May 9, 1999
Web posted at: 2:01 PM EDT (1801 GMT)

In this story: The procedure Post-operation Increased chance of prostate cancer? RELATED SITES

(WebMD) -- Although the word vasectomy causes many men to grimace in sympathetic pain, it has been a safe, simple, popular and effective means of birth control for an entire generation. According to Dr. Yosh Taguchi, an international expert on the male reproductive system, vasectomy is the best method of sterilization and is far less invasive than tubal ligation.

Taguchi, a Montreal urologist, is the author of "Private Parts: An Owner's Guide to the Male Anatomy," which is now in its second edition and has been translated into six languages. He has been performing vasectomies for 30 years, although according to Taguchi, the concept of the vasectomy was first developed as early as the 1940s. However, it was rarely performed until 1969, when it was recognized by Medicare and became a mainstream medical practice.

The procedure

Sperm is manufactured in the testes and then transported to the ejaculatory duct through two tubes called the vas deferens. Vasectomy is a surgical procedure that involves cutting both tubes and then sealing them off, thereby preventing the sperm from reaching the penis. In the past, most surgeons used a scalpel to cut the scrotal skin in order to reach the vas. This was done under a local anesthetic.

Today, most surgeons simply make a small puncture in the scrotum, reach in to grasp and extract the vas, and then cut and seal the tubes. This procedure requires no stitches. Although advertised as new, no scalpel or minimally invasive vasectomy, the procedure really isn't that new, according to Taguchi. He explained that it has always been possible to perform the surgery with a very small incision of only about 2 mm.

Although complications are rare, they are possible. The surgery itself only takes 15 minutes, but the patient should rest for approximately 48 hours afterwards.

Post-operation

Bruising and pain may take some time to clear up, and there is always the risk of infection and bleeding following any surgical procedure. In less than 1 percent of the cases, the tubes do rejoin naturally. Other forms of birth control must be used for a short period after the operation to flush out the system, since many sperm are stored between the sealed off tube and the penis.

Surgeons conduct one or two sperm tests up to a few months past the surgery in order to ensure that the operation has been a success and that no sperm remain. The more ejaculations following surgery, the faster the sperm are expelled from the body.

Fears about reduced sex drive as the result of a vasectomy are unfounded. Sperm production has no influence whatsoever on drive or potency. Similarly, the amount of ejaculate is also not affected, as most of the semen is manufactured in the prostate and seminal vesicles.

Increased chance of prostate cancer?

A 1993 Boston study suggested that men with vasectomies were confronted with an increased risk of prostate cancer, a disease that affects 9 percent of men worldwide. The study showed that 7 percent of men who had not had a vasectomy developed cancer compared to 11 percent for men who had a vasectomy.

The difference may only be 4 percent, but it does represents a 60 percent increase. However, Taguchi said that the researchers did not account for all the variables and that comparing men who had vasectomies to those who did not "is like comparing apples and oranges." For instance, men who had vasectomies may have had higher testosterone levels, a factor that is linked to the incidence of prostate cancer.

"Other studies have failed to substantiate the connection between vasectomy and prostate cancer," Taguchi said, "but if a causative link is established, I will abandon the procedure without hesitation."

Finally, anyone contemplating a vasectomy should consider that the procedure is final and irreversible. Surgeons can perform a reversal, but that is a much more complicated operation, and many health plans will not pay for it. Reversals have been successful in up to 80 percent of cases, according to Taguchi. Success used to be defined as resulting in a pregnancy but is now defined as simply having a sperm count.

RELATEDS AT :

Vasectomy: Still a Good Choice?
Complications of Vasectomy
New Caution,and Some Reassurance,on Vasectomy
Cancer Risk Found in Vasectomy

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