Vasectomy: Have No Fear?
By Ryan Smith, MD
With all the hubbub of the holiday season, you may have missed several recent important men’s health initiatives, including World Vasectomy Day, which took place on November 7.
Why do we need a day dedicated to vasectomies? World Vasectomy Day was founded in 2013 by filmmaker Jonathan Stack and physician Doug Stein to encourage men to take responsibility for family planning. Up to 500,000 vasectomies are performed each year in the United States, making vasectomy the fourth most-commonly used contraceptive method in the U.S. Condoms, oral contraceptives for women, and tubal sterilization precede it in terms of utilization.
When compared to tubal ligation, vasectomy is equally effective, but safer and cheaper. For instance, a vasectomy requires local rather than general anesthesia, which is required for a woman to undergo a tubal ligation, and can typically be performed in a clinic setting. Despite these advantages, data from 1998-2002 showed that tubal ligation was performed two to three times more often than vasectomy. Worldwide, the discrepancy between vasectomy and tubal ligation is even more marked.
There are many myths surrounding vasectomy, which may be why it’s not more common. For instance, some men confuse vasectomy with castration, which is the surgical removal of the testes. Others fear that vasectomy will somehow make them “less of a man.”
So, what really happens during a vasectomy, and what are the risks? For starters, sperm are made in the testes. From there, they travel to the epididymis, which connects the testicle to the vas deferens and aids in sperm maturation. The vas deferens is a muscular tube that transports sperm from the epididymis to the ejaculatory duct within the urethra (the channel through which men urinate and ejaculate) at the time of ejaculation. During a vasectomy, the vas deferens (tube carrying the sperm), is typically cut, clamped or sealed utilizing various techniques. This prevents newly created sperm from being ejaculated. The procedure should not cause any changes in a man’s libido, erectile capacity, testosterone or ability to ejaculate.
Vasectomy is intended to be a permanent form of contraception and is often covered by insurance. It has a less than one percent failure rate compared to condoms, which fail 18 percent of the time. While vasectomy is meant to be permanent, reversal is possible, with about 6 percent of men electing to do so.
As with all methods of birth control, vasectomy carries its own element of risk. Vasectomy does not produce immediate sterility and another form of contraception is required until a post-vasectomy semen test is performed. The rates of surgical complications such as hematoma (a blood clot) and infection are one to two percent. Chronic pain may develop following the procedure in a like percent of men; however, few men require additional surgery.
Vasectomy may not be the right choice for all men or their families, but it’s important for men to adopt an active role in family planning. Your primary care physician can refer to you to a urologist or provider who performs vasectomies to discuss the procedure further. A counseling visit is required prior to the procedure.
Fear and a lack of good information often keep men from taking charge of their health. Whether vasectomy is right for you or not, see your doctor regularly.
