a sample of ejaculate so that they can check whether the operation has been successful; again, clinics vary as to how many sperm-free samples they require before they feel that the man is fully sterile. Effectiveness after this point is over ninety-nine per cent.

Complications

At the moment there does not seem to be any major longterm complication of vasectomy other than very rare serious infections. The mortality rate is roughly 1 death in 100,000 operations, even under undesirable conditions (e.g. primitive clinics in developing countries). All complications together total only three per cent of patients, and are generally very minor such as swelling, discoloration and discomfort. Danger signs to be watched for after vasectomy are: fever (over 100.4°F), bleeding from the site of the incision, and excessive pain or swelling.

One controversial topic concerns sperm antibodies. Many men (between one and two-thirds of all vasectomy patients) form high levels of antibodies to their own sperm after the operation. These are formed as a reaction to the body’s breakdown of sperm which are not released as normal because the vasectomy has blocked their path. In monkeys, high levels of sperm antibodies have been found to accelerate atherosclerosis, which can lead to disease of the circulatory system. However, five studies on humans have failed to find a similar connection. Some doctors do err on the side of caution and suggest that men with a high-risk history of cardiovascular disease should delay vasectomy until further studies are completed. Many other doctors feel that this is over-cautious.

There are a few other, though rare, contraindications for vasectomy. These include genital or scrotal infection, bleeding disorders, or being on anticoagulant therapy. Some conditions such as variocele, hydrocele, scrotal hernia, or present or past undescended testis may require treatment as a hospital inpatient, under general anaesthetic. Also some psychosexual conditions may be considered as contraindications.

Reversibility

Of course the ideal vasectomy operation is one that can be fully reversed when wished, but this is still a thing of the future, although much research is being done into the problem. Some practitioners prefer to clip the vas deferens rather than cutting it, in the hope that the clip can be successfully removed later, but this is not such an effective method of sterilization meanwhile. Actual success rates of reversal operations vary from eighteen to sixty per cent of selected patients — some patients may not even be suitable for selection for a possible reversal operation. Success is linked to the surgical procedure that was originally used, the length of the vas removed, the site of the incision, whether or not the cut ends of the vas were coagulated, what type of suture was used, and how long ago the operation was performed.

Even among those men whose ejaculate contains sperm after a reversal attempt their success in actually fathering a child is only fifty to seventy per cent: and this may take many months. Theoretically it should be possible to develop a clip, plug or valve which can be removed or reversed when desired, but the practical problems to be surmounted are vast. Therefore a vasectomy should always be considered as permanent if the operation is chosen; a man who goes into it in the belief that it can be reversed if he changes his mind is very likely to be disappointed.

Conclusions

Vasectomy is a very safe and simple method of contraception. It is extremely effective in preventing conception, and is an excellent option for a healthy husband who, with his wife, is quite sure that he never wishes to have any more children. The operation should not be considered reversible, and so the couple should receive detailed counselling and be very sure that this is the option they want before the operation is done. Vasectomy gives the husband a chance to take full responsibility for contraception, which can be a

boon when this has previously tended to be the lot of the wife. Vasectomy can be done under the NHS, or privately if you prefer or if there is a long NHS waiting list.