Vasectomy

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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.

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Overview

Vasectomy is a surgical procedure in which the vasa deferentia of a male mammal are cut for the purpose of sterilization. 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.

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 bloodstream. Some studies find that sexual desire (libido) is unaffected in over 90% of vasectomized men [3] whereas other studies find higher rates of diminished sexual desire. [4] 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, 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. 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.[5]

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.[6] 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:[7]

  • 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.[8]

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[9] [10] [11] [12] 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, making it difficult to draw solid conclusions. [13] In severe cases orchiectomy has been resorted to. [14]

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.[15]

Reversal

Although men considering vasectomies should not think of them as reversible, and most men and their spouses are satisfied with the operation, [16][17][18] there is a procedure to reverse vasectomies using vasovasostomy (a form of microsurgery first performed by Earl Owen in 1971[19][20]). Vasovasostomy is 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 [21] 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.[22][23] The higher rates of aneuploidy and diploidy in the sperms of men who have undergone vasectomy reversal may lead to a higher rate of birth defects [24].

In order to allow a possibility of reproduction (via artificial insemination) after vasectomy, some men opt for cryostorage of sperm before sterilization.[25]

Various reversible male contraceptives are in research and development, but none are available. Many of these involve the implantation of micro-valves.

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.

See also

References

  1. Paul Popenoe (1934). "The Progress of Eugenic Sterilization". Journal of Heredity. 25:1: 19. 
  2. "No-scalpel vasectomies by skilled surgeons may speed recovery". EurekaAert. April 18 2007. Retrieved 2007-04-18.  Check date values in: |date= (help)
  3. Nielsen CM, Genster HG (1980). "Male sterilization with vasectomy. The effect of the operation on sex life.". Ugeskr Laeger. 142 (10): 641–643. PMID 7368333. 
  4. Dias PL (1983). "The long-term effects of vasectomy on sexual behavior.". Acta Psychiatr Scand. 67 (5): 333–338. PMID 6869041. 
  5. 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. 
  6. Bensyl, D.M. and Iuliano, D. and Carter, M. and Santelli, J. and Gilbert, B.C. (2005). "Contraceptive Use — United States and Territories, Behavioral Risk Factor Surveillance System, 2002". Morbidity and Mortality Weekly Report. 54 (SS06): 1–72. Retrieved 2006-05-05.  Unknown parameter |month= ignored (help)
  7. William R. Finger (1998). "Attracting Men to Vasectomy". Network. 18 (3). Retrieved 2006-05-05.  Unknown parameter |month= ignored (help)
  8. Pamela J. Schwingl, Ph.D., and Harry A. Guess, M.D. (2000). "Safety and effectiveness of vasectomy" (PDF). Fertility and Sterility. 73 (5): 923–936. 
  9. 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
  10. Choe J, Kirkemo A. "Questionnaire-based outcomes study of nononcological post-vasectomy complications." The Journal of Urology. 1996; 155:1284-1286. PMID 8632554
  11. 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
  12. Leslie TA, Illing RO, Cranston DW, Guillebaud J. "The incidence of chronic scrotal pain after vasectomy: a prospective audit." BJU International. 2007. PMID 17850378
  13. JK Nangia, JL Myles and AJ JR Thomas (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.  Unknown parameter |month= ignored (help);
  14. Granitsiotis P, Kirk D. "Chronic testicular pain: an overview." European Urology. 2005;47(5)720. PMID 15041105
  15. Salynn Boyles (2007). "Study Suggests Vasectomy-Dementia Link". WebMD Medical News.  Unknown parameter |month= ignored (help)
  16. Turek P, "Minimally Invasive Reproductive Urology: The No-Scalpel Vasectomy." University of California-San Francisco. http://urology.ucsf.edu/patientGuides/pdf/maleInf/Vasectomy.pdf
  17. Evelyn Landry and Victoria Ward (1997). "Perspectives from Couples on the Vasectomy Decision: A Six-Country Study" (PDF). Reproductive Health Matters. (special issue): 58–67. 
  18. 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. 
  19. "About Vasectomy Reversal". Professor Earl Owen's homepage. Retrieved 2007-11-29. 
  20. Owen ER (1977). "Microsurgical vasovasostomy: a reliable vasectomy reversal". Urology. PMID 11905902. }
  21. Vasectomy Reversal Cost and Payment Plans http://www.vasectomyinfo.com/vasectomy_reversal_costs.html
  22. Nares Sukcharoen, Jiraporn Ngeamvijawat, Tippawan Sithipravej and Sakchai Promviengchai (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.  Unknown parameter |month= ignored (help);
  23. Vicente Abdelmassih, Jose P. Balmaceda, Jan Tesarik, Roger Abdelmassih and Zsolt P. Nagy (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 2006-07-18.  Unknown parameter |month= ignored (help)
  24. "Vasectomy Reversal to Lead to Birth Defects". Bio-Medicine. Retrieved 2007-12-17. 
  25. "Men advised to freeze sperm before vasectomy". Reuters.com. Reuters news agency. June 21, 2006. Retrieved 2006-07-18. 

External links

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de:Vasektomiefa:وازکتومیit:Vasectomiafi:Vasektomia sv:Vasektomi



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