Sunday March 10, 2013
Making him sterile
THE DOCTOR SAYS
By Dr MILTON LUM
A man can be sterilised by blocking or cutting the vas deferens, a tube-like structure that carries sperm from the testicles to the penis.
STERILISATION is a permanent contraceptive method. It is meant only for people who are sure they do not want any more children or who never want any children.
If either partner has any doubts or concerns, it is advisable to use some other reversible contraceptive method, which is almost or just as effective as sterilisation.
There is evidence that the incidence of regret is higher among men and women aged less than 25 years, or who had no children or were not in a relationship. As such, most doctors are not keen to sterilise young or single people.
Sterilisation prevents the sperm and the egg from meeting by blocking the vas deferens, which is the tube-like structure that carries sperm from the testicles to the penis in the man; or by blocking, cutting or sealing off the fallopian tubes, which carry the egg from the ovaries to the uterus.
This article is about the former, which is male sterilisation (vasectomy). The vas deferens, which carry sperm from the testicles to the penis, are cut in this minor operation, which takes about 10 to 15 minutes, and which can be done as an outpatient procedure.
A vasectomy should always be viewed as permanent. Reversal is sometimes possible with microsurgery to re-join the cut vas deferens. However, a successful operation does not mean that it is possible to father a child.
A discussion with the doctor about the family circumstances and wishes is vital in making the correct decision. The doctor will provide the relevant information and counselling before carrying out the procedure.
A vasectomy should only be considered if there is absolute certainty that any, or any more, children are not wanted.
If there is any doubt, another contraceptive method should be used until one is absolutely sure.
Decisions about vasectomy or female sterilisation should never be made during or after a major event in one’s life, eg childbirth or miscarriage.
A discussion with spouse or partner is helpful prior to a decision on vasectomy. It would be preferable if the couple both agree to the procedure, although it is not a legal requirement to have the spouse’s or partner’s consent.
A vasectomy can be performed at any age. However, doctors are generally reluctant to do a vasectomy or female sterilisation in individuals below 30 years of age, especially if they do not have children because there is an increased likelihood of regret.
Advantages and disadvantages
A vasectomy is usually carried out as an outpatient procedure. It is a simpler, safer and more reliable alternative to female sterilisation.
The testicles will continue to produce male hormones and sperm after the procedure, just like before. The hormones get into the blood stream, but the sperm do not get into the ejaculate.
A vasectomy does not affect sex drive (libido) or sexual intercourse.
There are few or no disadvantages to vasectomy. Complications are uncommon. After the operation, there may be some bruising, swelling or pain in the sac around the testicles (scrotum).
Sometimes, there may be bleeding or swelling (haematoma), which is a collection of blood and clots around a disrupted blood vessel in the scrotum. Haematomas are usually small, about the size of a pea. A large haematoma can be painful and cause scrotal swelling.
If there is a large haematoma, it may have to be treated with surgical drainage.
As with all surgical procedures, however minor, infection can occur. As such, it is vital to keep the genital area clean and dry to reduce the likelihood of it occurring.
Sperm may sometimes leak out from the cut vas deferens and collect in the surrounding tissue, forming hard lumps (sperm granuloma). There may be swelling or pain immediately or a few weeks or months after the procedure.
The granuloma is usually not painful and is easily treated with anti-inflammatory medicines. If the granuloma is exceptionally large or painful, surgical removal may be necessary.
The epididymis, which is the coiled tube at the back of each testicle that transports and stores sperm, may become filled up with sperm after the operation. This may lead to a sensation of fullness in the testicles. Such feelings usually resolve within a few weeks.
During the vasectomy, a nerve may be pinched or scar formation may occur. This may result in pain in one or both testicles immediately or up to a few years after the procedure. The pain can be occasional, frequent or episodic, with dull constant ache and episodes of sharp pain.
This long term testicular pain is usually mild in most patients, with no need for further treatment. If it is problematic, additional surgery may be recommended.
The cut vas deferens may rejoin after a vasectomy. The failure rate is one in 2,000.
After injecting a local anaesthetic, the doctor will make one or two small incisions in the scrotal skin. After both vas deferens have been identified, they will be cut or a small segment of both removed, and the ends closed either by tying them with sutures or sealing them with heat from a diathermy device.
The scrotal incisions are usually small, about 1cm long, and stitches may not be required. If required, stitches that dissolve or surgical tape may be used.
Vasectomy can also be carried out without any scalpel. In this approach, the doctor feels for the vas deferens beneath the scrotal skin and holds them in place with a small clamp. A small puncture hole is made in the scrotal skin and the hole is opened up with a small pair of forceps to access the vas deferens without making an incision in the skin. The vas deferens are then cut or sealed as above.
There is minimal bleeding in no-scalpel vasectomy, which is believed to be less painful and with fewer complications and need for stitches.
The majority of vasectomies are carried out under local anaesthesia. This means that the patient will be awake during the operation but does not feel pain. Sometimes general anaesthesia is used. This means that the patient is asleep and unaware during the procedure.
There may be some mild discomfort and scrotal swelling and/or bruising for a few days after the procedure. Painkillers like paracetamol may be necessary for easing pain or discomfort. Close fitting underwear to support the scrotum will alleviate discomfort and swelling.
It is alright to have a shower or bath, but the genitalia has to be dried gently and thoroughly.
Most patients return to work within a day or two after the procedure. However, it is advisable to avoid heavy lifting or sports for about a week to reduce the likelihood of developing complications.
There will be some sperm left in the vas deferens, which leads to the penis, beyond the part that has been removed or cut. It will take some time for all these sperm to disappear from the semen. It has been estimated that this can take more than 20 ejaculations.
About eight to twelve weeks after the operation, two semen specimens will be analysed two to four weeks apart to confirm that there are no longer any more sperm. The vasectomy is considered successful only after there are two successive semen specimens that contain no sperm.
Until then, another contraceptive method has to be used if there is intercourse, which can take place any time it is comfortable to do so, although it is advisable to refrain for a few days.
It is possible for a vasectomy to be reversed. The likelihood of success is increased if the reversal operation is carried soon after the vasectomy. The likelihood of successful reversal is about 50% if carried out within 10 years and 25% if carried out more than 10 years after a vasectomy.
A vasectomy does not provide protection against sexually transmitted infections (STIs). It is advisable for anyone at risk of STIs – those who have more than one partner, or whose partner has more than one partner – to use condoms after a vasectomy to prevent STIs.
> Dr Milton Lum is a member of the board of Medical Defence Malaysia. This article is not intended to replace, dictate or define evaluation by a qualified doctor. The views expressed do not represent that of any organisation the writer is associated with. For further information, e-mail firstname.lastname@example.org. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.