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July 21, 2000
Vasectomy: A Doctor's Perspective

photo: J. Kevin Shushtari

Shortly after our last child, Hannah, was born the anesthesiologist came by the hospital room to prepare my wife, Julie, for a tubal ligation. The sterilization procedure required general anesthesia as well as an extra day in the hospital, and I couldn't help but feel guilty. Hannah's birth had been the smoothest of all of our three children's, and Julie seemed well enough to go home just hours after the birth. We didn't want to have any more children, and as a physician I knew that a vasectomy was a simple outpatient procedure. It just didn't make sense for Julie to undergo yet another medical procedure at this stage. "I'll just have a vasectomy," I announced. "Let's go home." Julie agreed.

Two weeks later, I lay on the urologist's table as he chatted with me about the stock market. I felt a burning sensation as he injected the local anesthetic into my scrotum, and an equally embarrassing flush as his two nurses, whom I knew well, watched the doctor perform the procedure. After a few minutes he was done, and one of the nurses escorted me to the dressing room, where I quickly pulled my pants on and hurried out the door to work. I felt fine. But that night, when I was called in to the hospital for an emergency at 3 a.m., I could barely walk. The nurses at the hospital laughed at me as I limped to see my patient. "You should try having a baby if you think that hurts," joked the nursing supervisor.

Tying the knot

In general, vasectomy is a simple, effective, and inexpensive surgical procedure designed to achieve permanent sterility in men. Vasectomy simply creates a physical impasse between sperm and the outside world. Sperm is created in the testes and is eventually transported through tiny tubes called the vas deferens. During a vasectomy, the surgeon creates a small opening in the scrotum after numbing it with a local anesthetic. Through this small opening, the surgeon severs the vas deferens and then ties off or cauterizes the ends. The entire procedure takes between 20 and 30 minutes.

Approximately 500,000 men have a vasectomy each year in the United States, and most are pleased with the results. Vasectomy is an extremely effective method of birth control, with a failure rate of less than 1 percent. It causes no change in sexual drive or performance. The testes still produce sperm cells, but they die and are reabsorbed by the body. For a few days after the surgery, discomfort is normal. A small percentage of men experience swelling of the scrotum, severe pain, bleeding, inflammation, and even infection, but these results are rare.

Myths and risks

You may be wondering if there are potential health risks involved with vasectomy that may make it an undesirable option for birth control. As with most health issues, there's plenty of false information out there, as well as some real concerns.

  • Prostate cancer? No. Several years ago, scientists raised the concern that vasectomy might cause prostate cancer. The issue was debated in the media and at medical conferences. The resulting studies do not indicate, however, that vasectomy leads to a greater risk of prostate cancer.
  • Testosterone production fluctuation? No. I once had a patient who claimed his sexual prowess was enhanced by his vasectomy. He even told his friends that his vasectomy increased his level of testosterone. Knowing this was impossible, since vasectomy does not affect sex hormones, I finally came to the conclusion that his increased virility was likely caused by his new spontaneous sex with his wife more than anything else. They had five children, and now there was no need to be concerned with condoms, pills, or spermicides. For this patient, undergoing a vasectomy rekindled his romantic spirit.
  • Autoimmune diseases? Possibly, with genetic predisposition. For a very few number of men, vasectomy has been known to lead to serious and chronic conditions. There is an extremely small incidence of autoimmune diseases like multiple sclerosis and rheumatoid arthritis following vasectomy. In my own case, I developed insulin-dependent diabetes mellitus, also an autoimmune disease, just six months following my vasectomy. Granted, I had the genetic predisposition to develop the condition -- both my father and sister suffered from it -- but it's possible that the vasectomy triggered it. Prior to my procedure, no one ever discussed the risk of autoimmune disease with me. Be sure to bring it up, and be clear about your family history to make sure you are not running any unnecessary personal risk.

In the vast majority of cases, vasectomy is an effective and safe method of birth control. It is not for everyone, however. As with any surgical procedure, be certain you do your homework before consenting to it. Talk to your doctor. Surf the Internet. If you know men who have had one, talk to them. Learn about the benefits and risks. Vasectomy tends to be viewed by most doctors as a simple outpatient procedure; generally it is performed as minor surgery. But the truth is, surgery is surgery; it alters your body permanently, and no matter how minor it seems, you need to have a heart-to-heart with your doctor about whether it is the best option for you.

Related links:

Rx.magazine feature story: Vasectomies Aren't for Weenies ...

Outside link: Information about vasectomies from JAMA's Contraception Information Center

Outside link: Facts about vasectomy safety from the National Institute of Health

 J. Kevin Shushtari, M.D., is's Chief Medical Officer and a co-founder of the company. He is also a board-certified internist with a medical degree from Dartmouth College. In Dr. Kevin's Column he will share his own experiences as a physician, a family member, and a patient.