In the UK in 2004, over 90,000 men had a vasectomy¹. Of these, most were married men, aged over 35 years.

Making the Decision

Whether or not to have a vasectomy is probably one of the most profound decisions a man can make in his lifetime. It can take him years to consider. It means the end of his reproductive capabilities and there may be the 'ignominy' of 'firing blanks'. (For some people, part of the fun of sex involves risk-taking.) On the plus side, there will be no more unplanned pregnancies, so sex should be worry-free if you are in a monogamous relationship². Eventually children (if you have any) grow into adults and even the baby will leave home (hopefully) so you can look forward to a time when there's just you and your partner.

The couple concerned should weigh up the pros and cons of vasectomy and sterilisation. Vasectomy is quite a simple procedure involving a local anaesthetic and is safer than female sterilisation (tubal ligation which closes the fallopian tubes), which involves a general anaesthetic — with all the risks that entails — and an invasive surgical operation. Vasectomy may be a simpler operation, but its effects are not immediate; a sterilisation may be more complicated but is immediately effective. The woman has to accept that she can no longer have children with this partner if they choose vasectomy over sterilisation. Many relationships break down and as a man is capable of fathering children well into old age, this should also be considered.

Doctors in the UK generally won't like a man to have a vasectomy without discussing it with his partner first, but permission from the partner is not required by law. It is important that the decision is the choice of both partners and that there is support with no pressure. The process usually begins with a counselling session, to ensure that the couple really have finished their family. It may seem a good time to have a vasectomy while the man's partner is pregnant but some people would consider that tempting fate and the pregnancy may not conclude with a live birth³.

Questions You Should Ask Yourself

• What's made you decide to have this done?
• Do you understand that this is permanent?
• Do you know reversal isn't available on the NHS?
• Do you know that a private reversal operation is expensive and is very often unsuccessful?
• How would you feel if your current relationship ended and you met another partner who wanted to start a family?

Talking About the Decision

On no account should you talk about your decision before the event to other men, down the pub or at work. You will not be able to bear the horror stories which will burst forth from someone who 'knows someone who...' ended up with balls the size of jacket spuds; lost all sensation; never had an erection again; orgasm lost intensity; was in excruciating pain... but it's not very often that you actually speak to a person who had such an experience. However, some people find peer reassurance very supportive. It's just a question of talking to the right people under the correct circumstances.

The Plumbing

Situated inside the scrotum is the vas deferens, which carries the sperm from the testicles to the prostate. The 'upper' urethra from the bladder also enters the prostate. The prostate secretes semen for the sperm and is also a switching valve between the urinary and ejaculatory functions. (Both can't happen at the same time.) The 'lower' urethra leaves the prostate with the appropriate cargo to the penis.

The Procedure

Relax. It's a relatively simple procedure that is performed on a day patient. A local anaesthetic is administered and a small cut is made in the skin of the scrotum. An 8mm section of the vas deferens tube is removed (to be preserved in formalin as proof to whoever audits these things), then cauterised and the stumps tied (twice). After a couple of dissolving sutures to close, a 'scrotum supporter' is put on. The whole thing is over in about 30 minutes and you're liable to be sore for a few days (swelling and bruising is not uncommon), but everyone is different so recovery rates vary. You are allowed to go home as soon as you want.

Afterwards

Do what the doctor says. This may sound like common sense but there's no point complaining about after-effects if you have gone against doctor's orders and gone straight back to work, driven a car or run round the block.

The patient is encouraged (depending on his surgeon) to have sex as soon as he feels up to it⁴. Be aware that you are still fertile until your doctor declares you sterile, so other contraception methods should be used. If you want to keep count, approximately 20 ejaculations should flush your system through. A couple of follow-up appointments will ordinarily show that the sperm count in the semen is nil, and the procedure has been a success.

Sperm is still produced but it won't be fertilising any eggs because it won't leave your body — instead, it will be re-absorbed. Testosterone production is not affected. Your sexuality, virility, erection and orgasm remain the same as they were before the operation. If your feelings change, it's usually psychological and it can help to talk to your partner. The risk of the tubes rejoining (recanalisation) and your becoming fertile again is 0.2%. Some people require a second vasectomy if the first procedure hasn't worked. Should this be required, it is likely to be more painful than the first. For further advice, talk to your GP, practice nurse or family planning clinic.

Reversal

The decision to have a vasectomy should be considered an irreversible one. If circumstances change and a reversal is required, an operation called a vasovasostomy can be performed by a urologist using microsurgery. Reversal success rate is low, approximately 30%, although the chances of success are higher the sooner the reversal is performed after the original vasectomy.

Future Procedures

Science and medicine are continually coming up with new options⁵ for male contraception, but none so far have been shown to be as effective over the long term as vasectomies. Trials are being carried out in the USA using a new hinged device called the 'Vasclip', which is about the size of a grain of rice. It uses a method of clamping the vas deferens and blocking the flow of sperm instead of cutting the tubes. As a result of the first trial on 124 men, three were found to still be fertile after ten months. The Vasclip procedure is expected to be available in the UK in 2007.

h2g2 Researchers Tell Their Vasectomy Stories

Two valiums and a widescreen television on the ceiling with landscape and ocean scenes. Soothing music. The doctor enters after the valium kicks in and offers a few relaxing comments. 'Just a pinprick in the skin and you won't feel a thing'. Quite an enjoyable experience. No need for crossed legs.

I walked to the operating theatre - there was no valium - and the only soothing view I had was of the one-armed theatre assistant dropping the tray of instruments — which also covered the musical accompaniment.

After the birth of our third child, I submitted to the voluntary bilateral sterilisation procedure, aka 'sex change'. (Damn those insouciant chatty nurses!) Prep: Valium (drifting away), followed by what they said was Demerol. Personally, I think they gave me epinephrine by mistake, because I became totally awake, very speedy, and was able to feel everything. The scalpel was sharp, so the scrotal incisions (lateral) only felt like scratches. The doctor told me I'd feel a 'pull' as he drew the vas deferens out for the snip. This did not feel quite as bad as a kick in the goolies, maybe only 80%, but was sustained while he did his thing to the testicular side of the snip. The other end led to the prostate, and pulling on that evoked a slightly less painful sensation. I didn't suffer any side-effects, but there was one unfortunate fellow I know who had to convalesce for a month... At any rate I was working construction the next day. A month later, I submitted a sample for sperm count, and was declared 'clear'. No regrets, at all.

My husband had his procedure done under local anaesthetic at our local Family Planning clinic. Patients were booked in every 15 minutes and my husband remarked to the surgeon that it was a bit of a production line. The surgeon replied, brandishing about an inch of vas in his tweezers, 'We like to think it's more of a non-production line'.

A Final Snippet

In most cases some post-operative pampering has been a must so it might be worthwhile thinking up a nice treat for you to look forward to: a day at the races, a steak-and-lobster dinner, an all-over body massage or a weekend away!