Vasectomy- the most effective male contraceptive

Vasectomy is among the most reliable and cost-effective method of “permanent” male birth control. A decade ago, surgery involved removal of the entire vasa deferentia. However, today the surgery is refined and involves microscopic surgery which allows for reconnecting the vasa deferentia, if desired.

Today it is a very common method used for contraception by more than 10-15% of couples. In Some European countries, is has over taken oral contraceptives as a method for birth control. Today, Vasectomy is performed by a minute skin incision and involves cutting the tubes (vas deferens) that allow the sperm to migrate to the penis from the testes. The procedure is commonly performed all over North America, done within an hour and is associated with few complications. Unlike the past 50 years where only women took part in birth control, today vasectomy is increasingly being selected by the male partner as a form of permanent birth control.

Vasectomy should not be confused with castration as the testicles are not removed, nor are the hormonal levels affected. Thus the sexual desire, ability to have an erection and ejaculate are normal. The only thing vasectomy does is that it does not allow the sperm to exit through the penis. The residual sperm are broken down and ingested by the body’s own cells.

Close to half a million vasectomies are performed annually in the United States. A vasectomy is an option for males who want permanent sterility. Results show that vasectomy is an excellent form of contraception compared to the birth control pill, condoms, IUDs and other creams. A corollary of vasectomy in the female is tubal ligation- an easy procedure to perform but a lot harder to reverse.

Why Vasectomy?

Vasectomy may an alternative for a couple where the female is unable to take the oral contraceptive pill.  Before undertaking vasectomy, it is most important to discuss one complication: the failure rate of vasectomy as a contraceptive method. Pregnancy does occur after a vasectomy. However, in most cases this occurs because the couple starts to have intercourse before verifying that that there is no sperm in the ejaculate. The failure to comply with this simple process after surgery is the main cause of failure of contraception. For patients who have not decided on whether to have a family, vasectomy is not a recommended procedure.

Male Reproductive System

To understand how a vasectomy works, one has to understand the anatomy and function of the male reproductive system. The testicles (testes) produce sperm and the male hormone -testosterone. Each testis contains a thin tube, called the epididymis, where sperm can be stored for as long as 6 weeks while they mature. The epididymis is connected to the prostate gland by a pair of tubes called the vas deferens. The vas deferens is a complex collection of blood vessels, nerves, and lymphatic channels called the spermatic cord. During ejaculation, seminal fluid produced by the prostate gland, which mixes with sperm from the testes to form semen, which then is ejaculated from the penis.

Who is the best candidate for vasectomy?

Vasectomy is strictly an elective procedure. The procedure should never be done on a spontaneous whim without any prior knowledge or thought. Before undergoing the procedure, one has to speak to the spouse/partner. Vasectomy is almost always undertaken by married men. This form of contraception is definitely not recommended for the single male because reversibility is not guaranteed. And the final responsibility lies with the surgeon on counseling his patients.

The decision about vasectomy should be made with thought given to the fact the procedure is permanent and that having a family in future may be impossible. One has to seek the advice of a physician and the pros and cons about the procedure be discussed before making a hurried decision.

Vasectomy may be appropriate:

- If the couple already have children and definitely do not want any more

- If the couple does not have children, do not want any children and want permanent contraception

- If one prefers permanent contraception

- If one partner has a medical disorder that will not allow the use of any other form of contraception

- If you want to enjoy sex without the hassles of worrying about pregnancy

Vasectomy may not be an appropriate:

-  If the couple wants protection from sexually transmitted disease

- If one has an inguinal hernia or related disorder and needs to be repaired prior to undertaking a vasectomy

- Children, teenagers or single men without children

- If one feels pressured by the partner/physician

- If the marriage is close to breaking up

- If you feel that vasectomy is the key to solving all your problems

- If you are still undecided about children in future

- If you think that in future vasectomy may be reversible

- If you are unable to make up your mind

- If your partner is unsure about the procedure

 

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. There are many a man who have had vasectomy prematurely and go on to regret it. The regret is never about its efficacy as a contraceptive, but that it is a permanent procedure, which is very difficult to reverse.

Surgery

The surgery is done on an outpatient basis whereby the patient goes home the same day. The procedure is performed by a urologist and done under local anesthesia with some intravenous sedation. The procedure may be done in the doctor’s office or clinic. Prior to the procedure, the groin and scrotal area are cleansed with an antibiotic and sterile drapes are placed around the area. A small amount of local anesthetic in injected and the vas deferens is identified after making a small 1 cm incision. The vas deferens is cut and clipped at both ends, and placed back in the scrotum. The incision is closed and the same procedure is done on the other side of the scrotum. Some surgeons may cauterize (heat) the ends of the vas deferens. This heating of the vas deferens almost always makes reversible impossible in future. After surgery, the patient is discharged home with a scrotal support.

No-scalpel Vasectomy

Recently no scalpel vasectomy has come into vogue. It basically means no incision is made with a knife. In this procedure, the vas deferens is identified from a small puncture hole in the scrotum and the vas is identified and picked up with special instruments. Through this small button hole, the vas deferens is divided (or cauterized) and placed back in the scrotum. The puncture wound in the scrotum does not require any sutures, except for a small dressing. Some surgeons recommend the no-scalpel method because it is quicker and lessens discomfort after surgery. The procedure also decreases the risk for bleeding and infection. The procedure is fast catching on with many urologists.

Vasclip

Dividing the vas deferens always complicates the reversal if one is required. With advances in technology, microclips have been used to block sperm transfer across the vas deferens. Reversal from the Vasclip is much easier than if the vas deferens was divided. The Vasclip procedure may be done either with a no scalpel technique or via an incision.

Results reveal that when the vas is not divided, the time to recovery is short and there are fewer complications. Results of reversibility after Vasclip indicate that reversal is a lot easier than after surgical division of the vas. However, the procedure should be considered permanent.

Post surgery

A few days rest is all that is required after surgery. A groin support should be worn until the healing is complete and strenuous exercise should be avoided for a few weeks. Pain is minimal and easily controlled with Tylenol or ice packs. Sexual intercourse is refrained for a week or so.

When does vasectomy work?

Vasectomy does produce sterility immediately after the procedure. There are always some viable sperm present in the vas deferens for at least 1-2 weeks and can be ejaculated. Thus, it is highly recommended that after a vasectomy one should have the ejaculate analyzed twice to ensure that no viable sperm are present. This ejaculate collection is generally done at 1 and 4 weeks after the procedure. When no sperm are seen, the man is sterile. During this 4 week period, it is recommended that some other type of sexual protection be undertaken for birth control. The majority of failures of vasectomy as a birth control measure occur during this time period.

Complications

Serious complications after vasectomy are rare. Pain, bleeding and some redness at the incision site may occur in a few individuals. Rarely, sperm remain in the vas may build up and may require removal. However, the majority of these collections disappear with time.

Vasectomy does not cause prostate cancer. Nevertheless, as a precaution, the American Urological Association (AUA) recommends that men over 40 who had a vasectomy for more than 20 years previously should have a yearly test for prostate cancer. Today, vasectomy is a safe procedure. Thousands of men have had this procedure and go on to lead healthy normal lives

Will vasectomy affect my libido?

Vasectomy has no affect on the male hormones. There is no change in libido, desire or the ability to make love. Both erections and orgasms remain the same. Infact, most couples report more spontaneity in their love making and devoting less time to worrying about pregnancy.

Does vasectomy protect against sexually transmitted disease?

Unfortunately, vasectomy does not protect against sexually acquired infections. For those who engage in high risk sexual behavior and have multiple sex partners, use of condoms is highly encouraged. For those who want no children, no disease and no surgery abstinence is the way to go.

Reversal of vasectomy

There are some surgeons who specialize in reversal of vasectomies. With some difficulty, it is possible to reconstruct the vas deferens and restore sperm flow. Several microscopic procedures have been developed. The success rate varies depending on whom one talks to. The surgeons (remember they get paid) all claim a high success in reversing the procedure. However, not all patients agree to what the doctors say. At best, only 30-50% of individuals are able to have their vasectomies reversed

For those desperate couples still desiring children, needle aspiration, is another technique of obtaining sperm after vasectomy. This is done usually when the surgical reconstruction of the vas deferens fails. Sperm which are collected in the testis are obtained via a needle. The procedure is done in the doctors’ office. The technique is still in its infancy and collection of viable sperm is difficult and time consuming. Repeated treatments are usually required. The collected sperm are then used with a variety of in vitro fertility techniques such as artificial insemination.

Which gender should undergo sterilization?

The choice between vasectomy and tubal ligated is often discussed with the doctor and ultimately it depends on the partners involved. Both procedures have low risks, are quite effective and both can be reversed in most cases. The majority of individuals who have had complications from either surgery have been related more to the anesthesia than the actual procedure itself. Ultimately, the choice between the two procedure and which couples undergoes it, is determined by the couple themselves.

Conclusion

Over the last decade, vasectomy has been shown to be an effective form of contraception. The chief advantage of vasectomy--its permanence--is also its main disadvantage. The procedure is simple, but reversing it is difficult, very expensive, and often unsuccessful. It is estimated that pregnancy does occur after about 1 in 2,000 vasectomies. Although there is a surgery to reverse vasectomy, the procedure fails in about 60% of cases.

Physicians 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. In the meantime, any man who chooses to have a vasectomy should consider it irreversible.