Vasectomy
If you and your partner are absolutely sure that you do not want to have any more children, then sterilization is a viable option, offering an almost completely safe and reliable form of permanent birth control. Because it is safer and less complicated, most physicians recommend male rather than female sterilization to couples.
What is a vasectomy?
The vasectomy is a simple surgical procedure in which a segment of the tubes [vas deferens] carrying the sperm from the testicles is removed, and the ends are sealed off. The procedure takes about fifteen minutes and is performed under a local anesthetic. In order to minimize the discomfort and complications, it is important to stay off your feet for one to two days after the procedure. Most instances of complications from vasectomies occur because of too much activity following the procedure.
What are the risks of a vasectomy?
One clinical study implied that men who have had a vasectomy have an increased incidence of prostate cancer after 20 years. Since that report, many other studies have refuted this association and it is probably unlikely there is any such risk, although it is still generally discussed.
Is it right for you?
The vast majority of men who have a vasectomy are pleased by the results. But roughly two of every 100 end up regretting the decision. Almost without exception, it wasn't the vasectomy's fault. Those two simply weren't ready to accept permanent birth control. Usually, they're men who have entered a new relationship and have changed their mind about fatherhood. (Although vasectomy can sometimes be reversed, it should be considered permanent.)
Some of the positive signs that you may be ready to have vasectomy include:
•You're in a stable, long-term marriage of 10 or more years, and both of you agree that you never want more children •You don't want to or can't use temporary methods of birth control •You or your partner has an inheritable disorder that you don't want to risk passing along to a child •Pregnancy poses a serious health risk to your partner
On the other hand, some of the warning signs that vasectomy may not be a good choice include:
•You are young •You have few or no children •Your relationship with your spouse is shaky •Either you or your partner is less than certain about the choice •You're worried about how it will affect your sexuality •You think there's a chance you might want more children if your situation changes (for example, a new spouse, death of a child, or improvement in finances) •You think vasectomy reversal is a good option if your situation changes •You're considering "banking" sperm just in case •Your situation requires protection against sexually transmitted diseases (Vasectomy offers no protection against STDs) •You don't understand how vasectomy works, how it's done, what the side effects can be, and what the alternatives are.
How vasectomy works:
Sperm are produced in a man's testes, and they mature in an area attached to the testes called the epididymis. It takes about 90 days from the time that the sperm are made for them to travel gradually up two tubes called the vas deferens and become available for ejaculation. Prior to ejaculation, they're mixed with fluids from the seminal vesicles and the prostate to form semen. Vasectomy interrupts this process by closing off the vas deferens, preventing the sperm from joining the other fluids. There is no noticeable change in the man's semen, because the sperm's contribution to volume is less than 5 percent.
Vasectomy has no physical effect on a man's virility because it doesn't change the testes' production of the male hormone, testosterone. His sex drive, potency, male characteristics, and sexual pleasure should be unchanged. (About 30 percent of men report improved sexuality after a vasectomy, most likely because the worry of pregnancy is eliminated.) After a vasectomy, sperm continue to be produced but at a decreased rate. Those that are produced die and are absorbed by the body - just as they would be in an unvasectomized man who did not ejaculate.
Only about 10 percent of men experience any sort of complication from a vasectomy, and these are usually minor. There has never been a death with a vasectomy. Of course, as is the case with any surgical procedure, there's always a small risk for bleeding, infection, or allergic reaction to the anesthetic, causing a rash. Complications specific to vasectomy include the possibility of a sperm granuloma, testicular pain, and epididymitis. Also, in very rare instances, a man can lose a testicle.
A sperm granuloma occurs if sperm leak from the vasectomy site or a rupture in the epididymis and provoke an inflammatory reaction. About half an inch in diameter, they require further attention in only about two percent of men. About one percent of men experience aching testicles from congestion in the epididymis. This usually disappears within six months. Epididymitis is an inflammation at the vasectomy site, usually taking place within the first year. Heat and anti-inflammatory medicine usually clear it up in about a week.
By far the most common complication we see is swelling of the scrotum in men who refuse to take it easy for a couple of days after a vasectomy. Unfortunately, once the swelling starts, it may take two weeks for it to reduce completely, so prevention is the best approach.
Long-terms risks of a vasectomy:
Vasectomy is one of the most studied of all medical procedures, yet rumors of long-term risks have persisted almost since the beginning of its use in the U.S. in the 1960s. To date, the body of medical evidence indicates that it is quite safe. Both the National Institutes of Health and the World Health Organization have given it a clean bill.
Although risks such as heart disease and arthritis were pretty much debunked by the 1980s, vasectomy's effect on the risk of prostate cancer continues to be studied. Although some studies have suggested a relation between the two, others have not. A panel of experts was convened by the National Institutes of Health to study the available research, and it concluded that the evidence for a link between vasectomy and prostate cancer was inconsistent and insufficient. No changes were recommended, including no increased screening for prostate cancer among men who have had vasectomies.
How effective is it?
The overall failure rate for vasectomy rate is 0.15 percent, but that doesn't give an accurate picture of its real effectiveness. Most vasectomy failures happen during the first couple of months after the procedure, when live sperm may still present in a man's semen. Couples must continue to use another method of birth control until the man has ejaculated about 20 times (clearing the sperm) over as long as six months and tests (we require two) have shown that no live sperm remain. About one of every 4,000 vasectomies fails because the vas deferens manage to reconnect - a failure rate of 0.025 percent.
What are the alternatives ?
Up to 40 percent of couples considering permanent birth control have experienced a failure with a temporary method such as condoms, a diaphragm, spermicides, IUDs, hormonal implants, and the pill, so the obvious alternative to vasectomy is tubal ligation for the woman. By comparison, tubal ligation is a more involved surgical procedure, always regarding a general anaesthetic.
What about female sterilisation ?
Tubal ligation is a procedure in which a woman's fallopian tubes are severed or sealed off, which prevents the egg from being fertilized by sperm. Unlike vasectomy, which is a simple outpatient procedure, tubal ligation typically is more complex and can require a hospital stay. Sometimes tubal ligation can be performed at an ambulatory surgery center.
In the most common tubal ligation procedure, the woman's fallopian tubes are sealed off with tiny metal rings or Filshie clips. It is necessary that two incisions be made just below the navel.
What if you change your mind?
We can plan, but we can't predict the future. So a few men who have had a vasectomy, (about one in 100) will attempt to reverse it. Fortunately, microsurgical techniques developed in recent years have greatly improved the likelihood of success. Two types of surgical procedures are used to reverse vasectomy. In men who still have sperm present in their vas deferens, vasovasostomy reconnects the vas. When no sperm are found (about one-third of all cases), the far ends of the vas deferens can be directly connected to the epididymis, using a technique called vasoepididymostomy.
Neither method of reconnection is easy, certain of success, or cheap. Overall, the rates of pregnancy are about 50 percent and 20 percent respectively, but the chances also depend on how recently the man had the vasectomy. For vasovasostomy, the chances of pregnancy are as high as three quarters for the first three years, declining to about half for years three through eight, and as low as one-third after the fifteenth year. Vasectomy reversal actually turns up sperm in semen considerably more often than the pregnancy numbers suggest. But sperm does not guarantee pregnancy, and pregnancy is the goal.
If reconnection fails, there is yet another option for couples who want children. In a new procedure, sperm are aspirated directly from a man's testicle and injected into an egg removed from the woman. Once fertilization takes place, the egg can be implanted in the woman, where normal gestation can take place. Needless to say, this is more complicated and expensive than reconnection, and the odds of success are lower.
Referral
If you would like have vasectomy, contact your GP, with your partner who can refer you for surgery in The Victoria Cottage Hospital. The waiting time from referral to surgery is only about a month so there is no need to rush into a decision.
Follow up sperm analysis is essential
This is essential and is normally carried out 4 months post vasectomy. Contact the Practice Nurse directly for the appropriate pots and advice, do not rely on the vasectomy until the sperm samples are negative.
What is a vasectomy?
The vasectomy is a simple surgical procedure in which a segment of the tubes [vas deferens] carrying the sperm from the testicles is removed, and the ends are sealed off. The procedure takes about fifteen minutes and is performed under a local anesthetic. In order to minimize the discomfort and complications, it is important to stay off your feet for one to two days after the procedure. Most instances of complications from vasectomies occur because of too much activity following the procedure.
What are the risks of a vasectomy?
One clinical study implied that men who have had a vasectomy have an increased incidence of prostate cancer after 20 years. Since that report, many other studies have refuted this association and it is probably unlikely there is any such risk, although it is still generally discussed.
Is it right for you?
The vast majority of men who have a vasectomy are pleased by the results. But roughly two of every 100 end up regretting the decision. Almost without exception, it wasn't the vasectomy's fault. Those two simply weren't ready to accept permanent birth control. Usually, they're men who have entered a new relationship and have changed their mind about fatherhood. (Although vasectomy can sometimes be reversed, it should be considered permanent.)
Some of the positive signs that you may be ready to have vasectomy include:
•You're in a stable, long-term marriage of 10 or more years, and both of you agree that you never want more children •You don't want to or can't use temporary methods of birth control •You or your partner has an inheritable disorder that you don't want to risk passing along to a child •Pregnancy poses a serious health risk to your partner
On the other hand, some of the warning signs that vasectomy may not be a good choice include:
•You are young •You have few or no children •Your relationship with your spouse is shaky •Either you or your partner is less than certain about the choice •You're worried about how it will affect your sexuality •You think there's a chance you might want more children if your situation changes (for example, a new spouse, death of a child, or improvement in finances) •You think vasectomy reversal is a good option if your situation changes •You're considering "banking" sperm just in case •Your situation requires protection against sexually transmitted diseases (Vasectomy offers no protection against STDs) •You don't understand how vasectomy works, how it's done, what the side effects can be, and what the alternatives are.
How vasectomy works:
Sperm are produced in a man's testes, and they mature in an area attached to the testes called the epididymis. It takes about 90 days from the time that the sperm are made for them to travel gradually up two tubes called the vas deferens and become available for ejaculation. Prior to ejaculation, they're mixed with fluids from the seminal vesicles and the prostate to form semen. Vasectomy interrupts this process by closing off the vas deferens, preventing the sperm from joining the other fluids. There is no noticeable change in the man's semen, because the sperm's contribution to volume is less than 5 percent.
Vasectomy has no physical effect on a man's virility because it doesn't change the testes' production of the male hormone, testosterone. His sex drive, potency, male characteristics, and sexual pleasure should be unchanged. (About 30 percent of men report improved sexuality after a vasectomy, most likely because the worry of pregnancy is eliminated.) After a vasectomy, sperm continue to be produced but at a decreased rate. Those that are produced die and are absorbed by the body - just as they would be in an unvasectomized man who did not ejaculate.
Only about 10 percent of men experience any sort of complication from a vasectomy, and these are usually minor. There has never been a death with a vasectomy. Of course, as is the case with any surgical procedure, there's always a small risk for bleeding, infection, or allergic reaction to the anesthetic, causing a rash. Complications specific to vasectomy include the possibility of a sperm granuloma, testicular pain, and epididymitis. Also, in very rare instances, a man can lose a testicle.
A sperm granuloma occurs if sperm leak from the vasectomy site or a rupture in the epididymis and provoke an inflammatory reaction. About half an inch in diameter, they require further attention in only about two percent of men. About one percent of men experience aching testicles from congestion in the epididymis. This usually disappears within six months. Epididymitis is an inflammation at the vasectomy site, usually taking place within the first year. Heat and anti-inflammatory medicine usually clear it up in about a week.
By far the most common complication we see is swelling of the scrotum in men who refuse to take it easy for a couple of days after a vasectomy. Unfortunately, once the swelling starts, it may take two weeks for it to reduce completely, so prevention is the best approach.
Long-terms risks of a vasectomy:
Vasectomy is one of the most studied of all medical procedures, yet rumors of long-term risks have persisted almost since the beginning of its use in the U.S. in the 1960s. To date, the body of medical evidence indicates that it is quite safe. Both the National Institutes of Health and the World Health Organization have given it a clean bill.
Although risks such as heart disease and arthritis were pretty much debunked by the 1980s, vasectomy's effect on the risk of prostate cancer continues to be studied. Although some studies have suggested a relation between the two, others have not. A panel of experts was convened by the National Institutes of Health to study the available research, and it concluded that the evidence for a link between vasectomy and prostate cancer was inconsistent and insufficient. No changes were recommended, including no increased screening for prostate cancer among men who have had vasectomies.
How effective is it?
The overall failure rate for vasectomy rate is 0.15 percent, but that doesn't give an accurate picture of its real effectiveness. Most vasectomy failures happen during the first couple of months after the procedure, when live sperm may still present in a man's semen. Couples must continue to use another method of birth control until the man has ejaculated about 20 times (clearing the sperm) over as long as six months and tests (we require two) have shown that no live sperm remain. About one of every 4,000 vasectomies fails because the vas deferens manage to reconnect - a failure rate of 0.025 percent.
What are the alternatives ?
Up to 40 percent of couples considering permanent birth control have experienced a failure with a temporary method such as condoms, a diaphragm, spermicides, IUDs, hormonal implants, and the pill, so the obvious alternative to vasectomy is tubal ligation for the woman. By comparison, tubal ligation is a more involved surgical procedure, always regarding a general anaesthetic.
What about female sterilisation ?
Tubal ligation is a procedure in which a woman's fallopian tubes are severed or sealed off, which prevents the egg from being fertilized by sperm. Unlike vasectomy, which is a simple outpatient procedure, tubal ligation typically is more complex and can require a hospital stay. Sometimes tubal ligation can be performed at an ambulatory surgery center.
In the most common tubal ligation procedure, the woman's fallopian tubes are sealed off with tiny metal rings or Filshie clips. It is necessary that two incisions be made just below the navel.
What if you change your mind?
We can plan, but we can't predict the future. So a few men who have had a vasectomy, (about one in 100) will attempt to reverse it. Fortunately, microsurgical techniques developed in recent years have greatly improved the likelihood of success. Two types of surgical procedures are used to reverse vasectomy. In men who still have sperm present in their vas deferens, vasovasostomy reconnects the vas. When no sperm are found (about one-third of all cases), the far ends of the vas deferens can be directly connected to the epididymis, using a technique called vasoepididymostomy.
Neither method of reconnection is easy, certain of success, or cheap. Overall, the rates of pregnancy are about 50 percent and 20 percent respectively, but the chances also depend on how recently the man had the vasectomy. For vasovasostomy, the chances of pregnancy are as high as three quarters for the first three years, declining to about half for years three through eight, and as low as one-third after the fifteenth year. Vasectomy reversal actually turns up sperm in semen considerably more often than the pregnancy numbers suggest. But sperm does not guarantee pregnancy, and pregnancy is the goal.
If reconnection fails, there is yet another option for couples who want children. In a new procedure, sperm are aspirated directly from a man's testicle and injected into an egg removed from the woman. Once fertilization takes place, the egg can be implanted in the woman, where normal gestation can take place. Needless to say, this is more complicated and expensive than reconnection, and the odds of success are lower.
Referral
If you would like have vasectomy, contact your GP, with your partner who can refer you for surgery in The Victoria Cottage Hospital. The waiting time from referral to surgery is only about a month so there is no need to rush into a decision.
Follow up sperm analysis is essential
This is essential and is normally carried out 4 months post vasectomy. Contact the Practice Nurse directly for the appropriate pots and advice, do not rely on the vasectomy until the sperm samples are negative.