Vasectomy
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226086922
2008-07-16T19:40:20Z
208.125.4.90
/* Reversal */ Removed typo
{{Infobox Birth control
|name = Vasectomy
|image =
|width =
|caption =
|bc_type = [[Sterilization (surgical procedure)|Sterilization]]
|date_first_use = 1897 (experiments from 1785)<ref>{{cite journal
|author=Paul Popenoe
|title=The Progress of Eugenic Sterilization
|journal=Journal of Heredity
|year=1934
|volume=25:1
|pages=19
|url=http://www.eugenicsarchive.org/html/eugenics/static/images/2287.html}}</ref>
|rate_type = Failure
|perfect_failure% = <0.1
|typical_failure% = 0.15
|duration_effect = Permanent
|reversibility = Often, but not always
|user_reminders = Additional methods required until 2 negative semen samples. Almost all failures are due to disregarding this instruction.
|clinic_interval = None
|STD_protection_YesNo = No
|periods =
|benefits = Local anesthetic to the scrotum and vasa deferentia by needle or jet injection, as opposed to general anesthesia usually needed for female sterilization.
|weight_gain_loss =
|risks = Risk of chronic pain, incidence and severity is widely debated.
|medical_notes =
}}
'''Vasectomy''' is a surgical procedure in which the [[vas deferens|vasa deferentia]] of a man are cut for the purpose of [[Sterilization (surgical procedure)|sterilization]].
==Types==
There are some variations on the procedure such as no-scalpel (keyhole) vasectomies,<ref>{{cite news | first= | last= | coauthors= | title=No-scalpel vasectomies by skilled surgeons may speed recovery | date=April 18 2007 | publisher= | url =http://www.eurekalert.org/pub_releases/2007-04/cfta-nvb041707.php | work =EurekaAert |pages=|accessdate=2007-04-18 |language=}}</ref> in which a sharp [[hemostat]], rather than a [[scalpel]], is used to puncture the [[scrotum]]. Another type of vasectomy which may reduce the risk of chronic pain is called an "open ended" vasectomy. A "normal" vasectomy typically seals both ends of the vas deferens with stitches, heat, metal clamps or a combination, after cutting. The open-ended vasectomy obstructs only the top end of the vas deferens. With this method sperm leaks out from the lower severed end of the vas deferens and into the scrotum, thus hopefully avoiding a build-up of pressure in the [[epididymis]]. The likelihood of long-term testicular pain from "backup pressure" seems to be reduced using this method.<ref>{{cite journal| author=Christiansen C, Sandlow J| title= Testicular Pain Following Vasectomy: A Review of Postvasectomy Pain Syndrome| journal=Journal of Andrology| year=2003| volume=24| issue =3|url=http://www.andrologyjournal.org/cgi/content/full/24/3/293 }}</ref>
==Side effects==
After vasectomy, the testes remain in the scrotum where [[Leydig cells]] continue to produce [[testosterone]] and other male hormones that continue to be secreted into the [[blood]] stream. Some studies find that [[libido|sexual desire]] is unaffected in over 90% of vasectomized men,<ref>{{cite journal| author=Nielsen CM, Genster HG| title=Male sterilization with vasectomy. The effect of the operation on sex life.| journal=Ugeskr Laeger| year=1980| volume=142| issue =10| pages=641–643| pmid=7368333}}</ref> whereas other studies find higher rates of diminished sexual desire.<ref>{{cite journal| author=Dias PL | title=The long-term effects of vasectomy on sexual behavior.| journal=[[Acta Psychiatrica Scandinavica]]| year=1983| volume=67| issue =5| pages=333–338| pmid=6869041 | doi=10.1111/j.1600-0447.1983.tb00350.x}}</ref> The sperm-filled fluid from the testes contributes about 10% to the volume of an ejaculation (in men who are not vasectomized) and does not significantly affect the appearance, texture, or smell of the ejaculate.<ref>[http://www.medicalsource.info/post-hernia-surgery/Post-Prostate-Surgery Post hernia surgery » Post Prostate Surgery<!-- Bot generated title -->]</ref>
When the vasectomy is complete, sperm can no longer exit the body through the [[penis]]. The testicles continue to produce sperm, but 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 the responding [[macrophages]] and re-absorbed via the blood stream. Sperm is matured in the epididymis for about a month once it leaves the testicles. Approximately 50% of the sperm produced never make it to the orgasmic stage in a non-vasectomized man. After vasectomy, the membranes increase in size to absorb and store more fluid; this triggering of the immune system causes more [[macrophages]] to be recruited to break down and re-absorb more of the solid content. Within one year after a vasectomy, sixty to seventy percent of vasectomized men develop antisperm antibodies. In some cases, [[vasitis nodosa]], a benign proliferation of the ductular epithelium, can also result.<ref>{{cite journal |author=Deshpande RB, Deshpande J, Mali BN, Kinare SG |title=Vasitis nodosa (a report of 7 cases) |journal=J Postgrad Med |volume=31 |issue=2 |pages=105–8 |year=1985 |month=April |pmid=4057111 |doi= |url= http://www.jpgmonline.com/article.asp?issn=0022-3859;year=1985;volume=31;issue=2;spage=105;epage=8;aulast=Deshpande }}</ref><ref>{{cite journal |author=Hirschowitz L, Rode J, Guillebaud J, Bounds W, Moss E |title=Vasitis nodosa and associated clinical findings |journal=J. Clin. Pathol. |volume=41 |issue=4 |pages=419–23 |year=1988 |month=April |pmid=3366928 |pmc=1141468 |doi= |url=http://jcp.bmj.com/cgi/pmidlookup?view=long&pmid=3366928}}</ref> The buildup of sperm increases pressure in the vas deferens and epididymis. To prevent damage to the testes, these structures eventually rupture in more than half the cases. The entry of the sperm into the scrotum causes [[sperm granuloma]]s to be formed by the body to contain and absorb the sperm which the body treats as a foreign substance.<ref>{{cite journal| author=Christiansen C, Sandlow J| title= Testicular Pain Following Vasectom: A Review of Postvasectomy Pain Syndrome| journal=Journal of Andrology| year=2003| volume=24| issue =3|url=http://www.andrologyjournal.org/cgi/content/full/24/3/293 }}</ref>
==Effectiveness==
Early failure rates, i.e. pregnancy within a few months after 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.
Although late failure, i.e. pregnancy after recanalization of the vasa deferentia, is very rare, it has been documented.<ref>{{cite journal
|author=Philp, T; Guillebaud ''et al''
|title=Late failure of vasectomy after two documented analyses showing azoospermic semen
|journal=British Medical Journal (Clinical Research Ed.)
|year=1984
|volume=289
|issue =6437
|pages=77–79
|pmid=6428685}}</ref>
==Prevalence==
Worldwide, approximately 6% of married women using contraception rely on vasectomy.<!--
note that this is % of those using contraception = % of married women / total % using any method --><ref name=PRBFPWorld />
===Compared to tubal ligations===
The rate of vasectomies compared to [[tubal ligation]]s worldwide is extremely variable among countries, and the statistics are mostly based on questionnaire studies rather than actual counts of procedures performed. Worldwide, approximately five times as many married women rely on female sterilization as those relying on male sterilization.<!--
--><ref name=PRBFPWorld>{{cite paper |title=Family Planning Worldwide: 2008 Data Sheet |publisher=Population Reference Bureau |date=2008 |url=http://www.prb.org/pdf08/fpds08.pdf |format=PDF |accessdate=2008-06-27 }}</ref> In the U.S. about 3 times as many women at risk for unintended pregnancy rely on tubal ligation as on vasectomy.<ref>{{cite journal | journal = Contraception |title=Reducing unintended pregnancy in the United States |url=http://www.arhp.org/editorials/january2008.cfm |date=January 2008}}</ref> In the U.S. tubal ligation is used more frequently than vasectomy, although the proportions vary from state to state.<ref>
{{cite journal
|author=Bensyl, D.M. and Iuliano, D. and Carter, M. and Santelli, J. and Gilbert, B.C.
|year=2005
|month = November
|title=Contraceptive Use — United States and Territories, Behavioral Risk Factor Surveillance System, 2002
|journal = Morbidity and Mortality Weekly Report
|volume = 54
|issue = SS06
|pages=1–72
|url=http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5406a1.htm
|accessdate=2006-05-05
}}</ref> 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 giving birth at a hospital
* Fear of side effects in the man
* Fear of "minor" surgery in the man
Couples who choose vasectomy are motivated by, among other factors:<ref>
{{cite journal
|author=William R. Finger
|year=1998
|month = Spring
|title=Attracting Men to Vasectomy
|journal = Network
|volume = 18
|issue = 3
|url=http://www.fhi.org/en/rh/pubs/network/v18_3/nw182ch8.htm
|accessdate=2006-05-05
}}
</ref>
* The lower cost of vasectomy
* The simplicity of the surgical procedure
* The lower mortality of vasectomy{{Fact|date=July 2008}}
* Fear of "major" surgery in the woman
==Complications==
Short-term complications include temporary [[bruising]] and [[bleeding]], known as [[hematoma]]. The primary long-term complication is a permanent feeling of pain - [[Post-Vasectomy Pain Syndrome]].
Animal and human data indicate that vasectomy does not increase [[atherosclerosis]] and that increases in circulating immune complexes after vasectomy are transient. Furthermore, the weight of the evidence regarding prostate and testicular cancer suggests that men with vasectomy are not at increased risk of these cancers.<ref>{{cite journal
|author=Pamela J. Schwingl, Ph.D., and Harry A. Guess, M.D.
|title=Safety and effectiveness of vasectomy
|journal=Fertility and Sterility
|year=2000
|volume=73
|issue = 5
|pages=923–936
|url=http://www.vasectomy-information.com/links/docguidecom.pdf
|doi=10.1016/S0015-0282(00)00482-9}}</ref>
===Post-Vasectomy Pain Syndrome===
[[Post-Vasectomy Pain Syndrome]] (PVPS), genital pain of varying intensity that may last for a lifetime, is estimated to appear in between 5% and 35% of vasectomized men, depending on the severity of pain that qualifies for the particular study<ref name="ahmed">Ahmed I, Rasheed S, White C, Shaikh N. "The incidence of post-vasectomy chronic testicular pain and the role of nerve stripping (denervation) of the spermatic cord in its management." British Journal of Urology. 1997; 79:269-270. PMID 9052481</ref><ref name="choe">Choe J, Kirkemo A. "Questionnaire-based outcomes study of nononcological post-vasectomy complications." The Journal of Urology. 1996; 155:1284-1286. PMID 8632554</ref><ref name="mcmahon"> McMahon A, Buckley J, Taylor A, Lloyd S, Deane R, Kirk D. "Chronic testicular pain following vasectomy." British Journal of Urology. 1992;69:188-191. PMID 1537032 </ref><ref name="guillebaud">Leslie TA, Illing RO, Cranston DW, Guillebaud J. "The incidence of chronic scrotal pain after vasectomy: a prospective audit." BJU International. 2007. PMID 17850378 </ref> The pain can be orchialgia, pain with intercourse, ejaculation, or physical exertion, or tender epididymides.<ref>{{cite journal| author=Christiansen C, Sandlow J| title= Testicular Pain Following Vasectomy: A Review of Postvasectomy Pain Syndrome| journal=Journal of Andrology| year=2003| volume=24| issue =3|url=http://www.andrologyjournal.org/cgi/content/full/24/3/293 }}</ref> In one study, vasectomy reversal was found to be 69% effective for reducing the symptoms of chronic post-vasectomy pain. Treatment options for 31% of patients whose pain did not respond to vasectomy reversal were limited. The study was very small, only evaluating 13 patients, making it difficult to draw solid conclusions.<ref>{{cite journal
|author=JK Nangia, JL Myles and AJ JR Thomas
|year=2000
|month = December
|title=Vasectomy reversal for the post-vasectomy pain syndrome: a clinical and histological evaluation.
|journal = Journal of Urology
|volume = 164
|issue = 6
|pages=1939–1942
|doi = 10.1016/S0022-5347(05)66923-6
|pmid = 11061886
|accessdate=2007-05-16
}}</ref> In severe cases [[Castration|orchiectomy]] has been resorted to.<ref name="granitsiotis"> Granitsiotis P, Kirk D. "Chronic testicular pain: an overview." European Urology. 2005;47(5)720. PMID 15041105 </ref>
===Possible Vasectomy-Aphasia Link===
Researchers reported in February 2007 that a survey of a small number of men with [[primary progressive aphasia]], a rare speech disorder, found that more than twice as many as would be expected had undergone vasectomies. The study has not yet been verified by other researchers, and the authors say larger studies are needed to better understand the issue.<ref>
{{cite journal
|author=Salynn Boyles
|year=2007
|month = February
|title=Study Suggests Vasectomy-Dementia Link
|journal = WebMD Medical News
|url=http://men.webmd.com/news/20070222/study-suggests-vasectomy-dementia-link
}}</ref>
===Psychological Reactions===
Some men experience depression or anger and go through a period of mourning over the loss of their reproductive ability. This emotion is similar to what some women experience after menopause. Approximately half of all vasectomized men prefer to keep their sterilization secret.
<ref>{{cite journal
|author=Harvard Medical School
|year=2001
|month = September
|title=Vasectomy and Vasovasostomy
|journal = Well Connected
|url=http://www.well-connected.com/info/board.html
}}</ref> Depending upon the study, between five and eleven percent of men regret the decision to have a vasectomy.<ref>{{cite journal
|author=ADAM
|year=2007
|month = April
|title=Vasectomy And Vasovasostomy In-Depth
|journal = HowStuffWorks.com
|url=http://healthguide.howstuffworks.com/vasectomy-and-vasovasostomy-in-depth.htm
}}</ref>
==Reversal==
Although men considering vasectomies should not think of them as [[reversible]], and most men and their spouses are satisfied with the operation, <ref> Turek P, "Minimally Invasive Reproductive Urology: The No-Scalpel Vasectomy." University of California-San Francisco. http://urology.ucsf.edu/patientGuides/pdf/maleInf/Vasectomy.pdf</ref><ref>
{{cite journal
|author=Evelyn Landry and Victoria Ward
|title=Perspectives from Couples on the Vasectomy Decision: A Six-Country Study
|journal=Reproductive Health Matters
|year=1997
|volume=(special issue)
|pages=58–67
|url=http://pdf.dec.org/pdf_docs/Pnacq010.pdf}}
</ref><ref name="regret">
{{cite journal
|author=Denise J. Jamieson ''et al''
|title=A Comparison of Women’s Regret After Vasectomy Versus Tubal Sterilization
|journal=Obstetrics & Gynecology
|year=2002
|volume=99
|issue = 6
|pages=1073–1079
|pmid=12052602
|url=http://www.greenjournal.org/cgi/content/full/99/6/1073
|doi=10.1016/S0029-7844(02)01981-6}}
</ref> there is a procedure to reverse vasectomies using [[vasovasostomy]] (a form of [[microsurgery]] first performed by Earl Owen in 1971<ref>{{cite web |url=http://www.earlowen.com.au/about%20vasectomy%20reversal.htm |title=About Vasectomy Reversal |accessdate=2007-11-29 |work=Professor Earl Owen's homepage}}</ref><ref>{{cite journal |author=Owen ER |title=Microsurgical vasovasostomy: a reliable vasectomy reversal |journal=Urology|year=1977 |pmid=11905902}}}</ref>). Vasovasostomy is effective at achieving pregnancy in only 50%-70% of cases, and it is very costly, with total out-of-pocket costs in the United States of approximately $7,000 <ref>Vasectomy Reversal Cost and Payment Plans http://www.vasectomyinfo.com/vasectomy_reversal_costs.html</ref>. The rate of [[pregnancy]] depends on such factors as the method used for the vasectomy and the length of time that has passed since the vasectomy was performed. The reversal procedures are frequently impermanent, with [[occlusion]] of the vas recurring two or more years after the operation. Sperm counts are rarely at pre-vasectomy levels. There is evidence that men who have had a vasectomy may produce more abnormal sperm, which would explain why even a mechanically successful reversal does not always restore fertility.<ref>{{cite journal
|author=Nares Sukcharoen, Jiraporn Ngeamvijawat, Tippawan Sithipravej and Sakchai Promviengchai
|year=2003
|month = May
|title=High Sex Chromosome Aneuploidy and Diploidy Rate of Epididymal Spermatozoa in Obstructive Azoospermic Men
|journal = Journal of Assisted Reproduction and Genetics
|volume = 20
|issue = 5
|pages=196–203
|doi = 10.1023/A:1023674110940
|accessdate=2006-07-18
}}</ref><ref>{{cite journal
|author=Vicente Abdelmassih, Jose P. Balmaceda, Jan Tesarik, Roger Abdelmassih and Zsolt P. Nagy
|year=2002
|month = March
|title=Relationship between time period after vasectomy and the reproductive capacity of sperm obtained by epididymal aspiration
|journal = Human Reproduction
|volume = 17
|issue = 3
|pages=736–740
|pmid = 11870128
|url=http://humrep.oxfordjournals.org/cgi/content/full/17/3/736
|accessdate=2006-07-18
|doi = 10.1093/humrep/17.3.736
}}</ref> The higher rates of [[aneuploidy]] and [[diploidy]] in the sperms of men who have undergone vasectomy reversal may lead to a higher rate of birth defects <ref>{{cite web |url=http://www.bio-medicine.org/medicine-news/Vasectomy-Reversal-to-Lead-to-Birth-Defects-11505-1/ |title=Vasectomy Reversal to Lead to Birth Defects |accessdate=2007-12-17 | work=Bio-Medicine}}</ref>.
In order to allow a possibility of reproduction (via [[artificial insemination]]) after vasectomy, some men opt for [[cryostorage]] of sperm before sterilization.<ref>{{cite news
|url=http://today.reuters.com/news/newsarticle.aspx?storyid=2006-06-21T125323Z_01_L21419074_RTRUKOC_0_US-FERTILITY-VASECTOMY.xml
|title=Men advised to freeze sperm before vasectomy
|work=Reuters.com
|publisher=Reuters news agency
|date= June 21, 2006
|accessdate=2006-07-18
}}</ref>
==Availability==
* In the UK vasectomy is often available free of charge through the [[National Health Service]] upon referral by one's [[General Practitioner|GP]]. However, some [[NHS Trust| PCT]]s do not fund the procedure. There are private clinics (such as [[Marie Stopes|Marie Stopes International]]) who perform the operation with short waiting times.
==References==
{{reflist|colwidth=30em}}
==External links==
*[http://urology.ucsf.edu/patientGuides/pdf/maleInf/Vasectomy.pdf The No-Scalpel Vasectomy.]
*[http://www.infoforhealth.org/globalhandbook/book/fph_chapter12/index.shtml Family Planning: A Global Handbook for Providers Chapter 12:Vasectomy]
*[http://www.vasectomy.com Articles on Vasectomies and Vasectomy Reversals]
*[http://www.vasectomy-information.com Vasectomy information from a non institutional source]
{{Birth control methods}}
{{Urogenital surgical procedures}}
[[Category:Surgical contraception]]
[[Category:Contraception for males]]
[[Category:1897 introductions]]
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