Under The Knife

By Pat Albertson

Well, you have got those two, three or however many beautiful children to brighten your life and keep you busy.

Now you and your partner have decided that the family is complete and it is time to think about some very reliable form of contraception.

There are a variety of options out there these days, and most of them involve something to do with the female partner. For men there are just two options, condoms or “the V word”, ie vasectomies.

In the Western World, vasectomies are on the increase and have been in use in New Zealand for at least 50 years. In fact, we are the most vasectomised nation in the world with 22-25% of men choosing this option.

However, before we start examining the pros and cons of using this form of contraception, it’s time for a few facts, some of which may set at rest the minds of a few men out there:
A vasectomy involves cutting and tying the tubes known as vas deferentia that transport the sperm from the epididymis to the ejaculatory ducts (as an interesting aside, the sperm originate in the testes and their journey through the epididymis takes three weeks while they swim through the twenty foot coiled tube; maybe you could think about that the next time you are feeling romantic); A vasectomy that is performed correctly will have no noticeable effect on sexual drive, performance or pleasure.

In fact, some men report an improvement in their sex life since the worry of accidental pregnancy is substantially reduced; Having a vasectomy will make only minimal difference to the amount of semen you ejaculate since the sperm is only a very small component of semen – the rest is made up of fluid from the prostate gland and semenal vesicales.

Therefore you can rest assured that, after the operation, you may be firing blanks but you will still have plenty of ammunition.

It is easy to see why vasectomy is such an attractive option, especially since (despite the title of this article) it can even be done with lasers.

However, is it presented as being too easy? After all, vasectomies were being offered as prizes in a fathers’ day radio competition last year, and men that I talked to seemed to have made up their minds about having the op without actually having read about the possible health risks.

Not only that – it may seem like the same people who are loudly proclaiming that “women should have control over their own bodies” are also the first ones to tell you that “men should take the responsibility for permanent contraception”!

Then again, there is the relationship aspect; after all, if this relationship ends, there are no guarantees that your new partner will not want kids.

Let’s talk about the health risks first.

Interestingly, the Family Planning Association handout did not mention any of these but there is plenty of literature out there, much of it conflicting.

For example, a study reported in the American Journal of Epidemiology, December 1990 stated that there was a 70% higher risk of prostate cancer for men who have had vasectomies.

That is obviously cause for alarm and yet other studies were inconclusive and Family Planning, who were familiar with the 1990 study, questioned its validity.

The Lycos Health Network, which has a lot of interesting and useful information, also discusses studies with conflicting results and found that there may be a very slight increased risk of developing prostate cancer following a vasectomy (ie 27 cases out of 13 000 over a thirteen year period). They conclude that “men who have a family history of prostate cancer should discuss the risks and benefits of vasectomy with their physicians”.

Personally, I would advise all men who are considering having a vasectomy to discuss the risks and benefits with a variety of people.

Men should be pleased to know that there is no evidence of any link between vasectomies and testicular cancer, so that brings us to the question of what happens to all the sperm that is made in the testes? After all, we continue to generate 500 000 sperm an hour (another thought for a romantic moment) so where does it all go?

When I put this question to the person who performed my vasectomy, he advised me that it was all protein and would therefore be harmlessly absorbed back into the body. However, this does not appear to be com-pletely correct.

One information source stated that it affected the autoimmune system and could lead to various unpleasant complications such as lymph node enlargement, joint inflammation and diabetes – small comfort may be gained by the fact that no studies were cited to support this.

The Lycos Health Network, on the other hand, reported that the World Health Organisation and the National Institute of Health have concluded that vasectomy is a safe procedure so maybe we can all breathe easier.

Family Planning advised me that the main effect of sperm on the autoimmune system was to produce anti-sperm antibodies and this is why the chance of a successful reversal decreases as the years go by.

Speaking of reversals, let’s talk about the man who, for one reason or another, changes his mind following a vasectomy. After all, you may have made a rash decision to stop at one or two children especially if you happen to win lotto, or if (perish the thought) a tragic accident should occur.

Of course there is also the possibility that your family situation may change, and you and your new partner may want some children.

Everyone knows that vasectomies can be reversed but how successful is it really? Family Planning advise that, in their experience, relationship changes are the most common reason from men wanting a reversal and that the success rate for this is around 70-80% within the first five years, gradually decreasing over time due to these anti-sperm antibodies that were discussed earlier.

If in doubt, you can always arrange for some sperm to be frozen prior to the vasectomy but this is not guaranteed to work, either, and Family Planning told me that they have never had anyone use that option.

All the literature and health professionals seem to agree that you should think of worst case scenarios before deciding on an operation that is, after all, intended to be permanent sterilization. Also consider the $1200 fee for reversal before you take the plunge.

Can vasectomies be seen as being empowering for men who are now able to exercise control over their own bodies, or is there any truth to that stereotypical picture of the henpecked male being pushed into the operating room by his domineering partner?

Family Planning say that, if they are concerned that a man is being “pushed” by his partner into having a vasectomy, they may advise against going through with the operation and instead recommend marital counselling.

Of course, if a man decides not to have a vasectomy, that decision alone will not solve the couple’s contraception problems and they must they re-examine the other alternatives, most of which involve the woman and all of which have their own pros and cons.

In summary, vasectomies are often seen as an easy option for permanent contraception, but remember that it involves invasive surgery and has its own short and long term health risks, however minimal they may be.

Check out the Lycos health website to get some of the facts and don’t be afraid to ask questions of your GP – after all, it is your body.

Also, don’t forget that a vasectomy is for permanent sterilisation and there are no guarantees that it can be successfully reversed in any individual case. Consideration of all possible future scenarios, such as deaths in the family or relationship break-ups, may help you to appreciate the gravity of your decision (or at least keep you awake at night worrying.)

Finally, don’t forget that contraception involves you and your partner working together to find a satisfactory method and, although many men are very happy with having had successful vasectomies, there are still plenty of other options out there for both of you to check out before deciding to go under the knife.

Next: Hollywood Dads