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July 19, 2000
Vasectomies Aren't for Weenies ...
But they are an easy and effective method of long-term birth control
By Robert Bryce

illustration: Barbara Shone

The first day was easy. Too easy.

In the hours following my departure from the urologist's office, I was certain that my friends who had had vasectomies were liars. I felt great. The operation was quick: I was in and out of the doctor's office within 40 minutes. Aside from some consternation about the puffs of smoke emanating from my pelvic area as the doctor cauterized a couple of blood vessels, the surgery was a breeze. I went home, had breakfast, and went back to work. I was pain-free. And better yet, there wasn't even any swelling.

The next morning, however, reality hit. My testicles were swollen and bruised, and my abdomen and lower back felt like they'd been pounded with a baseball bat. I began walking like a geisha to avoid unnecessary jostling and spent every spare moment sitting astride an ice bag. As it turned out, the tale my pals had been telling was true. The truth just took its time showing up.

I could rattle off some silly bromide like "real men get vasectomies," but the truth is no laughing matter. The fact is, vasectomies can be painful and the pain may last for weeks. In my case, it was three weeks before I could even think about running again. Even after a month, the idea of riding a bicycle wasn't appealing. Despite these facts, a vasectomy is the easiest and safest way for a couple to accomplish permanent sterilization. And that's what my wife and I wanted. We were overjoyed at the birth of our third child, but we wanted to make sure -- adorable as he is -- that he was our last.

Better birth control

Vasectomy has many advantages over other forms of birth control. Unlike tubal ligation, the female sterilization method, a vasectomy is cheap, can be done in a doctor's office, and involves little risk. And best of all, it's permanent. Because of the advantages, about half a million American men get vasectomies every year; one in every six men over the age of 35 has had a vasectomy. After tubal ligation and oral contraception, vasectomy is the most common form of long-term birth control among married couples.

The procedure works by preventing sperm, which are produced in the testicles, from traveling through the vas deferens -- the tubes sperm move through during sexual climax -- and exiting the penis during an ejaculation. Studies have shown that there are very few health risks associated with vasectomy, and the procedure doesn't have any negative effect on sex drive, potency, or orgasm.

Office procedure

Several surgical methods are now being used in vasectomy. In all methods, the doctor locates the left and right vas deferens, cuts a short section out of each, then cauterizes or ties the severed ends. The most common technique is the dual incision method, in which the doctor makes two cuts -- one on either side of the scrotum -- for easier access to each section of the vas deferens. A less common method, and the one used by my doctor, involves a single incision in the center of the scrotum. After making the incision, the doctor uses various instruments to locate and sever each side of the vas deferens. The newest method, known as the "no-scalpel" technique, makes use of a surgical tool to puncture the skin. A specialized clamp is then used to cut and divide the vas deferens. Proponents of this technique say it results in less discomfort and swelling and has fewer complications. In addition, because the hole is so small, no sutures are needed.

Whichever method is used, urologists make sure that the procedure is effective. As a rule of thumb, 15 to 20 post-vasectomy ejaculations are necessary to remove any remaining sperm from the system. Most doctors will require that a post-procedure semen sample be tested for the presence of live sperm. My doctor insisted that I provide two specimens several days apart to make sure that the vas deferens hadn't grown back together and rendered the vasectomy ineffective. He also required that I wait six weeks before ejaculating. "The normal internal healing span is six to eight weeks. That's the most likely time that the vas might grow back together. So it's not just number of ejaculations -- it's also the time frame," explains urologist Bernard A. Weinstein, M.D., a Texas doctor who has been a solo practitioner for 26 years.

Treat it like a sports injury

There are a few things you should be sure to do after your vasectomy. First and foremost, apply ice as soon as you can after surgery; it will reduce swelling later. That was perhaps my biggest mistake -- since I wasn't in pain, I didn't think I needed ice. Second, 24 hours or so after the procedure, begin taking hot baths daily -- the water temperature helps to reduce inflammation.

Finally, trust your friends. When they tell you it hurts, believe them. It does. But the pain goes away fairly quickly, and the worry-free rewards you'll reap afterward are worth it.

Related links:

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

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