Immunologic Effects of Vasectomy

Vasectomy can be performed in a doctor’s office in around twenty minutes. Vasectomy is “pushed” as a completely safe, side-effect free procedure in advertisements on the Internet. It is pushed culturally and a suggestion is implicit that men should become more responsible for birth control. In fact, you will see references like this on the Internet, “…an estimated 20 to 30 women die in the United States each year from complications from tubal ligation surgery. Dr. Kennon, an urologist at Tripler Army Medical Center in Honolulu observes, “We [men] are subjecting our wives to a life-threatening procedure when we should be stepping up to the plate ourselves.”

The idea that men should “step up” to the plate and have a vasectomy may contribute to the estimated 500,000 vasectomies performed each year in the United States. Even with the vasectomy “push”, tubal ligations still outnumber vasectomies by about two to one. But this article is not about which procedure is best. I am not a fan of surgical treatment for infertility, but accept that each person must choose for themselves what to do about these matters.

The post-operative pain and swelling associated with vasectomy are fairly easy to mange with Tylenol, ice packs, and a few days rest. The acute complications of excess bleeding and infection are not common and usually respond to available treatments. This is the story you are meant to see. During the consent process, little is said about the long-term effects of vasectomy or effects on sexual function.

When a man has a vasectomy, his body continues to produce sperm. There is nowhere for this sperm to go and while some of it is reabsorbed, the amount produced can present some problems. In many men, this sperm builds up in the tail of the epididymis (a mushy sperm maturation organ connected to the testes). This leads to leaks in the epididymal lining. Sperm can then leak into areas they were never meant to be, and stimulate a different and stronger antibody response than is normal and seen during puberty.

You see, sperm is highly antigenic, meaning it stimulates a strong immune response. It is recognized by the man’s body as foreign. During puberty, some anti-sperm antibodies develop when the body is first exposed to sperm. Prior to this, the man’s immune system has never “seen” sperm. After puberty, the sperm are protected by a “blood-testes barrier”. When this barrier is broken by vasectomy and sperm are “presented” to the immune system, new anti-sperm antibodies are formed and the previous “normal” immune response becomes abnormal in strength, specific antibody types, and perseverance of response.