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Vasectomy is a simple operation designed to make a man sterile, or unable to
biologically father a child. 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 fluid that is ejaculated (ejaculate). All vasectomy
techniques involve cutting or otherwise blocking both the left and right vas deferens,
so that the man's ejaculate will no longer contain sperm, and he will not be able to
make a woman pregnant.
Vasectomy 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 of
men undergoing the procedure increases with higher levels of education and income.
Among married couples in the United States, only female sterilization and oral
contraception are relied upon more often for family planning.
In the conventional approach, a physician makes one or two small incisions, or cuts, in the skin of the scrotum, which has been numbed 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.
A newer 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 worldwide.
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. A special instrument is then 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 causes less pain
and fewer complications than conventional vasectomy
provides permanent contraception. Vasectomy, however, is medically much simpler
than female sterilization, has a lower incidence of complications, and is much less
After vasectomy, the patient will probably feel sore for a few days, and he should rest
for at least one 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 major study of vasectomy side effects occurring within 8 to 10 years after the
procedure was published in the British Medical Journal in 1992. Investigators
questioned 10,590 vasectomized men, and an equal number of nonvasectomized men,
to determine 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, the condition usually clears within a week.
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
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 able to cause pregnancy.
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 the procedure is extremely effective in preventing pregnancy, vasectomy
does not offer any protection whatsoever against HIV/AIDS or any other sexually
transmitted diseases (STDs). 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
Not at all. Vasectomy has no effect on the production or release of testosterone, the
male hormone responsible for a man's sex drive, beard, deep voice, and other
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.
After vasectomy, the testes continue to make sperm. When the sperm cells die, they
are absorbed by the body, much like unused sperm in a nonvasectomized man.
Nevertheless, many vasectomized men develop immune reactions to sperm, although
current evidence indicates that these reactions do not cause any harm.
Ordinarily, sperm do not come in contact with immune cells, so they do not elicit an
immune response. But vasectomy breaches the barriers that separate immune cells
from sperm, and many men develop anti-sperm antibodies after undergoing the
procedure. This has given rise to concern on the part of doctors and researchers,
because immune reactions against parts of one's own body sometimes cause disease.
(Rheumatoid arthritis, juvenile diabetes, and multiple sclerosis are some of the
illnesses suspected or known to be caused by immune reactions of this type.)
Immune reactions can also contribute to the development of atherosclerosis, the
clogging of arteries that leads to heart attacks. In the late 1970s, after a study of 10
monkeys showed an increased risk of atherosclerosis in vasectomized animals,
doctors became concerned that vasectomy might increase the risk of heart disease in
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