VASECTOMY

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.

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.

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

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 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.

The incidence of chronic post-vasectomy pain is estimated to be less than 10%.