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

[edit] Types

Typically 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 have been explored/used in hopes of reducing recovery time and pain (in recovery and post-surgery). The No-Scalpel method (coined Key-Hole),^[2] in which a sharp hemostat, rather than a scalpel, is used to puncture the scrotum may reduce healing times as well as mitigate the chance of infection.

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.^[3]

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 claims reduced pain in recovery, but statistics suggest a much lower overall success rate compared to traditional methods.

[edit] 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,^[4] whereas other studies find higher rates of diminished sexual desire, for example nearly 20%.^[5] 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.^[6]

When the vasectomy is complete, sperm cannot exit the body through the penis. The testicles continue to produce sperm, 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.^[7][8] 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.^{[citation needed]} 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.^[9]

[edit] Effectiveness

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. Although late failure, i.e. pregnancy after recanalization of the vasa deferentia, is very rare. Nonetheless, it has been documented.^[10]

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

[edit] Prevalence

Worldwide, approximately 6% of married women using contraception rely on vasectomy.^[11]

[edit] Compared to tubal ligations

The rate of vasectomies compared to tubal ligations worldwide is extremely variable among countries, and the statistics are mostly based on questionnaire studies rather than actual counts of procedures performed. Worldwide, approximately five times as many married women rely on female sterilization as those relying on male sterilization.^[11] In the U.S. about 3 times as many women at risk for unintended pregnancy rely on tubal ligation as on vasectomy.^[12] In the U.S. tubal ligation is used more frequently than vasectomy, although the proportions vary from state to state.^[13] In Britain, vasectomy is more popular than tubal ligation, though this statistic may be as a result of the data-gathering method.^{[citation needed]}

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:^[14]

• The lower cost of vasectomy
• The simplicity of the surgical procedure
• The lower mortality of vasectomy^[15] (for example 0.1 per 100,000 vasectomies vs. 4 per 100,000 tubal ligations in industrialized nations)^[16]
• Fear of side effects in the woman
• Fear of "major" surgery in the woman

[edit] Complications

A post-vasectomy scrotum, showing typical post-operative bruising, incision stitches and a shaved scrotum.

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.^[17]

[edit] 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 35% of vasectomized men, depending on the severity of pain that qualifies for the particular study^{[18][19][20][21]} The pain can be orchialgia, pain with intercourse, ejaculation, or physical exertion, or tender epididymides.^[9] In one study, vasectomy reversal was found to be effective for 9 out of 13 patients in reducing the symptoms of chronic post-vasectomy pain. Treatment options for the 4 patients whose pain did not respond to vasectomy reversal were limited. The limited size of the study makes it difficult to draw solid conclusions.^[22] In severe cases castration has been resorted to.^[23]

[edit] Link to dementia

Researchers reported^[24] in February 2007 that a survey of a small number of men with primary progressive aphasia, a rare speech disorder, found that more than twice as many as would be expected had undergone vasectomies. Because primary progressive aphasia is so rare compared to the number of men undergoing vasectomy it is statistically very unlikely that any one individual would develop this problem. The study has not yet been verified by other researchers, and the authors say larger studies are needed to better understand the issue.^[25]

[edit] Psychological reactions

Some men experience depression or anger and go through a period of mourning over the loss of their reproductive ability. This emotion is similar to what some women experience after menopause. Approximately half of all vasectomized men prefer to keep their sterilization secret. ^[26] Depending upon the study, between five and eleven percent of men regret the decision to have a vasectomy.^[27]

[edit] Reversal

Although men considering vasectomies should not think of them as reversible, and most men and their spouses are satisfied with the operation,^[28][29][30] there is a procedure to reverse vasectomies using vasovasostomy (a form of microsurgery first performed by Earl Owen in 1971^[31][32]). 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 ^[33]. 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.^[34][35] 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 ^[36].

In order to allow a possibility of reproduction (via artificial insemination) after vasectomy, some men opt for cryostorage of sperm before sterilization.^[37]

[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. There are private clinics (such as Marie Stopes International) who perform the operation with short waiting times.

• The vasectomy is also covered in Canada and Australia.

• In Costa Rica, the vasectomy is also covered by the Caja Costarricense del Seguro Social (Costa Rica's national insurance).

• In 2006 Argentina approved vasectomy in public health service^[38]

[edit] See also

• Male contraceptive

[edit] References

[edit] External links

• All about vasectomy, no-scalpel vasectomy and finding a doctor
• Vasectomy procedure
• Royal College of Obstetricians and Gynaecologists
• [1]
• The No-Scalpel Vasectomy.
• Family Planning: A Global Handbook for Providers Chapter 12:Vasectomy
• Articles on Vasectomies and Vasectomy Reversals
• Information for Making a Vasectomy Decision
• Vasectomy information from a non institutional source
• No-Scalpel Vasectomy: The NSV Book
• Video: The NSV Procedure (graphic)