Vasectomy: all it takes is a snip

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From The Times
November 25, 2006
Vasectomy: all it takes is a snip
Aches, pains, sex life in ruins. Jim Pollard uncovers some nasty side-dJects of a simple
procedure
"Vasectomy is a real nightmare. There's swelling in my lower abdomen and scrotum, and the pain is unbearable"; "I'm
constantly getting aches and pains. Orgasm is terrible and sex is the last thing on my mind"; "Worst mistake of my life!"
These quotes are taken from recent reader feedback to the malehealth.co.uk website; just the tip of what has developed over
the past two years into a large iceberg. They make painful reading, yet I suspect that most people would share the view of
one Malehealth correspondent who thought that vasectomy surgery, the operation for male sterilisation, was a "no- brainer,
like cutting hair".
Certainly, if you had asked me when I took over as editor of the website to guess the most common
topics for readers' comments, I would not have put vasectomy at number two, just after the most
popular topic, penis problems.
It has been estimated that one British man in five of reproductive age has had a vasectomy. With those
sorts of numbers, perhaps it is unsurprising that there are complications in a few cases.
Vasectomy is an everyday procedure that requires only a local anaesthetic, and takes about 30
minutes. The vas deferens, the tube that leads from the testes (see graphic) is cut and heat-sealed. In
the procedure, the vas is accessed either by means of a small cut in the scrotum or, in the new noscalpel technique, a tiny puncture, which requires no stitches. Despite the ease of surgery, for a handful
of men the post-op pain can take over their lives.
Dr Tim Black, who has carried out 15,000 vasectomies for the Marie Stopes clinic, does not deny that
some men have problems, but doubts that there are any serious long-term complications. "Sixty million
men have had this operation worldwide. If there were real problems, they would have emerged," says
Dr Black, who is also the chief executive of Marie Stopes International, the reproductive healthcare
organisation.
He says that in perhaps 0.5 per cent of cases, there is mild pain for a couple of weeks in the epididymis.
This is the tube in which matured sperm is stored before ejaculation along the vas deferens.
In theory, a vasectomy should not affect the quantity of semen produced on ejaculation as it is only
sperm (which makes up just 2 per cent to 5 per cent of semen) that is cut off. The other secretions that
make up semen are produced as normal in the prostate gland.
But some men say that the operation has destroyed their sex life. Graham, 53, from Lancashire, says
that he is still suffering from the vasectomy he had six years ago. "My sex life has never been the same.
I even struggled to get an erection to produce the semen specimen I had to give after the operation, and
I've struggled ever since."
Chris, whose husband had his vasectomy earlier this year, has a similar story. "My husband says that
about 85 per cent of the sensation he used to feel at orgasm simply isn't there. Worse, in addition to
greatly reduced pleasure, he is in pain 24 hours a day, with a dull ache in both testicles."
With luck, Chris and her husband may see some improvement. Dr Black says: "I've seen a handful of
cases in which pain has continued beyond nine months after the operation." He suggests that the
debate about longer-term post-vasectomy pain exists because of the industry that has sprung up
around it. "Some urologists, especially in the US, are making money by removing the epididymis or
even the testicles of men in post-vasectomy pain, promising that the pain will disappear," he says. "But
I've never seen anyone who really needed this."
He suggests that the pain can also be psychological. "A previous trauma may be causing pain, not the
vasectomy. I think it's psychological. It is understandable; men obsess about the family jewels. What's
more, some people who are having sexual problems have a vasectomy in the hope that it will help. It's
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highly unlikely."
So are post-vasectomy problems all in the mind? Dr Andrew Dawson, of the Hartlepool Vasectomy
Reverse Clinic, is not so sure. He, too, has suffered post-vasectomy pain: "My own problems made me
realise that this was something we needed to take seriously. I've come across men whose pain has
taken over their lives. We've performed vasectomy reversals (re-joining the cut tubes) for them, which
have been 100 per cent effective and eliminates the pain."
Although of the 1,100 men whose vasectomy Dr Dawson has reversed, he estimates that only 15 came
to him because of pain. "But the low figure could be because not everyone who has suffered the pain is
willing to undergo surgery again or is aware of the option," he says.
He believes that he can explain what is happening. "Vasectomy is pretty crude really; it just traps sperm
in the epididymis. In some, often highly sexed, men this can cause the epididymis to become swollen.
Eventually it can rupture - Americans call this a blowout - which will solve the problem naturally but
can be very painful. A vasectomy reversal can reduce the pressure." He is concerned that few men are
properly prepared for the procedure. "They're usually just having it to please the wife."
The National Institute for Health and Clinical Excellence has no specific guidelines on vasectomy and it
remains a doctor's responsibility to ensure that patients are informed. Guidelines from professional
bodies such as the Royal College of Obstetricians and Gynaecologists are clear that doctors should
always discuss alternative forms of contraception to vasectomy with patients, and possible risks such as
post-vasectomy pain.
By keeping their patients better informed, doctors would be doing men a favour. And at
malehealth.co.uk we might have more time for articles on the all-important penis problem.
Patients' names have been changed
Need to know
About 90,000 vasectomies are performed in the UK each year.
They can be performed in NHS hospitals, GP practices or private clinics.
536 vasectomy reversals are done every year on the NHS, but many more are done privately.
A reversal can cost over £2,000.
For information, www.mariestopes.org.uk; www.vasectomyreversals.co.uk
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