vasectomy

Vasectomy
Background
B.C. type	Sterilization
First use	1897 (experiments from 1785)^[1]
Failure rates (first year)
Perfect use	<0.1%
Typical use	0.15%
Usage
Duration effect	Permanent
Reversibility	Often, but not always
User reminders	Additional methods required until 2 negative semen samples. Almost all failures are due to disregarding this instruction.
Clinic review	None
Advantages and Disadvantages
STD protection	No
Benefits	Local anesthetic to the scrotum and vasa deferentia by needle or jet injection, as opposed to general anesthesia usually needed for female sterilization.
Risks	Risk of chronic pain, incidence and severity is widely debated.

Vasectomy is a permanent birth control method for men in which the vasa deferentia are cut, thus sterilizing the patient. There are some variations on the procedure such as no-scalpel (keyhole) vasectomies, ^[2] in which a surgical hook, rather than a scalpel, is used to enter the scrotum.

Vasectomy should not be confused with castration: vasectomy does not involve removal of the testicles and it does not affect either the production of male sex hormones (mainly testosterone) or their secretion into the bloodstream, therefore sexual desire (libido) is unaffected. The ability to have an erection and an orgasm with an ejaculation do not seem to be affected unless one suffers from post-vasectomy pain. Because the sperm-filled fluid from the testes makes up only about 10% of an ejaculation, vasectomy does not seem to significantly affect the volume, appearance, texture or taste of the ejaculate.

When the vasectomy is complete, sperm can no longer exit the body through the penis. They are broken down and absorbed by the body. Much fluid content is absorbed by membranes in the epididymis, and much solid content is broken down by macrophages and re-absorbed via the blood stream. Sperm is matured in the epididymis for about a month once it leaves the testicles, and approximately 50% of the sperm produced never make it to ejaculation in a non-vasectomized man. After vasectomy, the membranes increase in size to absorb more fluid, and more macrophages are recruited to break down and re-absorb more of the solid content. The fraction of sperms that exceed the digestive capabilities of macrophages exit into the scrotum as sperm granulomas.

Effectiveness

Early failure rates, i.e. pregnancy within a few months after vasectomy, are below 1%, but the effectiveness of the operation and rates of complications vary with the level of experience of the surgeon performing the operation and the surgical technique used.

Although late failure, i.e. pregnancy after recanalization of the vasa deferentia, is very rare, it has been documented.^[3]

Popularity

How popular vasectomy is as a birth control method varies by age and nationality. Men in their mid 30s to mid 40s are most likely to have a vasectomy.

Compared to tubal ligations

The rate of vasectomies to tubal ligations worldwide is extremely variable, and the statistics are mostly based on questionnaire studies rather than actual counts of procedures performed. In the U.S. in 2005, the CDC published state by state details of birth control usage by method and age group.^[4] Overall, tubal ligation is ahead of vasectomy but not by a large factor. In Britain vasectomy is more popular than tubal ligation, though this statistic may be as a result of the data-gathering methodology. Couples who opt for tubal ligation do so for a number of reasons, including:

Convenience of coupling the procedure with delivery at a hospital
Fear of side effects in the man
Fear of surgery in the man

Couples who choose vasectomy are motivated by, among other factors:^[5]

The lower cost of vasectomy
The simplicity of the surgical procedure
The lower mortality of vasectomy
Fear of surgery in the woman

Complications

Short-term complications include temporary bruising and bleeding, known as hematoma. The primary long-term complication is a permanent feeling of pain - chronic post-vasectomy Pain.

Animal and human data indicate that vasectomy does not increase atherosclerosis and that increases in circulating immune complexes after vasectomy are transient. Furthermore, the weight of the evidence regarding prostate and testicular cancer suggests that men with vasectomy are not at increased risk of these cancers.^[6]

Post-Vasectomy Pain Syndrome

Post-Vasectomy Pain Syndrome (PVPS), genital pain of varying intensity that may last for a lifetime, is estimated to appear in between 5% and 33% of vasectomized men, depending on the severity of pain that qualifies for the particular study^[7] ^[8] ^[9] ^[10] ^[11] In one study, vasectomy reversal was found to be 69% effective for reducing the symptoms of chronic post-vasectomy pain. Treatment options for 31% of patients whose pain did not respond to vasectomy reversal were limited. The study was very small, only evaluating 13 patients, and it was performed only once, making it difficult to draw solid conclusions. ^[12] In severe cases orchiectomy has been resorted to. ^[13]

Possible Vasectomy-Dementia Link

Researchers reported in February 2007 that a survey of a small number of men with a rare form of dementia found that more than twice as many as would be expected had undergone vasectomies. The study has not yet been verified by other researchers, and the authors say larger studies are needed to better understand the issue.^[14]

Reversal

Although men considering vasectomies should not think of them as reversible, and most men and their spouses are satisfied with the operation, ^[15]^[16]^[17] there is a procedure to reverse vasectomies using vasovasostomy (a form of microsurgery). It is, however, effective at achieving pregnancy in only 50%-70% of cases, and it is very costly, with total out-of-pocket costs in the United States ranging from $7,000 ^[18] to more than $35,000. The rate of pregnancy depends on such factors as the method used for the vasectomy and the length of time that has passed since the vasectomy was performed. The reversal procedures are frequently impermanent, with occlusion of the vas recurring two or more years after the operation. Sperm counts are rarely at pre-vasectomy levels. There is evidence that men who have had a vasectomy may produce more abnormal sperm, which would explain why even a mechanically successful reversal does not always restore fertility.^[19]^[20]

In order to allow a possibility of reproduction (via artificial insemination) after vasectomy, some men opt for cryostorage of sperm before sterilization, and some experts advise that this be done before vasectomy.^[21].

Various reversible male contraceptives are in research and development, but none are available. Many of these involve the implantation of micro-valves^{[citation needed]}.

Availability

In the UK vasectomy is often available free of charge through the National Health Service upon referral by one's GP. However, some PCTs do not fund the procedure. There are private clinics (such as Marie Stopes International) who perform the operation with short waiting times.

References

^ Paul Popenoe (1934). "The Progress of Eugenic Sterilization". Journal of Heredity 25:1: 19.
^ "No-scalpel vasectomies by skilled surgeons may speed recovery", EurekaAert, April 18 2007. Retrieved on 2007-04-18.
^ Philp, T; Guillebaud et al (1984). "Late failure of vasectomy after two documented analyses showing azoospermic semen". British Medical Journal (Clinical Research Ed.) 289 (6437): 77–79. PMID 6428685.
^ Bensyl, D.M. and Iuliano, D. and Carter, M. and Santelli, J. and Gilbert, B.C. (November 2005). "Contraceptive Use — United States and Territories, Behavioral Risk Factor Surveillance System, 2002". Morbidity and Mortality Weekly Report 54 (SS06): 1-72. Retrieved on 2006-5-5.
^ William R. Finger (Spring 1998). "Attracting Men to Vasectomy". Network 18 (3). Retrieved on 2006-5-5.
^ Pamela J. Schwingl, Ph.D., and Harry A. Guess, M.D. (2000). "Safety and effectiveness of vasectomy". Fertility and Sterility 73 (5): 923–936.
^ Ahmed I, Rasheed S, White C, Shaikh N. "The incidence of post-vasectomy chronic testicular pain and the role of nerve stripping (denervation) of the spermatic cord in its management." British Journal of Urology. 1997; 79:269-270. PMID 9052481
^ Choe J, Kirkemo A. "Questionnaire-based outcomes study of nononcological post-vasectomy complications." The Journal of Urology. 1996; 155:1284-1286. PMID 8632554
^ McMahon A, Buckley J, Taylor A, Lloyd S, Deane R, Kirk D. "Chronic testicular pain following vasectomy." British Journal of Urology. 1992;69:188-191. PMID 1537032
^ Leslie TA, Illing RO, Cranston DW, Guillebaud J. "The incidence of chronic scrotal pain after vasectomy: a prospective audit." BJU International. 2007. PMID 17850378
^ Bowins B. Vasectomy, the cruelest cut of all: the modern medical nightmare of post-vasectomy pain syndrome. Infinity. 2006. ISBN 0741430991
^ JK Nangia, JL Myles and AJ JR Thomas (December 2000). "Vasectomy reversal for the post-vasectomy pain syndrome: a clinical and histological evaluation.". Journal of Urology 164 (6): 1939-1942. DOI:10.1016/S0022-5347(05)66923-6. PMID 11061886. Retrieved on 16 May 2007.
^ Granitsiotis P, Kirk D. "Chronic testicular pain: an overview." European Urology. 2005;47(5)720. PMID 15041105
^ Salynn Boyles (February 2007). "Study Suggests Vasectomy-Dementia Link". WebMD Medical News.
^ Turek P, "Minimally Invasive Reproductive Urology: The No-Scalpel Vasectomy." University of California-San Francisco. http://urology.ucsf.edu/patientGuides/pdf/maleInf/Vasectomy.pdf
^ Evelyn Landry and Victoria Ward (1997). "Perspectives from Couples on the Vasectomy Decision: A Six-Country Study". Reproductive Health Matters (special issue): 58–67.
^ Denise J. Jamieson et al (2002). "A Comparison of Women’s Regret After Vasectomy Versus Tubal Sterilization". Obstetrics & Gynecology 99 (6): 1073–1079. PMID 12052602.
^ Vasectomy Reversal Cost and Payment Plans http://www.vasectomyinfo.com/vasectomy_reversal_costs.html
^ Nares Sukcharoen, Jiraporn Ngeamvijawat, Tippawan Sithipravej and Sakchai Promviengchai (May 2003). "High Sex Chromosome Aneuploidy and Diploidy Rate of Epididymal Spermatozoa in Obstructive Azoospermic Men". Journal of Assisted Reproduction and Genetics 20 (5): 196 - 203. DOI:10.1023/A:1023674110940. Retrieved on 18 July 2006.
^ Vicente Abdelmassih, Jose P. Balmaceda, Jan Tesarik, Roger Abdelmassih and Zsolt P. Nagy (March 2002). "Relationship between time period after vasectomy and the reproductive capacity of sperm obtained by epididymal aspiration". Human Reproduction 17 (3): 736-740. PMID 11870128. Retrieved on 18 July 2006.
^ "Men advised to freeze sperm before vasectomy", Reuters.com, Reuters news agency, Wed Jun 21, 2006. Retrieved on 18 July 2006.

External links

Birth control
Behavioral:	Avoiding vaginal intercourse: Anal sex, Oral sex, Non-penetrative sex, Masturbation, Abstinence Including vaginal intercourse: Fertility awareness, Rhythm Method, Withdrawal, Breastfeeding infertility
Barrier:	Condom, Female condom, Diaphragm, Lea's shield, Cervical cap
Spermicide	Contraceptive sponge
Hormonal:	Combined: Combined oral contraceptive pill ('the Pill'), Contraceptive patch, NuvaRing Progestogen only: Progestogen only pill ('minipill'), Depo-Provera, Norplant/Jadelle, Implanon
Anti-estrogen:	Ormeloxifene (a.k.a. Centchroman)
Intra-uterine:	IUD (copper or progestogen), IUS (progestogen)
Post-intercourse:	Contraception: Emergency contraception (pills or copper IUD) Abortion: Surgical abortion, Medical abortion (RU-486/abortion pill)
Sterilization:	Male: Vasectomy Female: Tubal ligation, Essure