VASECTOMY

Vasectomy, Reversing
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. 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. 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.

Peace Of Mind
For most men with vasectomies, the permanence is a benefit; it frees them from worries of unwanted pregnancies and the hassles of other forms of birth control.

Vasectomy Risks
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 man 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 man rests for an hour or two before going home. The cost of a vasectomy is roughly one-fifth the cost of female sterilization. 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, according to the Institute. As with all procedures, men are encouraged to ask his physician about the benefits, risks and costs of vasectomy and those of alternatives.

Vasectomy & Counseling
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.