What is a vasectomy?

A vasectomy is simply a minor operation which makes a man sterile. It works by preventing his sperm from entering the fluid he normally ejaculates during intercourse and ensuring, in-stead, that they are reabsorbed into the body. It’s important to emphasize that a vasectomy doesn’t alter a man’s sexual performance in any way nor does it appreciably alter the quantity or appea-rance of the seminal fluid.

Male sterilization through vasectomy is achieved by cutting or blocking the two vasa, the thick-walled tubes about 4 mm in diameter that take the sperm from the testicles to the urethra, the tube running through the penis. You can see from the diagram that these tubes run close to the surface sicin on each side of the scrotum, so they can be easily reached through one or two small incisions made in the scrotum just below the base of the penis. Either a single incision is made in the middle of the scrotal sac, or one is made on each side. The tubes are cut, a short section is removed, and the ends are usually tied with absorbable thread.

A variety of techniques may be used to try to prevent the cut ends of the from rejoining: sometimes one end is doubled over and tied. Alternatively, the ends may be cauterized, or else sealed electrically or chemically. Metal clips, also, are occasionally used. The skin is then sewn up with material that can be absorbed by the body and does not need to be removed.

The whole operation takes about 10 minutes and a man can usually go home after a short rest. Healthy men rarely need to stay in hospital overnight, either before or after the operation.

However, this may be necessary if a man has had a previous operation or problem in this region -a hernia, for example – since the vasectomy may be a litde more difficult to perform.

Local anaesthetic is normally all that is neces-sary for a vasectomy although some men and doctors prefer general anaesthetic. Out-patient operations are still possible with either type of anaesthetic, but recovery from general anaesthetic obviously takes a few hours longer.

It is advisable for the patient to go straight home and rest for the remainder of the day, and to take things easy for the next day or two. Vasectomies are often arranged at or just before the weekend so that it’s not usually necessary to take time off work (although only strenuous work is likely to cause problems).

There is no guarantee that the operation is reversible so a man must make his decision on the basis that he can never have any more children. Naturally this is a very big step to take, and it’s vital that he and his partner give the matter a great deal of serious consideration before making up their minds. Doctors have no hard and fast rules about those they recommend for vasectomy, but they are especially cautious when the couple is under 30 years old, if they have very young children, or if their relationship seems to be unstable.

Of course, a man chooses vasectomy so that he and his partner need no longer worry about contraception or the possibility of pregnancy, but before going through with it he must first of all ask himself three vital questions: ? If one of my existing children died, might I want to have another child? ? Is there any chance my marriage or partnership might break up, and might I then want to have children with another woman? ? Am I being pushed into vasectomy by my wife when I’m still not absolutely certain in my own mind that I want to be sterilized? Vasectomy must be seen as a final and irrever-sible step, so it’s certainly not one to be taken lightly. However, if the answer to these three questions is a definite and both you and your partner are quite sure you don’t want to have any more children (or even that you don’t want to have any children) sterilization has many advantages over other types of contraception.

The contraceptive Pill is now felt to pose a greater health risk at just the age when most women are likely to have completed their families, which makes this, the most effective contraceptive method, inadvisable. Many women are also reluctant to have intra-uterine devices (IUDs) inserted because of the possible problems asso-ciated with them. Furthermore, they are under-standably reluctant about coping with the heavier, longer periods that IUDs often cause. The only male method of contraception, the sheath, like the cap or diaphragm, is not totally reliable, and can sometimes lessen or spoil sexual pleasure.

If a man has a vasectomy, neither he nor his partner have to bother with any type of contra-ception and the woman can allow her menstrual cycle to carry on naturally- possibly an advantage through the menopausal years.

Perhaps the single biggest advantage of vasec-tomy is that the couple can make love as often or as spontaneously as they like without the fear or possibility of pregnancy.

The amount of time it takes to clear these sperm depends on the frequency of intercourse or masturbation and also on your age, but it usually takes at least three or four months. So during this time it’s important to continue to use some other method of contraception. About three months after the operation you will be asked to supply an initial sample of semen for a sperm test. A few weeks later you’ll be asked to provide a further sample for testing. If both tests are clear you will no longer need to use any other form of contraception. However, if the semen is still not free of sperm you’ll be given further tests every few weeks until it is certain that all the stored sperm have been ejaculated.

If sperm continue to be present, another operation may be carried out to make sure the original operation did, in fact, block the tubes.

Once his semen is found to be free of sperm, the chances of a man making his wife pregnant are very remote. However, if what appear to be symptoms of pregnancy occur in the partner of a man who has had a vasectomy, they certainly shouldn’t be ignored. For it is a fact that vasectomy fails in about one in 300 men.

When this happens, the sperm fail to be prevented from passing through the penis during intercourse, and so may cause an unwanted pregnancy. In the majority of cases, this is ecause the two sealed ends of one of the tubes have rejoined. Indeed, the human body’s amazing self-repair mechanism occasionally manages to overcome the drastic surgical intervention of a vasectomy to such an extent that the tubes are found to have regrown, and joined up again over a gap of several millimetres.

In a few very rare cases, failure to prevent sperm reaching the penis can also be due to the presence of an extra vas or tube, which was not spotted by the surgeon at the time when the first operation was carried out.

Lastly, if the ends of the tubes are not sealed off, it is just possible for sperm, despite all odds, to find their way into the seminal fluid. But this occurs in only a few cases.

The amount of pain or discomfort men feel after a vasectomy varies enormously, lasting from a few hours to several days, but long-term side effects are extremely rare. Sexual intercourse can be resumed almost immediately, but a man may experience some discomfort at first due to tenderness and soreness.

It’s a fact that every operation, however simple, carries with it some risk. However, serious complications following vasectomy are unusual. About one in a 100 men can expect to have some kind of minor complication, but these can usually be dealt with quite easily. The most common problem is infection, but this can be quickly cleared up with antibiotics. Internal bleeding in the scrotum because of damage to blood vessels can occasionally result in a painful swelling. The pain may be quite severe for a few days and can take weeks to subside completely. In a few cases, a further operation may be necessary.

Although there is no physical reason for a man’s feeling of masculinity to change in any way, his emotional attitudes do sometimes alter after vasectomy. In most cases, if he has understood exacdy what the operation entails and has discussed the matter thoroughly with his partner and his doctor beforehand, such problems don’t arise. Sometimes however, it’s not until after vasectomy has taken place that the man realizes that being fertile – capable of making a woman pregnant- is essential to his view of himself as a complete man. Mentally, he no longer feels truly masculine, and consequendy his sexual performance and general attitude to life may suffer. This kind of problem is particularly likely if the man feels he was pushed into having a vasectomy by his wife. However, you can be reassured that such feelings are unusual, and normally become obvious long before the operation takes place.

A vasectomy operation can sometimes be reversed but the success rate is not high, and can never be guaranteed. No man shoula ever have a vasectomy thinking at the back of his mind that it can be reversed if necessary. This simply is not true, and it would be foolish to think otherwise.

Reversal operations take up to three hours of complicated surgery to perform and require much longer incisions than the original vasectomy. Several nights in hospital are necessary. The surgeon attempts to sew together the edges of the cut, tied or blocked ends of the tubes, leaving a clear passage through which the sperm may once again travel. This is an exceptionally difficult and delicate procedure, requiring considerable skill on the part of the surgeon. Indeed an operating microscope often has to be used.

Unfortunately, even though successful re-connection of the tubes may be possible in a fairly high proportion of men, this does not always guarantee renewed fertility. The longer a man has been sterilized the smaller are his chances of impregnating his partner because his body will begin to produce large amounts of sperm antibodies.

It’s quite natural for all men to have insignifi-cant amounts of sperm antibodies. No one yet knows why or how the male body produces them. Yet once a man has had a vasectomy his body then begins to produce these antibodies at a much faster rate than usual, and their build up, say, after five years and certainly after 10 years, will mean that the ratio of sperm antibodies to sperm is sufficiently high to make his chances of fathering a child very small. Older men, whose bodies produce low amounts of sperm, will have even smaller chances of becoming fathers since their ratio of sperm antibodies to sperm will be higher. Less than 50 per cent of reversal operations actually restore a man’s fertility by ensuring a high enough number of sperm in his ejaculate. The operating difficulties, combined with the expense of a long operation and the low chance of success, make doctors reluctant to attempt reversals except in exceptional circumstances.