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A vasectomy is a procedure in which the link between the penis and the testicular cells that produce sperm is severed. This renders a male able to have sex with considerably reduced probability of impregnating his female partner. Men (or couples) who do not want to have a child may opt for vasectomy. This is one of very few effective contraception methods available for men. However, people who are considering a vasectomy may have a number of questions and concerns about the nature, benefits and risks of this process. The more common may be addressed below:
Vasectomy is often achieved by bisecting (or slicing in two) the vas deferens, which connects the testes with the tube that releases sperm during ejaculation.
There are a number of different types of vasectomy, including:
These procedures are typically performed under local anesthetic to prevent pain and discomfort.
This procedure is associated with some degree of pain, mainly in the scrotum. A study of 76 men found that the average pain score (on a scale of zero to ten) post-surgery was 3.5. Another study including 182 men found that approximately 19% of these had post-operative pain, but 2% reported that this negatively affected their quality of life. This pain is usually temporary. Estimates suggest that more long-term (or chronic) scrotal pain occurs in up to 2% of cases. Treatment for this pain includes surgery to reverse the vasectomy, which is effective in up to 93% of patients. Other main complications associated with vasectomy are infection and haematoma, which are estimated to arise after approximately 2% of procedures.
Vasectomies tend to have very high rates of success in their goal, i.e. the secretion of seminal fluid with significantly reduced counts of sperm cells (also known as azoospermia or sterility). A study including 895 men who had received vasectomy found that 96% of them achieved sterility 60 days after the procedure.
Vasectomies are not instantaneous.
Guidelines suggest that an analysis of semen at sixteen to eighteen weeks after vasectomy is carried out to confirm sterility. The European association of urology guidelines suggest that vasectomy is successful if semen analysis shows sterility (or reduced counts of non-motile sperm) at three months after the procedure.
There is widespread anecdotal evidence, concern and popular hypothesis that a vasectomy may fail, or lose effect over time, through the restoration (or 'healing') of the vas deferens. However, these procedures are associated with a low rate of failure. Spontaneous reversal of vasectomy (also known as 'recanalisation' of the vas) is reported as occurring in approximately 1% of cases. A review of clinical trials comparing vasectomy methods found that fascial interposition appeared to be more successful in preventing this. Another review concluded that interposition and cauterisation may be superior to ligation and excision in ensuring the lack of sperm in ejaculate, but that there is not enough clinical data to state this conclusively. If a patient wishes to restore the ability to produce sperm, a separate surgery to reverse a vasectomy is often necessary.
Vasectomy is suitable for most men who are in a position to give legal informed consent. It may be contraindicated if the patient has a pre-existing serious condition or pain in the scrotum or testes, however. A man who is considering vasectomy should be given full information on the effects, risks, failure rates and the need for follow-up semen analysis. A physician or urologist may advise against vasectomy if the man requesting the procedure is aged 30 years or younger, has no children, has not adequately consulted their partner, or is not part of a couple, but the decision is ultimately that of the man in question.
Many men may encounter negative psychological effects based on fears, misconception and a lack of information concerning changes in sexual performance and satisfaction resulting from vasectomy.
Studies have shown men receiving vasectomy found no significant differences in measures of sexual satisfaction or frequency recorded before and five months after a procedure.
Some reports indicate a link between the increased risk of prostate cancer and vasectomy. On the other hand, other studies have not found this association. A recent longitudinal study documented over 12,000 men in the United States who had had vasectomies and the incidence of prostate cancer among them. This resulted in an association between the procedure and a modest increase of high-grade and fatal prostate cancer risk. There was no association between low-grade forms of this cancer and vasectomy. However, this is an individual study on this subject, and may require more studies to replicate and verify the result. Vasectomy may be associated with a low incidence of anxiety and depression, which is thought to result from misconceptions, poor information-giving and low-quality counselling about vasectomy prior to the surgery.