Vasectomy

What is a Vasectomy?

Vasectomy is a minor surgical procedure wherein the vasa deferentia of a man are severed, and then tied/sealed in a manner such to prevent sperm from entering the seminal stream (ejaculate).

Usually done in an outpatient setting, a traditional vasectomy involves numbing (local anesthetic) of the scrotum after which 1 (or 2) small incisions are made, allowing a surgeon to gain access to the vas deferens. The "tubes" are cut and sealed by tying, stitching, cauterization (burning), or otherwise clamped to prevent sperm from entering the seminal stream.

Variations of the procedure currently in practice may reduce recovery time, while mitigating post-surgery pain (and/or pain syndrome(s)).

The No-Scalpel method (coined Key-Hole), in which a sharp hemostat, rather than a scalpel, is used to puncture the scrotum may reduce healing times as well as lowering the chance of infection (incision).

An "open-ended" vasectomy obstructs (seals) only one end of the vas deferens, which allows continued streaming of sperm (by virtue of the un-sealed vas-deferens) into the scrotum. This method may avoid build-up of pressure in the epididymis. Testicular pain (from "backup pressure") may also be reduced using this method.

The "Vas-Clip" method does not require cutting the Vas Deferens, but rather uses a clip to squeeze shut the flow of sperm. This method may facilitate a better chance/outlook for reversal, as well as reduced pain (post-procedure). That said, statistics suggest a much lower overall success rate compared to traditional methods.

The Royal College of Obstetricians and Gynaecologists state there is a generally agreed upon rate of failure of about 1 in 2000 vasectomies which is considerably better than tubal ligations for which there is one failure in every 200 to 300 cases. Early failure rates, i.e. pregnancy within a few months after vasectomy typically result from having unprotected intercourse too soon after the procedure. Late failure, i.e. pregnancy after recanalization of the vasa deferentia, has been documented but is very rare.

Most Physicians/Surgeons who perform vasectomies recommend one (sometimes 2) post-procedural semen specimens to verify a successful vasectomy.

Worldwide, approximately 6% of married women using contraception rely on vasectomy. In the U.S. about 3 times as many women at risk for unintended pregnancy rely on tubal ligation as on vasectomy. In the U.S. tubal ligation is used more frequently than vasectomy, although the proportions vary from state to state. In Britain, vasectomy is more popular than tubal ligation, though this statistic may be as a result of the data-gathering method.

Couples who opt for tubal ligation do so for a number of reasons, including:

  • Convenience of coupling the procedure with giving birth 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:

  • The lower cost of vasectomy
  • The simplicity of the surgical procedure
  • The lower mortality of vasectomy (for example 0.1 per 100,000 vasectomies vs. 4 per 100,000 tubal ligations in industrialized nations)
  • Fear of side effects in the woman
  • Fear of major surgery in the woman

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Vasectomy Side Effects

After vasectomy, the testes remain in the scrotum where Leydig cells continue to produce testosterone and other male hormones that continue to be secreted into the blood stream.

Some studies find that sexual desire is unaffected in over 90% of vasectomized men, whereas other studies find higher rates of diminished sexual desire, for example nearly 20%. The sperm-filled fluid from the testes contributes about 10% to the volume of an ejaculation (in men who are not vasectomized) and does not significantly affect the appearance, taste, texture, or smell of the ejaculate.

When the vasectomy is complete, sperm cannot exit the body through the penis. Sperm are still produced by the testicles, but 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 the responding macrophages and re-absorbed via the blood stream. Sperm is matured in the epididymis for about a month once it leaves the testicles. Approximately 50% of the sperm produced never make it to the orgasmic stage in a non-vasectomized man.

After vasectomy, the membranes increase in size to absorb and store more fluid; this triggering of the immune system causes more macrophages to be recruited to break down and re-absorb more of the solid content. Within one year after a vasectomy, sixty to seventy percent of vasectomized men develop antisperm antibodies. In some cases, vasitis nodosa, a benign proliferation of the ductular epithelium, can also result. The buildup of sperm increases pressure in the vas deferens and epididymis. To prevent damage to the testes, these structures eventually rupture in more than half the cases. The entry of the sperm into the scrotum causes sperm granulomas to be formed by the body to contain and absorb the sperm which the body treats as a foreign substance.

This article is licensed under the Creative Commons Attribution-ShareAlike License. It uses material from the Wikipedia article on "Vasectomy" All material adapted used from Wikipedia is available under the terms of the Creative Commons Attribution-ShareAlike License. Wikipedia® itself is a registered trademark of the Wikimedia Foundation, Inc.

Vasectomy Complications

Short-term complications include temporary bruising and bleeding, known as hematoma. The stitches on small incisions required are prone to irritation, but this can be minimized by covering them with sticking plasters. The primary long-term complication is a permanent feeling of pain - Post-Vasectomy Pain Syndrome.

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.

Post-Vasectomy Pain Syndrome

Post-Vasectomy Pain Syndrome (PVPS) is a long term complication of vasectomy, a chronic scrotal pain of varying intensity lasting more than three months, possibly indefinitely. It is an uncommon condition with an unknown incidence. The pain can be orchialgia, pain with intercourse, ejaculation, or physical exertion, or tender epididymides. Another study found that nerve stripping provided complete relief in 13 of 17 cases, and that the other four patients improved enough that they were satisfied with the results.

This article is licensed under the Creative Commons Attribution-ShareAlike License. It uses material from the Wikipedia article on "Vasectomy" All material adapted used from Wikipedia is available under the terms of the Creative Commons Attribution-ShareAlike License. Wikipedia® itself is a registered trademark of the Wikimedia Foundation, Inc.

Vasectomy Reversal

Although men considering vasectomies should not think of them as reversible, and most men and their spouses are satisfied with the operation, there is a procedure to reverse vasectomies using vasovasostomy (a form of microsurgery first performed by Earl Owen in 1971).

Vasovasostomy is effective at achieving pregnancy in only 50%-70% of cases, and it is costly, with total out-of-pocket costs in the United States of approximately $7,000 . 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.

Since the body often produces antibodies against sperm, 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. The higher rates of aneuploidy and diploidy in the sperm cells of men who have undergone vasectomy reversal may lead to a higher rate of birth defects .

In order to allow a possibility of reproduction (via artificial insemination) after vasectomy, some men opt for cryostorage of sperm before sterilization.

This article is licensed under the Creative Commons Attribution-ShareAlike License. It uses material from the Wikipedia article on "Vasectomy" All material adapted used from Wikipedia is available under the terms of the Creative Commons Attribution-ShareAlike License. Wikipedia® itself is a registered trademark of the Wikimedia Foundation, Inc.