Permanent Birth Control For Men
About the procedure
Vasectomy is a simple operation designed to make a man sterile, or unable to father a child. It is used as a means of contraception in many parts of the world. A total of about 50 million men have had a vasectomy--a number that corresponds to roughly 5 percent of all married couples of reproductive age.
In comparison, about 15 percent of couples rely on female sterilization for birth control.
Approximately half a million vasectomies are performed in the United States each year. About one out of six men over age 35 has been vasectomized, the prevalence increasing along with education and income. Among married couples in this country, only female sterilization and oral contraception are relied upon more often for family planning.
Vasectomy involves blocking the tubes through which sperm pass into the semen. Sperm are produced in a man's testis and stored in an adjacent structure known as the epididymis. During sexual climax, the sperm move from the epididymis through a tube called the vas deferens and mix with other components of semen to form the ejaculate.
All vasectomy techniques involve cutting or otherwise blocking both the left and right vas deferens, so the man's ejaculate will no longer contain sperm, and he will not be able to make a woman pregnant.
In the conventional approach, a physician makes one or two small incisions, or cuts, in the skin of the scrotum, which has been number with a local anesthetic. The vas is cut, and a small piece may be removed. Next, the doctor ties the cut ends and sews up the scrotal incision. The entire procedure is then repeated on the other side.
An improved method, devised by a Chinese surgeon, has been widely used in China since 1974. This so-called nonsurgical or no-scalpel vasectomy, was introduced into the United States in 1988, and many doctors are now using the technique here.
In a no-scalpel vasectomy, the doctor feels for the vas under the skin of the scrotum and holds it in place with a small clamp. Then a special instrument is used to make a tiny puncture in the skin and stretch the opening so the vas can be cut and tied.
This approach produces very little bleeding, and no stitches are needed to close the punctures, which heal quickly by themselves. The newer method also produces less pain and fewer complications than conventional vasectomy.
Regardless of how it is performed, vasectomy offers many advantages as a method of birth control. Like female sterilization, it is a highly effective one-time procedure that provides permanent contraception. But vasectomy is medically much simpler than female sterilization, has a lower incidence of complications, and is much less expensive.
After vasectomy, the patient will probably feel sore for a few days, and he should rest for at least 1 day. However, he can expect to recover completely in less than a week. Many men have the procedure on a Friday and return to work on Monday.
Although complications such as swelling, bruising, inflammation, and infection may occur, they are relatively uncommon and almost never serious. Nevertheless, men who develop these symptoms at any time should inform their physician.
A man can resume sexual activity within a few days after vasectomy, but precautions should be taken against pregnancy until a test shows that his semen is free of sperm. Generally, this test is performed after the patient has had 10-20 post-vasectomy ejaculations. If sperm are still present in the semen, the patient is told to return later for a repeat test.
A major study of vasectomy side effects occurring within 8 to 10 years after the procedure was published in the British Medical Journal in 1992. This study -- the Health Status of American Men, or HSAM -- was sponsored by the National Institute of Child Health and Human Development (NICHD). Investigators questioned 10,590 vasectomized men, and an equal number of nonvasectomized men, to see if they had developed any of 99 different disorders. After a total of 182,000 person-years of follow-up, only one condition, epididymitis/orchitis (defined as painful, swollen, and tender epididymis or testis)-- was found to be more common after vasectomy. This local inflammation most often occurs during the first year after surgery. Treated with heat, it usually clears up within a week.
Disadvantages of vasectomy
The chief advantage of vasectomy--its permanence--is also its chief disadvantage. The procedure itself is simple, but reversing it is difficult, expensive, and often unsuccessful. Researchers are studying new methods of blocking the vas that may produce less tissue damage and scarring and might thus permit more successful reversal. But these methods are all experimental, and their effectiveness has not yet been confirmed. It is possible to store semen in a sperm bank to preserve the possibility of producing a pregnancy at some future date. However, doing this is costly, and the sperm in stored semen do not always remain viable (able to cause pregnancy). For all of these reasons, doctors advise that vasectomy be undertaken only by men who are prepared to accept the fact that they will no longer be able to father a child. The decision should be considered along with other contraceptive options and discussed with a professional counselor. Men who are married or in a serious relationship should also discuss the issue with their partners.
Although it is extremely effective for preventing pregnancy, vasectomy does not offer protection against AIDS or other sexually transmitted diseases. Consequently, it is important that vasectomized men continue to use condoms, preferably latex, which offer considerable protection against the spread of disease, in any sexual encounter that carries the risk of contracting or transmitting infection.
Masculinity and sexuality
Vasectomy does not affect production or release of testosterone, the male hormone responsible for a man's sex drive, beard, deep voice, and other masculine traits. The operation also has no effect on sexuality. Erections, climaxes, and the amount of ejaculate remain the same.
Occasionally, a man may experience sexual difficulties after vasectomy, but these almost always have an emotional basis and can usually be alleviated with counseling. More often, men who have undergone the procedure, and their partners, find that sex is more spontaneous and enjoyable once they are freed from concerns about contraception and accidental pregnancy.