Vasectomy
From Wikipedia, the free encyclopedia
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Vasectomy
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| Background | |
| B.C. type | Sterilization |
| First use | 1897 (experiments from 1785)[1] |
| Failure rates (first year) | |
| Perfect use | <0.1% |
| Typical use | 0.15% |
| Usage | |
| 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 review | None |
| Advantages and Disadvantages | |
| STD protection | No |
| Benefits | Local anesthetic to the scrotum and vasa deferentia by needle or jet injection, as opposed to general anesthesia usually needed for female sterilization. |
| Risks | Risk of chronic pain, incidence and severity is widely debated. |
Vasectomy is a surgical procedure in which the vasa deferentia of a man are cut for the purpose of sterilization. There are some variations on the procedure such as no-scalpel (keyhole) vasectomies,[2] in which a surgical hook, rather than a scalpel, is used to enter the scrotum. Another type of vasectomy which may reduce the risk of chronic pain could be the so-called "open ended" vasectomy. A "normal" vasectomy typically seals both ends of the vas deferens with stitches, heat, or both, after cutting. The open-ended vasectomy seals only the top end of the vas. With this method sperm are free to spill out from the lower severed end of the vas thus avoiding any build-up of pressure. The likelihood of long-term testicular pain from "backup pressure" seems to be eliminated using this method.
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 sexual desire is unaffected in over 90% of vasectomized men,[3] whereas other studies find higher rates of diminished sexual desire.[4] 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.[5] There are anecdotal reports regarding volume of ejaculate being much diminished, regardless of the actual quantity of semen that is blocked off. This phenomena is not entirely understood.
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. 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 more fluid, and more macrophages are recruited to break down and re-absorb more of the solid content. The fraction of sperms that exceed the digestive capabilities of macrophages exit into the scrotum as sperm granulomas.
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[edit] 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.[6]
[edit] Compared to tubal ligations
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.[7] 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 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:[8]
- The lower cost of vasectomy
- The simplicity of the surgical procedure
- The lower mortality of vasectomy
- Fear of "major" surgery in the woman
[edit] 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.[9]
[edit] 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 33% of vasectomized men, depending on the severity of pain that qualifies for the particular study[10][11][12][13] 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.[14] In severe cases orchiectomy has been resorted to.[15]
[edit] Vasectomy-Dementia Link
Research on potential risk factors for Alzheimer’s disease has revealed a surprising association – the development of an unusual form of dementia is much more common among men who have experienced a vasectomy. Although the finding is recognition of an association, not a cause and effect, additional research is indicated.
The dementia is Primary Progressive Aphasia (PPA), a neurological disease in which people have trouble recalling and understanding words. In PPA, people lose the ability to express themselves and understand speech. It differs from typical Alzheimer’s disease in which a person’s memory becomes impaired.
Northwestern University physicians began investigating a possible link between the surgery and PPA after a male patient connected the onset of his language problem at age 43 to the period after his vasectomy.
Sandra Weintraub, principal investigator and professor of psychiatry and behavioral sciences and of neurology and her team of researchers surveyed 47 men with PPA who were being treated at Northwestern’s Cognitive Neurology and Alzheimer’s Disease Center and 57 men with no cognitive impairment who were community volunteers. They ranged from 55 to 80 years old. Of the non-impaired men, 16 percent had undergone a vasectomy. In contrast, 40 percent of the men with PPA had had the surgery.
“That’s a huge difference,” said Weintraub, director of neuropsychology in the Cognitive Neurology and Alzheimer’s Disease Center. “It doesn’t mean having a vasectomy will give you this disease, but it may be a risk factor to increase your chance of getting it.”
In addition, the men who had undergone a vasectomy developed PPA at a younger age (58 years) than men with PPA who hadn’t had one (62 years.)
The study was published in Cognitive and Behavioral Neurology.
While PPA robs people of their ability to speak and understand language, an unusual twist of the disease is patients are still able to maintain their hobbies and perform other complicated tasks for a number of years before other symptoms develop. Some people garden, build cabinets and even navigate a city subway system.
By contrast, Alzheimer’s patients lose interest in their hobbies, family life and may become idle. As PPA progresses over a number of years, however, patients eventually lose their ability to function independently.
Preliminary evidence from the study also seemed to connect another form of dementia to a vasectomy. In a smaller group of 30 men with a dementia called frontotemporal dementia (FTD,) 37 percent had undergone a vasectomy. The earliest symptoms of FTD are personality changes, lack of judgment and bizarre behavior. As in PPA, FTD usually starts at an earlier age, in the 40s and 50s.
One of Weintraub’s patients with FTD was eating lunch in a restaurant with his family and excused himself to go to the bathroom. When he hadn’t returned after 10 minutes, his sons went to investigate. They found him doing pushups on the bathroom floor. Other FTD patients begin shoplifting, compulsively gambling, misspending large amounts of money or become sexually demanding.
The most common form of dementia caused by brain deterioration in individuals over age 65 is Alzheimer’s disease. Weintraub did not find an increased rate of vasectomy in patients with Alzheimer’s.
Many patients with FTD and PPA share a common brain disease that is completely different from Alzheimer’s. Whether a patient will get the behavioral or language problems depends on where the disease causes the most destruction in the brain. In FTD, most of the damage is in the frontal lobes; in PPA, it’s in the language centers of the left hemisphere of the brain.
Weintraub theorizes a vasectomy may raise the risk of PPA (and possibly FTD) because the surgery breeches the protective barrier between the blood and the testes, called the blood-testis barrier.
Certain organs - including the testes and the brain - exist in what is the equivalent of a gated community in the body. Tiny tubes within the testes (in which sperm are produced) are protected by a physical barrier of Sertoli cells. The tight connections between these cells prevent blood-borne infections and poisonous molecules from entering the semen.
After a vasectomy, however, the protective barrier is broken and semen mixes into the blood. The immune system recognizes the sperm as invading foreign agents and produces anti-sperm antibodies in 60 to 70 percent of men.
Weintraub said these antibodies might cross the blood-brain-barrier and cause damage resulting in dementia. “There are other neurological models of disease which you can use as a parallel,” Weintraub said. Certain malignant tumors produce antibodies that reach the brain and cause an illness similar to encephalitis, she noted.
The next step in Weintraub’s research will be to launch a national study to see if her results will be confirmed in a larger population.
“I don’t want to scare anyone away from getting a vasectomy,“ Weintraub stressed. “It’s obviously a major birth control alternative. This is just a correlational observation,” she said of the dementia connection. “We need to do more research to find out.”
The research was conducted as part of an Alzheimer’s Disease Core Center Grant from the National Institute on Aging.
Source: Northwestern University
[edit] Reversal
Although men considering vasectomies should not think of them as reversible, and most men and their spouses are satisfied with the operation, [16][17][18] there is a procedure to reverse vasectomies using vasovasostomy (a form of microsurgery first performed by Earl Owen in 1971[19][20]). 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 can be approximately $7,000 [21]. 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.[22][23] 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 [24].
In order to allow a possibility of reproduction (via artificial insemination) after vasectomy, some men opt for cryostorage of sperm before sterilization.[25]
[edit] Availability
- In the UK vasectomy is often available free of charge through the National Health Service upon referral by one's GP. However, some PCTs do not fund the procedure. There are private clinics (such as Marie Stopes International) who perform the operation with short waiting times.
[edit] See also
[edit] References
- ^ Paul Popenoe (1934). "The Progress of Eugenic Sterilization". Journal of Heredity 25:1: 19.
- ^ "No-scalpel vasectomies by skilled surgeons may speed recovery", EurekaAert, April 18 2007. Retrieved on 2007-04-18.
- ^ Nielsen CM, Genster HG (1980). "Male sterilization with vasectomy. The effect of the operation on sex life.". Ugeskr Laeger 142 (10): 641-643. PMID 7368333.
- ^ Dias PL (1983). "The long-term effects of vasectomy on sexual behavior.". Acta Psychiatrica Scandinavica 67 (5): 333-338. PMID 6869041.
- ^ Post hernia surgery » Post Prostate Surgery
- ^ Philp, T; Guillebaud et al (1984). "Late failure of vasectomy after two documented analyses showing azoospermic semen". British Medical Journal (Clinical Research Ed.) 289 (6437): 77–79. PMID 6428685.
- ^ Bensyl, D.M. and Iuliano, D. and Carter, M. and Santelli, J. and Gilbert, B.C. (November 2005). "Contraceptive Use — United States and Territories, Behavioral Risk Factor Surveillance System, 2002". Morbidity and Mortality Weekly Report 54 (SS06): 1-72.
- ^ William R. Finger (Spring 1998). "Attracting Men to Vasectomy". Network 18 (3).
- ^ Pamela J. Schwingl, Ph.D., and Harry A. Guess, M.D. (2000). "Safety and effectiveness of vasectomy". Fertility and Sterility 73 (5): 923–936.
- ^ 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
- ^ Choe J, Kirkemo A. "Questionnaire-based outcomes study of nononcological post-vasectomy complications." The Journal of Urology. 1996; 155:1284-1286. PMID 8632554
- ^ 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
- ^ Leslie TA, Illing RO, Cranston DW, Guillebaud J. "The incidence of chronic scrotal pain after vasectomy: a prospective audit." BJU International. 2007. PMID 17850378
- ^ JK Nangia, JL Myles and AJ JR Thomas (December 2000). "Vasectomy reversal for the post-vasectomy pain syndrome: a clinical and histological evaluation.". Journal of Urology 164 (6): 1939-1942. doi:. PMID 11061886.
- ^ Granitsiotis P, Kirk D. "Chronic testicular pain: an overview." European Urology. 2005;47(5)720. PMID 15041105
- ^ Turek P, "Minimally Invasive Reproductive Urology: The No-Scalpel Vasectomy." University of California-San Francisco. http://urology.ucsf.edu/patientGuides/pdf/maleInf/Vasectomy.pdf
- ^ Evelyn Landry and Victoria Ward (1997). "Perspectives from Couples on the Vasectomy Decision: A Six-Country Study". Reproductive Health Matters (special issue): 58–67.
- ^ Denise J. Jamieson et al (2002). "A Comparison of Women’s Regret After Vasectomy Versus Tubal Sterilization". Obstetrics & Gynecology 99 (6): 1073–1079. PMID 12052602.
- ^ About Vasectomy Reversal. Professor Earl Owen's homepage. Retrieved on 2007-11-29.
- ^ Owen ER (1977). "Microsurgical vasovasostomy: a reliable vasectomy reversal". Urology. PMID 11905902.}
- ^ Vasectomy Reversal Cost and Payment Plans http://www.vasectomyinfo.com/vasectomy_reversal_costs.html
- ^ Nares Sukcharoen, Jiraporn Ngeamvijawat, Tippawan Sithipravej and Sakchai Promviengchai (May 2003). "High Sex Chromosome Aneuploidy and Diploidy Rate of Epididymal Spermatozoa in Obstructive Azoospermic Men". Journal of Assisted Reproduction and Genetics 20 (5): 196 - 203. doi:.
- ^ Vicente Abdelmassih, Jose P. Balmaceda, Jan Tesarik, Roger Abdelmassih and Zsolt P. Nagy (March 2002). "Relationship between time period after vasectomy and the reproductive capacity of sperm obtained by epididymal aspiration". Human Reproduction 17 (3): 736-740. PMID 11870128.
- ^ Vasectomy Reversal to Lead to Birth Defects. Bio-Medicine. Retrieved on 2007-12-17.
- ^ "Men advised to freeze sperm before vasectomy", Reuters.com, Reuters news agency, June 21, 2006. Retrieved on 2006-07-18.
[edit] External links
- The No-Scalpel Vasectomy.
- Family Planning: A Global Handbook for Providers Chapter 12:Vasectomy
- Articles on Vasectomies and Vasectomy Reversals
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