Vasectomy

From Wikipedia, the free encyclopedia

Vasectomy
Background
B.C. type	Sterilization
First use	1957
Failure rates (per 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
Clinic review	None
Advantages
Benefits	Generally, minor local anaesthetic. Some states of the United States, such as New Jersey, now require full anaesthesia.
Disadvantages
STD protection	No
Weight gain	No

Vasectomy is a permanent birth control method. In some conventional clinics part of the vasa deferentia are surgically removed, thus sterilizing the patient. In more modern clinics and in no-scalpel (keyhole) vasectomies none of the vas is removed, but is instead cut and sealed.

Vasectomy should not be confused with castration: vasectomy does not involve removal of the testicles and it affects neither the production of male sex hormones (mainly testosterone) nor their secretion into the bloodstream. Therefore sexual desire (libido) and the ability to have an erection and an orgasm with an ejaculation are not affected. Because the sperm itself makes up a very small proportion of an ejaculation, vasectomy does not significantly affect the volume, appearance, texture or flavor of the ejaculate. Similarly, in females, hormone production, libido, and the menstrual cycle are not affected by a tubal ligation.

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.

Contents 1 Safety and effectiveness 2 Recovery 3 Reversal 4 Availability 5 Chronic Post-Vasectomy Pain 6 Potential Dementia Risk 7 See also 8 References 9 External links

[edit] Safety and effectiveness

Early failure rates of 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. Most men will experience minor bruising in the scrotum for three to five days following the operation. Animal and human data indicate that vasectomy does not increase atherosclerosis and that increases in circulating immune complexes after vasectomy are transient. The weight of the evidence regarding prostate and testicular cancer suggests that men with vasectomy are not at increased risk of these cancers.^[1].

Although late failure (caused by recanalization of the vasa deferentia) is very rare, it has been documented.^[2] Some sources recommend yearly prostate examinations starting at an earlier age, (40).

Vasectomy is the most effective long-term contraceptive method, and is among the safest options for family planning. How popular sterilization is as a birth control method varies by age, with men in their mid 30's to mid 40's being most likely to have a vasectomy. 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.^[3]. 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

Couples who choose vasectomy are motivated by, among other factors^[4]:

• The lower cost and simplicity of vasectomy
• Fewer complications
• The lower mortality of vasectomy
• Fear of surgery in the woman

[edit] Recovery

Depending on the clinic, patients may be offered or given anti-anxiety medication (such as Xanax) approximately one hour prior to the procedure. After the procedure, the patient may rest for a short time, about 15-30 minutes. It is recommended that the patient be driven home, mainly due to the sedative effects caused by the anti-anxiety medication.

Ice should be placed over the dressing or gauze, at the area of incision for 20 minutes each hour for the first 12 hours, helping to reduce swelling and pain. The dressing or gauze should be kept in place for several days to absorb any minor bleeding (bleeding should be minimal). Anecdotal evidence highly supports faster (and more comfortable) recoveries for those who follow the strict advice regarding rest and icing of the incision.

For the next 24-72 hours, the patient should remain at home, sitting or lying for most of the time. Patients should not shower, bathe, or wet the incision for 24 hours after the procedure. Patients are typically advised not to operate a motor vehicle or engage in moderate activity (such as climbing stairs more than necessary) for 72 hours. Patients may usually resume normal day-to-day activity after 72 hours but it is recommended that they wear scrotal support (can be found in sporting goods stores) or normal supportive underwear (such as briefs rather than boxer shorts) for one week. A light dressing is to be held in place for up to one week. Sexual activity should be avoided for approximately one week, but some physicians recommend resumption when comfortable. Of course, this varies from patient to patient and their respective recovery rate. Vigorous exercise (especially bicycle riding) should be avoided for two to four weeks. After four weeks, the patient is typically clear to resume all normal activities. In some cases pain in the testicles can last past four weeks, maybe even years. This side effect is not well understood. Some men have to undergo further surgery to reduce the pain. Typically removal of the epididymis, removal of the testicle(s) or in some cases reversal of the vasectomy is employed to lessen the pain.

[edit] Reversal

Although men considering vasectomies should not think of them as reversible, and most men and their spouses are satisfied with the operation^{[5] [6]}, there is a procedure to reverse vasectomies using vasovasostomy (a form of microsurgery). It is, however, not effective in all cases, with the success rate depending on such factors as the method used for the vasectomy and the length of time that has passed since the vasectomy was performed. There is evidence that men who have had a vasectomy produce abnormal sperm, which would explain why even a mechanically successful reversal does not always restore fertility.^[7][8]

In one study, vasectomy reversal was found to be 75% effective for reducing the symptoms of chronic post-vasectomy pain. ^[9]

In order to allow a possibility of reproduction (via artificial insemination) after vasectomy, some men opt for cryostorage of sperm before sterilization, and although the long term viability of spermatozoa in cryostorage is questionable,^{[citation needed]} some experts advise that this be done before vasectomy.^[10]

Various temporary male contraceptives are being researched but not yet available, such as male hormonal contraceptives and the intra vas device. There has been at least one documented case of a vasectomy being reversed on a dog, which then fathered puppies after the reversal.^[11]

[edit] 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 and patients may have to obtain a vasectomy privately. There are also private clinics (such as Marie Stopes International) who perform the operation with shorter waiting times.

[edit] Chronic Post-Vasectomy Pain

The incidence of chronic post-vasectomy pain is estimated to be less than 10% depending on the severity of pain that qualifies for the particular study. Sample studies that describe post-vasectomy pain in more detail can be obtained from ^[12] and ^[13]. There is strong evidence of post vasectomy pain (PVP).

A recent study by John Guillebaud on 5000 patients studying the effects of PVP confirmed the evidence quoted above. However, it also showed that the background risk of testicular pain in the general (non vasectomised) population is 10%. All 5000 patients when asked in questionnaires following the procedure said they would have a vasectomy again as benefits outweighed the risks.

[edit] Potential Dementia Risk

Very preliminary studies suggest a correlation between vasectomies and certain forms of dementia. The theory suggests that antisperm antibodies which eliminate sperm from the bloodstream in post-vasectomy men may also attack the brain. Much more extensive study is necessary before the theory can be confirmed. See:

• Vasectomy May Put Men At Risk For Type Of Dementia
• Study Suggests Vasectomy-Dementia Link

[edit] See also

• Sterilization (surgical procedure)
• Tubal ligation

[edit] References

1. ^ Pamela J. Schwingl, Ph.D., and Harry A. Guess, M.D. (2000). "Safety and effectiveness of vasectomy". Fertility and Sterility 73 (5): 923–936. 
2. ^ 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. 
3. ^ 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. 
4. ^ William R. Finger (Spring 1998). "Attracting Men to Vasectomy". Network 18 (3). Retrieved on 2006-5-5. 
5. ^ Evelyn Landry and Victoria Ward (1997). "Perspectives from Couples on the Vasectomy Decision: A Six-Country Study". Reproductive Health Matters (special issue): 58–67. 
6. ^ 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. 
7. ^ 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. 
8. ^ 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. 
9. ^ 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): 39-42. DOI:10.1023/A:1023674110940. Retrieved on 18 July 2006. 
10. ^ "Men advised to freeze sperm before vasectomy", Reuters.com, Reuters news agency, Wed Jun 21, 2006. Retrieved on 18 July 2006.
11. ^ "Dog's Vasectomy Reversed", CBS News, April 29, 2005.
12. ^ Granitsiotis and Kirk (2003). "Chronic Testicular Pain: An Overview". European Urology 45: 430-436. PMID 15041105. 
13. ^ Christiansen and Sandlow (2003). "Testicular Pain Following Vasectomy: A Review of Postvasectomy Pain Syndrome". Journal of Andrology 24: 293–298. PMID 12721203. 

[edit] External links

• Information regarding Vasectomy, No-Scalpel Vasectomy and No-Needle Vasectomy.
• Planned Parenthood FAQ page on vasectomy.
• VasectomyMedical.com - devoted to vasectomy and vasectomy reversal.
• EngenderHealth (Vasectomy-Questions and Answers)

Birth control edit
Sterilization:	Tubal ligation, Vasectomy, Essure
Post-intercourse:	Abortion: Surgical, Medical Emergency contraception
Intra-uterine:	IUD, IUS (progestogen)
Anti-estrogen:	Ormeloxifene (a.k.a. Centchroman)
Hormonal:	Combined: COCP ('the Pill'), Patch, Nuvaring Progestogen only: POP mini-pill, Depo Provera, Norplant, Implanon
Barrier:	Male condom,Female condom, Diaphragm, Shield, Cap, Sponge, Spermicide
Behavioral:	Coitus interruptus, Rhythm Method, Lactational, Fertility awareness Avoiding vaginal intercourse: Anal sex, Oral sex, Outercourse, Masturbation, Abstinence