Is Vasectomy Really Safe?

Vasectomy rates are at an all-time high and approximately 500,000 men in the U.S. per year put their intact sexual function on the line to join the ranks of their care-free, sterile, vasectomized peers. Most of them do little research on the procedure prior to taking this risk and simply talk to a few friends or relatives, giving them a sample size of 4 or 5  with which to extrapolate their own vasectomy outcome. Many are pushed to get the procedure done by a recent unplanned addition to their family or by a spouse who figures “its your turn to take care of the birth control” after several pregnancies or a cesarean section. Who can blame them? Taking hormone tablets for decades is troublesome, risky, can have side effects, and may cause a lot of unintended effects. Guess what? So can vasectomy.

The advertising for vasectomy promises a relatively pain-free procedure, minimal or no side effects, with no change in sexual function. The websites of doctors who perform this lucrative procedure (a doctor who does several vasectomies a day at $600 or more per procedure can easily add $300,000 per year to their practice income) are written to placate men and focus almost entirely on good outcomes. The bad outcomes are barely mentioned and the consent forms for the procedure are frequently inadequate and gloss over these outcomes in deference to the party line: No change in sexual function, or no noticeable changes at all with minimal pain, a very short recovery, and no after-effects whatsoever. This is simply not always true.

It is true that many men do well with vasectomy. Satisfaction rates can be up to ninety percent or more. If a man experiences a change in sexual function after vasectomy, he is not going to mention it to anyone. Men are very shy about talking to anyone about their sexual function due to the “macho” culture we live in. Can you imagine talking to a friend about how your vasectomy went bad? No way. If you were brave enough to mention it, you would be told “mine went fine, no troubles at all” and left with the feeling that you were just “not man enough”, are a “complainer” or were just unlucky. Soon, everyone you hang out with would know how your “vasectomy went bad” bringing up connotations that you are a sexual invalid or not an able bodied man in the sexual arena. You would never mention it again, and there’s the rub, the men with bad outcomes do not talk about them.

Changes in sexual function that have been reported to me either in my on-line support group or reported in the medical literature include:

• Decreased ejaculate volume or expulsive force (you can go from a “shooter” to a “dribbler” which would seem to reduce sexual pleasure) as well as decreased ejaculate consistency (men complain that this reduces orgasmic sensation).
• Decrease in orgasm sensation (likely due to anatomical variants amongst men as to the innervation or nerve pathway of this function or damage to nerves from the surgery or scar tissue)
• Decrease in libido (perhaps due to psychological issues with being sterile or from other changes in orgasmic function or from a drop in testosterone levels over time from testicular damage/fibrosis)
• Decrease in erectile potency (usually not frank impotence) or an increase in erectile latency (taking longer to get an erection)
• Pain during ejaculation (due to back pressure in the now closed system and congestion of sperm in the epididymides) or after ejaculation (from the same mechanism)
• Testicular pain that can be a chronic dull ache (congestion related or due to an auto-immune reaction to sperm that causes testicular inflammation/scarring) or sharp pains in the testes has also been reported

I have written many other articles here on these topics and direct you to these if interested:

• http://healthmad.com/addiction/why-is-vasectomy-oversold-and-described-as-having-no-sexual-side-effects/
• http://healthmad.com/addiction/the-affects-of-post-vasectomy-pain-on-sexuality-and-quality-of-life/
• http://healthmad.com/addiction/vasectomy-causes-testicular-damage/
• http://healthmad.com/addiction/ten-reasons-not-to-have-a-vasectomy/
• http://healthmad.com/addiction/immunologic-effects-of-vasectomy/

Known side effects of vasectomy that are usually included on the consent form include:

• Hematoma - bleeding in the scrotum from the surgery itself can cause nasty bruising, pain, and large blood collections that can take up to six weeks to get “reabsorbed” or sometimes need a second procedure to drain the blood
• Infection – like any surgery, you can get an infection that would require antibiotics, but some men develop abscesses that require surgical drainage and may have a rubber drain inserted in to the scrotum for days
• Sperm granuloma – a local immunologic reaction to sperm leakage that causes scar tissue that can become attached to nearby nerves and may require surgical removal. These can be up to a few centimeters in size and can be quite painful, although they resolve on their own in many men.
• Congestive epididymitis - If the re-absorption of backed up sperm fails or is inadequate, the epididymides become enlarged, inflamed and can be quite painful. This known side effect can sometimes lead to chronic post-vasectomy pain and can affect ability to participate in sports on a long-term basis. Some men with congestive pain respond to conservative treatment, but about 1% of vasectomized men seek a vasectomy reversal to relieve this condition. The corrective surgery (vasectomy reversal) is not covered by insurance and can cost from $6000 to $10,000.

With the reported sexual side effects and the known physical complications, it is amazing to me that vasectomy enjoys relatively unblemished public support. I encourage you (or your spouse) to read extensively about the procedure before you put your intact sexual function on the line. I guarantee that if you end up in the men with bad outcomes, you will kick yourself for not having been better informed. In addition, any pressure to have the procedure is unfair given the known problems with vasectomy. The average vasectomized male is married, 35 to 40 years old and has several children. You might choose ten years of condoms over vasectomy and simply wait until your spouse goes through menopause. Condoms are over 90% effective and can’t cause chronic pain or any other complications except unintended pregnancy. Personally, I’d rather have another child than end up with chronic testicular pain or significant changes in sexual function.