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Friday, January 23, 2009

Vasectomy (sterilisation for men)

What is vasectomy?Vasectomy is a simple and straightforward operation that stops sperm entering semen. It is a permanent form of contraception, but as a rule it shouldn’t interfere with your sex life because you will still have erections and produce semen.However, it's clear that a very small number of men do run into trouble after the operation. These include males who have psychological problems such as fear of castration. Also, there is an uncommon condition called ‘sperm granuloma’, which is a painful little lump occurring in the scrotum as a result of leakage of sperm. If it causes pain, it can be removed surgically or treated with anti-inflammatory pills. A few men get chronic (long-term) testicular pain after the operation. This is so uncommon that I personally have never seen a case in the UK. However, in some countries – notably the USA – there has recently been a good deal of publicity about this ‘Post-Vasectomy Pain Syndrome’ (PVPS). Nevertheless, vasectomy is a popular and routine operation these days, with about 18 per cent of British men having had ‘the snip’. Who can have a vasectomy?Provided you have thought it over carefully, any man can choose to be sterilised by having a vasectomy - though doctors are generally unwilling to do the operation on very young males, especially those without children.Vasectomy is a much simpler procedure than the sterilisation of women and is almost always done on an outpatient basis – in other words, without having to stay in hospital. You can usually go home a couple of hours after the operation.Can you get a vasectomy on the NHS?In some parts of the UK vasectomy is available free under the NHS, although in recent years getting funding has become more difficult.Even where NHS vasectomy is available, going private will almost certainly get you operated on much more quickly.
In remoter country areas of Britain, there is often one GP who does private vasectomies at his or her surgery.
In large cities, there are many clinics that will perform the operation for you, at a cost of anything between £350 and £700. The excellent Marie Stopes chain of charitable clinics currently charges a flat fee of £400.Who should you contact? You can talk to your GP, a family planning clinic or any reputable clinic that advertises vasectomy. They should tell you how the sterilisation procedure works and discuss the small risk of unwanted effects.You should talk over any worries with them - especially about sex. It's then a good idea to have at least a few days to think things over and discuss the procedure with your partner.I suggest you steer clear of any clinic that doesn't give you time to think about whether you want to go ahead. A vasectomy is a big step in a man’s life, and you shouldn’t let yourself be rushed into it.Does your partner need to know?It is folly to have a vasectomy without your wife or partner’s consent. Taking such a unilateral decision can lead to marital discord.In addition, it is technically possible that your spouse could sue you for depriving her of the chance of having further children.A good clinic will want to discuss alternative types of contraception with you, and to make sure that you and your partner are really happy with the idea of vasectomy and that you understand that you are taking this decision for life.What happens in a vasectomy? The actual surgical procedure sounds a bit alarming for most men, but there's usually very little pain and the operation is short.These days, it's nearly always done under a local anaesthetic.A few surgeons – mainly in private practice – like to do it while the patient is under a general anaesthetic. (Inevitably, this pushes the cost up quite a lot, because you have to pay for the anaesthetist and all his equipment and drugs.)
Did you know?
The tube that carries sperm to semen is called the vas.
Vasectomy means 'cutting out a piece of vas'.
You’ll be lying flat on your back. The surgeon will inject a little local anaesthetic into the skin of your scrotum, and after that you’ll feel no pain.
The surgeon makes a small cut in your scrotum. Working through this incision, he finds the slim, spaghetti-like tube that carries sperms upwards from your testicle. This tube is called the vas.
The surgeon cuts through the vas and then seals off the ends.
The surgeon does the same thing to the tube on the other side – and that’s it.
With modern techniques, the surgeon may not even need to use stitches. If there are any, they’ll probably be dissolvable.There are minor variations in the way that different surgeons perform the operation.
The surgeon may do the whole procedure through one incision instead of two.
The surgeon may use the much advertised no-scalpel technique. Instead of an incision, the surgeon makes a small ‘puncture’ in the scrotum, and then inserts a slim instrument through it. Some private clinics now have a lot of experience with this technique.Whatever the method, it’s generally all over within fifteen minutes. Will you have any problems afterwards?Most men are just a bit sore and bruised afterwards, but a few develop bleeding, marked swelling or an infection (symptoms: pain and a temperature). If any of these things happen, contact a doctor.Heavy bleeding is uncommon, but if it happens it could put you off work for several weeks.You should wear an athletic support (a jock strap) for a week or so after the vasectomy to ease the discomfort. Getting into a warm bath is also very soothing.Do not attempt any strenuous physical activity for at least a month after the op. Lifting a heavy weight could make a stitch slip and so cause bleeding, but this is uncommon.
Did you know?
In the last three years, a few men have tried to sue surgeons after developing sperm granulomas.
They claim they weren't told of the possibility of developing a granuloma.
When can you have sex again?You can have sex as soon as you feel like it after the operation (some men have sex within hours), but you'll need to use an additional contraceptive method for a while.Yes – you will produce semen. It will look just the same as before and the volume should be the same.Does sterilisation work immediately?After the operation, you will still have some sperm left in the tubes that lead to the penis. This means that you must use another contraceptive method for the time being.About two to three months after your surgery, you'll need to have a semen test to see if all the sperm have gone. Many surgeons like to make really sure by doing two tests.Once you have been reassured that no sperm can be seen in your ejaculate - under a microscope - then you can rely on your vasectomy without using any back-up contraception.But there is still a tiny failure rate. Occasionally, men who have had vasectomies find they have sired a child. This is because the tubing has joined up again.Can vasectomy make you impotent?Vasectomy does not cause impotence (erectile dysfunction). But it is easy to see that a man who already has psychological problems about sex could feel that his potency is threatened by the operation.This is why every man who wants to have a vasectomy should have careful preliminary counselling.If you are troubled by deep castration fears, and are terrified by the whole idea of the operation, then don’t go ahead.Similarly, anybody who has difficulties with getting or maintaining an erection is probably not the best candidate for a vasectomy.Is vasectomy 100 per cent effective against pregnancy? Vasectomy is not 100 per cent effective. Occasionally, pregnancies do happen. In Britain, estimates are that one in every 2000 vasectomies fails. This generally isn’t anybody’s fault.Are there any long-term consequences of vasectomy? We can’t answer this question for certain, because it’s only in recent years that vasectomy has become popular - so relatively little research has been done. As of yet, there have been no reports of any serious long-term consequences of having the snip.Some researchers have suggested that blood pressure is higher in men who have had vasectomies, but this has not been proven.Is vasectomy in any way linked to cancer?There have been studies that have indicated the risks of prostate cancer and testicular cancer are higher in vasectomised men, but so far nothing has been proven.Ask the doctor you consult before the operation to tell you if there’s been any newly published research. Will you regret being sterilised?You need to accept that having a vasectomy means you will probably never be able to have children again. You may be sure at the moment that you want to go ahead with the operation, but sometimes circumstances change.Men often change partners at some point in their lives - and a guy who has had a vasectomy will not be able to father children in a new relationship. What about reversal?It is possible to reverse a vasectomy, but this procedure is frequently unsuccessful.There are very few surgeons who can claim a success rate of more than 40 per cent.Some surgeons claim they have much higher success rates, but it usually turns out they mean that they have succeeded in re-joining the tubes or enabling the man to produce some sperm. This isn’t the same thing as achieving fatherhood.Reversal is now virtually unobtainable on the NHS. So if you are contemplating having a vasectomy, you should be as sure as you possibly can be that you won't regret the decision. The doctor should talk all this over fully with you before the vasectomy.At present, having a vasectomy reversal in Britain tends to cost about £4500 – with no guarantee of success. Health insurance companies are very unlikely to pay for this.In general, attempts at reversal of vasectomy are more likely to succeed if they are carried out fairly soon after the sterilisation.If you've had a vasectomy and later want to have children, there is the option of conceiving a child by artificial retrieval of sperm from your testicle. This is then followed by in-vitro fertilisation (IVF) of your partner's egg – in other words, a variant of the test-tube baby technique.But this is exceedingly expensive, and often does not work.

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