Family planning is an important issue for many young couples as they join their lives together today. For most, birth control is paramount in their planning, especially after their first child.
There are several ways to achieve birth control for a young family. Among these are; intercourse timing, condoms, hormonal drugs, and abstinence. Excepting hormonal medications, which are only available for females, both men and women can use the techniques mentioned above. And each of them has a finite failure rate.
Surgical options are available for women, typically in a hospital, consisting of cutting or tying off the fallopian tubes that exit the ovaries carrying unfertilized eggs.
The primary surgical option for men is a vasectomy, typically performed on an out-patient basis in a urologist facility. Unlike some of the items mentioned, surgical sterilization provides, for all practical purposes, a 100 percent efficacy rate for both men and women.
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What is a Vasectomy?
A vasectomy is a surgical procedure that results in the complete sterilization of a man. When properly done, a man’s sperm cells can no longer be released to the outside world, and thus, he cannot conceive a child.
While a vasectomy can sometimes be reversed (see below), it should be viewed as a permanent and irreversible method of birth control for practical purposes.
A urologist typically performs a vasectomy, but it is offered by many general surgeons as well. It is usually an out-patient procedure performed with a local anesthetic and takes about 30 minutes to perform. Recovery is accompanied by a short period of low-level localized pain and supplanted by using ice to prevent pain and swelling. The patient can usually return to normal activities within 1 to 3 days.
The male reproductive anatomy includes two tubes called the vas deferens. These tubes convey active sperm cells from production in each testicle to storage in the seminal vesicles along with lubricating and nourishing fluids released by the prostate gland. This combined fluid is called semen.
When the man has an ejaculation, powerful muscles around the prostate force the semen stored in the seminal vesicles to be expelled to the outside world through the penis, if an active sperm cell in the semen embeds itself in a ripe egg in a female reproductive tract, a pregnancy occurs.
During the procedure, the doctor locates the vas deferens tubes on each side of the scrotum and manually manipulates them to be near the skin surface. Through a small incision in the scrotum, each tube is exposed and severed. Some doctors tie off the cut ends of the tubes; others remove a section of the severed vas deferens tube and may or may not tie off the severed ends. In all cases, the path of the sperm cells to the outside world is interrupted permanently.
Efficacy and Side Effects of a Vasectomy
A vasectomy is usually 100 percent effective. In very rare cases, the tubes’ severed ends can rejoin, or the body can build a path around them. This, of course, can result in a pregnancy. The success of a vasectomy is defined by a microscopic post-surgical examination of the patient′s ejaculate.
It can take several ejaculations to clear all of the sperm cells from storage. Most doctors require a minimum number of ejaculations post-procedure before examining the patient′s ejaculate. If the examination shows no sperm cells, the vasectomy is considered successful. If sperm cells are still present, the patient needs to have more ejaculations to clear the stored semen and sperm cells.
Once the microscopic semen examination shows zero sperm cells, the vasectomy is deemed successful, and the patient is cleared for sexual activity without ancillary birth control methods.
Aside from the usual complications associated with any surgery, bleeding, clots, etc., a vasectomy has very few disturbing side effects. One common short-term side effect is sperm granuloma. This is a lump of sperm about 1 to 2 centimeters in size that typically forms at or near one of the cut ends of the vas deferens tubes. A sperm granuloma does not usually cause any symptoms, and the body will often reabsorb it in a few months.
Vasectomy and Prostate Cancer
Vasectomy began to come into wide use in the early 1950s as a viable method of birth control. Due to its low cost, simplicity of technique, and measurable success, it became a popular sterilization technique for couples.
A tubal ligation on a woman, while also effective, required more intense surgery, a hospital stay as well as the usual surgical risk. Thus, a vasectomy became the birth control choice for many couples.
As the procedure became more popular, concerns arose that it could increase the risk of prostate-related problems, such as; BPH, erectile dysfunction, and especially prostate cancer. Several studies in the 1980s and early 1990s examined these issues and seemed to suggest that men with vasectomies may have a higher risk of getting prostate cancer. 1
However, recent studies have produced mixed results. The most current findings are still inconclusive. Most suggest that a vasectomy does not raise a man’s risk for prostate cancer, but some suggest it introduces a minimal risk. This is a challenging issue to study.
Men typically undergo a vasectomy when they decide they are done having children. In most cases, this is around the age of 35. Most prostate cancer is not detected until a man is considerably older, leaving a gap of about 30 or more years from the vasectomy procedure to a prostate cancer diagnosis.
During this lengthy period, there can be many confounding factors that limit the potential for determining the cause of cancer. In addition, many, many factors might influence the development of cancer over a long period. Low sperm quality, low ejaculation frequency, low number of offspring, as well as hormone imbalances, particularly long-term low testosterone levels, have been associated in numerous studies with an increased prostate cancer risk. 2
A man and his partner should seriously evaluate the choice of a vasectomy. In my opinion, it should be considered as a permanent, irreversible procedure since there are a few options for achieving pregnancy after a successful vasectomy. Mainly if the surgery was performed many years before.
Many urological surgeons remove 1 to 2 cm of the vas deferens tubes during the initial surgery, making a successful reconnection difficult. In addition, the human body is quite good at shutting down processes that it detects as unused. After a vasectomy, sperm produced by the testicles have nowhere to go since the normal distribution channel (the vas deferens) has been severed.
The body detects this and absorbs the sperm produced by the testicles. As time progresses, the body senses that the sperm no longer has a purpose, eventually stopping sperm production. Reversing a vasectomy invariably involves reconnecting the vas deferens tubes that carry the sperm from the testicles to the outside world. However, this exercise is futile if the body is no longer producing viable sperm.
A surgical vasectomy reversal can take several hours compared with the initial operation taking less than 1 hour. In addition, there is no guarantee that the reversal will be successful and result in a pregnancy.
Various studies claim high pregnancy success rates after vasectomy reversal. However, many of these reports may be financially motivated, depending on the facility. Recent studies reviewed for this article claim success rates from less than 30 percent to more than 90 percent. Note that almost all of these studies came from urology clinics that performed the procedure. Other studies have indicated dismal rates of effectively reversing vasectomies.
A man and his partner that decide they would like to have children after vasectomy was performed many years before may find their options limited to surgical sperm extraction, in-vitro fertilization techniques, or a combination of both. 3
There is some controversy regarding whether the standard sterilization procedure of vasectomy influences prostate cancer risk. While some studies associate vasectomy with an increased risk, others find no direct association. In any case, the absolute increase in risk for prostate cancer following a vasectomy is minimal. Other lifestyle, aging, and dietary factors may play a much more critical role in risk stratification.
Scares about a vasectomy inducing prostate cancer was fueled by a few studies in the early 90s as the procedure became popular. However, fears that a vasectomy would lead to prostate cancer years later have been debunked by recent research.
Men with vasectomies seem to have a minimally higher risk of acquiring prostate cancer. But this risk may be strongly related to the characteristics of the type of man that chooses a vasectomy.
A vasectomy is an extremely effective method of preventing pregnancy. If the vasectomy was performed correctly and a lack of viable sperm subsequently confirmed post-surgery, the rate of success at preventing pregnancy is 100 percent.
Find out some more Prostate Cancer Prevention Strategies and How To Reduce Your Risk.