Facts About Vasectomy

Introduction

Until recent years, few people questioned the long-term safety of vasectomy. A couple considering vasectomy was more likely to ask a doctor about the operation itself, its effectiveness, or how it might change their sexual relationship. Things have changed. Men considering vasectomy and their partners now want to know about long-term side effects. Their biggest concern is hardening of the arteries or heart disease--issues raised by animal studies in the late 1970s. Researchers speculated then that sperm antibodies, produced by many men following vasectomy, could be responsible for these and other health risks.

This concern prompted the National Institute of Child Health and Human Development (NICHD), the nation's largest supporter of research on birth control methods, to start a multimillion dollar program of vasectomy research. Fortunately for the millions of men with vasectomies and their families, the latest news about its long-term safety is good.

Almost 40,000 men took part in four studies completed in recent years under contracts with the Institute. The findings are reassuringly similar: None show an increased risk of hardening of the arteries or other forms of cardiovascular disease in men with vasectomies. In fact, one study found that, for unknown reasons, men who have had vasectomies are healthier in some ways than those who have not.

While this is good news for men with vasectomies, those who are considering it should still give the decision serious thought, because vasectomy is generally permanent. Although new techniques for reversing vasectomies may increase the odds that fertility will return, there are no guarantees. Realizing this, and being up-to-date on news about long-term safety, can help couples today to make informed decisions about vasectomy.

After Decline, Vasectomy Popularity Jumps

Sterilization--including both vasectomy and female sterilization--is now the most popular form of birth control in the United States, chosen by four out of 10 couples who use contraception.

Vasectomy is far simpler and less expensive than sterilization for women. Yet today, fewer men than women undergo sterilization procedures. Just a short while ago, this was not the case.

In the mid-1970s, men and women had sterilizations in nearly equal numbers. Gradually, however, more and more couples opted for female sterilization, until these procedures outnumbered vasectomies by 2 to 1 in 1982.

Fears about the long-term safety of vasectomy were at least partly responsible for a decline in vasectomies, experts believe, along with easier and safer sterilization operations for women.

But now that trend seems to be reversing. The Association for Voluntary Sterilization (AVS) noted a 50 percent jump in vasectomies performed between 1982 and 1983. The AVS credits this increase to "evidence from scientific studies that has dispelled lingering doubts about the safety of vasectomy."

Long-Term Safety: The Antibody Question

Concern over the long-term safety of vasectomy first arose several years ago when researchers discovered that many men produce antibodies to sperm following the operation. Fortunately, investigators have since found no evidence that this immune response causes health problems in men.

Antibodies are disease-fighting substances that circulate in the bloodstream. Normally they protect the body from invaders such as viruses, bacteria, and foreign cells. In the case of many vasectomized men, however, the body's immune system mistakes sperm for foreign cells and forms antibodies against them.

This happens because early in infancy, the immune system learns what is native to the body and what is foreign. Sperm cells are not produced until years later, at puberty. But at that time, they are essentially hidden from the immune system by barriers in the reproductive tract, so antibodies are not formed.

After vasectomy, however, the protective barriers can be broken. The testicles still produce sperm, which the body absorbs. In the process, antibodies often form.

One-half to two-thirds of men who have had vasectomies develop antibodies to sperm after the procedure. It is not known why some men produce more or fewer antibodies than other, and some none at all. A very small percent of men without vasectomies also develop sperm antibodies because of surgery, infection, or inborn abnormalities of the reproductive tract.

In men with vasectomies, the antibodies may persist for 10 years or more after surgery. Doctors became concerned about this immune response because they felt that, in theory, it might have adverse consequences.

The most serious side effect that was suggested by studies in monkeys is a worsening of hardening of the arteries. When these studies were reported in the late 1970s, the investigators thought the antibodies might play a part in damaging inner walls of arteries. Nevertheless, research to date has not demonstrated that these findings apply to men.

As an example, one study showed that the level of sperm antibodies in a man's bloodstream does not affect his risk of developing coronary heart disease. At the Battelle Human Affairs Research Centers in Seattle, WA, a group of scientists found that high levels of sperm antibodies were equally common in men with and without heart disease. There was no evidence, moreover, that the antibody levels increase over time.

Before a man has a vasectomy, it is very important that he and his partner receive thorough counseling that permits them to ask questions and express any fears they may have. This forces a couple to become sure of their decision; without it, some anxieties are likely to remain. Vasectomy counselors are urged to explain all other methods of birth control, in addition to giving full details on the benefits and possible drawbacks of vasectomy.

Largest Study on Vasectomy: Healthier Men

Even before the findings from the monkey studies were reported, the NICHD started a project that became the largest study on vasectomy performed to date. The study, involving more than 20,000 men in four U.S. cities, was designed to find out if the immune reaction following vasectomy could lead to any health problems.

In announcing the study, health officials stated that because it is the most comprehensive assessment ever performed on this topic, the results are especially encouraging. In almost every category of illness, the men with vasectomies were either no more prone to disease than the other men, or even less likely to become ill.

In this study, based at the University of California at Los Angeles, scientists compared the rates of more than 100 diseases in 10,590 men who had vasectomies and an equal number who had not. When the study began in 1976, they were mainly interested in diseases that might be related to an immune response, such as rheumatoid arthritis. But when early results from the monkey studies appeared the next year, they added a special focus on cardiovascular disease.

The study's results, reported widely in 1983, showed that men with vasectomies have no more health problems than other men--including diseases involving the immune system, cardiovascular disease, cancer, and impotence. This held true for specific diseases that had been cited as possible complications of vasectomy, including hardening of the arteries, rheumatoid arthritis, blood clotting disorders, gout, and multiple sclerosis.

The only condition seen markedly more often in the vasectomized men was epididymitis, a local inflammation near the site of the operation. This complication, which was previously known, occurs mostly within the first year after vasectomy. Treated with heat, it usually clears up in a week.

Otherwise, men with vasectomies were just as healthy as other men, if not more so. Besides having fewer cases of cancer and heart disease, the men with vasectomies also had one-third fewer deaths. The lower death rate was found for all causes of death except accidents and violence, which killed the same number of men with and without vasectomies. The researchers do not know why men with vasectomies had better survival rates overall.

The vasectomy operation is quick, safe, and inexpensive. Usually it is performed in a doctor's office or clinic and takes only 10 to 15 minutes.

After giving the patient a local anesthetic, a doctor generally makes two small incisions, one on either side of the scrotum, then locates the two thin tubes that carry sperm, seals them off, and closes the incisions. The patient rests for an hour or two before going home.

Recovery from the vasectomy operation is rapid, and serious complications are rare. Swelling, bruising, and pain--the most common complaints--occur in about half of men after vasectomy. The discomfort subsides within a week or two and usually responds to treatment with ice packs, mild pain killers, scrotal support and rest. Men are generally advised to avoid strenuous work or exercise for about 2 days after the operation.

A minority of men develop a small lump of inflammatory tissue called a granuloma near the incision site. Granulomas, caused by sperm leaking into surrounding tissues, usually stay so small that they don't cause symptoms. If they do cause pain, it is generally treated with bed rest and mild pain killers.

Fewer than 3 in 100 men develop complications such as infection, hematoma (bleeding under the skin), or epididymitis (inflammation of the tube that collects sperm from the testes). All can be treated, and no deaths from vasectomy have been reported in the United States.

Vasectomy is one of the most effective means of birth control, with a less than 1 to 100 chance of failure. It does not offer immediate protection from unwanted pregnancy, however.

The reproductive tract is not clear of sperm for several weeks, and other forms of birth control must be used until a semen sample, generally checked at 6 to 8 weeks, shows no sperm. The most common reason for vasectomy failure is probably unprotected intercourse before all sperm have cleared the reproductive tract.

Other Major Studies: Consistent Findings

While the UCLA project looked at the rates of all possible diseases in men, other studies in the NICHD's program of vasectomy research have taken a more specialized approach. Three large studies in men have focused on the question raised in animal studies about hardening of the arteries and heart disease. Again, the findings for men with vasectomies are favorable.

One study involved more than 7,000 men who had hardening of the coronary arteries, which supply the heart muscle with blood. Researchers at the Medical College of Wisconsin looked for factors that might influence the severity of coronary blockage. They found no connection between vasectomy and the disease, but they did confirm that age, smoking, and high blood pressure all make coronary blockage more severe.

The question of long-term safety was tackled in another study--this one involving 5,000 men--based at the Battelle Human Affairs Research Centers in Seattle, WA. Many men in the study had had vasectomies for more than 25 years, while the average time since vasectomy was 15 years, the longest in any study to date.

Regardless of the length of time since the procedure, the men with vasectomies did not have a greater risk of heart disease. The researchers reported that "this finding strengthens the results of all previous studies in humans," which also found no relation between vasectomy and heart disease.

Similarly reassuring findings have come from the latest study, a Boston University project involving about 6,000 men. Results show no higher risk of heart attack in men with vasectomies.

In all, the NICHD and other organizations have sponsored more than a dozen large studies on vasectomy involving more than 100,000 men. None show a greater risk of any serious illness in men with vasectomies. And contrary to the findings in monkeys, none demonstrate an increased risk of hardening of the arteries or heart disease.

When Permanence Is a Problem

While safety is a major consideration in choosing a birth control method, another important factor is convenience. Vasectomy's permanence makes it convenient; within a few weeks after the operation, no other steps must be taken to prevent pregnancy.

Although this is an advantage to most men who have the operation, it is a drawback for a very small percent of them.

Approximately 2 in 1000 men who have vasectomies regret it later and wish to have the operation reversed.

The main reasons for requesting a reversal are remarriage, death of a child, or an improvement in finances followed by a wish for another child. Fewer than 10 percent of men who request reversals do so because of physical or psychological problems following vasectomy.

After vasectomy, a man can safely resume having sex (using another form of birth control until his semen is free of sperm) as soon as he feels comfortable. Because the sperm and fluids from the area sealed off by vasectomy make up only a small fraction of the total fluid ejaculated, he should notice no difference in the amount of fluid nor in its appearance. The size of the testicles remains unchanged as well.

Two common worries about vasectomy are that it will reduce a man's sex hormone levels or take away his ability to have sex. These myths have no biological basis, however, because vasectomy only prevents the escape of sperm from the reproductive system, not the release of testosterone, the male sex hormone, into the bloodstream.

Both sperm and testosterone are produced in the testicles, but they leave by different routes. Sperm move through a series of ducts that channel through the reproductive organs to the outside of the body, while tiny veins in the testicles transport testosterone into the bloodstream.

So when vasectomy seals the tubes that carry sperm, it doesn't affect the transfer of testosterone into the bloodstream. Therefore there is no physical reason for a loss of sex drive or other sexual characteristics. A small percentage of men--less than 1 to 5 percent--have psychological problems after vasectomy that can include a drop in sex drive. But according to a report from the Johns Hopkins University Population Information Program, reactions like these can be reduced with careful counseling before the operation.

Serious marital, psychological, or sexual instability should be treated as possible reasons for not having a vasectomy, according to the report. It also states that "vasectomized men and their wives usually report either no change or an improvement in marital happiness and sexual satisfaction.

Reversal Operations: No Guarantees

In contrast to the original operation, the vasectomy reversal is a complicated, delicate and expensive procedure that is not covered by medical insurance. The difficulty lies in trying to reconnect the sperm-carrying tube's inner canal, which is the size of a pinpoint. And although new surgical techniques are improving the chances of success, no doctor can guarantee that a reversal operation will result in both the reappearance of sperm in the semen and, ultimately, the achievement of pregnancy.

Pregnancy rates following vasectomy reversal range from 16 to 85 percent. Success depends on several factors, including the ability of the surgeon performing the reversal, the way in which the original operation was performed, and the time lapsed since vasectomy.

Some reports show that when reversal is performed within 2 years of the original operation, men can expect sperm counts eventually to return to normal. If it is done between 2 and 10 years later, they have about a 90 percent chance, and if it is more than 10 years they have only a 35 percent chance of regaining normal sperm counts.

But returning sperm counts to normal is only half the battle; the other half is achieving pregnancy. Here, the fertility of the woman must be considered as well. Another factor in question is whether men with high levels of antibodies to sperm are less likely to regain fertility following a reversal operation.

Physicians are often asked about the possibility of storing frozen semen in sperm banks before vasectomy, as a safety measure. Few men follow up on this, however. While it is possible to bank sperm and later establish pregnancy, it works an estimated one time out of four. Some experts believe that individuals who want to bank sperm probably shouldn't have a vasectomy, because they most likely have doubts about giving up their ability to father a child.

Peace of Mind

For most men with vasectomies, though, the permanence is a benefit; it frees them from worries of unwanted pregnancies and the hassles of other forms of birth control. And now they can also take reassurance from findings of current research on vasectomy's long-term safety.

More information on vasectomy is available from the following sources:

• Association for Voluntary Sterilization
  122 East 42nd Street
  New York, NY 10168
  (Brochures for men and women interested in sterilization)

• Population Information Program
  Johns Hopkins University
  Hampton House
  624 North Broadway
  Baltimore, MD 21205
  (In-depth reports on vasectomy and other forms of birth control)

• National Clearinghouse for Family Planning Information
  P.O. Box 12921
  Arlington, VA 22209
  (Bibliography on male and female sterilization; other birth control information)

• Planned Parenthood
  Publications Department
  810 7th Avenue
  New York, NY 10019
  (Send 50 cents for brochure called "All About Vasectomy")

"Facts About Vasectomy Safety" was written by Maureen B. Gardner, Office of Research Reporting, National Institute of Child Health and Human Development (NICHD).

The NICHD, part of the Federal Government's National Institutes of Health, conducts and supports research on the processes that determine the health of children and adults. For copies of this fact sheet or others in this series, write to the National Institute of Child Health and Human Development, P.O. Box 29111, Washington, D.C., 20040.

Document Source:
U.S. Department of Health and Human Services
Public Health Service
National Institutes of Health
National Institute of Child Health and Human Development
[Thanks also to: Rees AM (ed): Phoenix, Oryx Press, 1995, pp 90-93. And MEDSCAPE]

This information is provided for educational purposes only. Please read the disclaimer. All rights reserved ©2006.  Do not reproduce without permission of the.