Vasectomies are the most reliable method of male contraception and an estimated 40 to 60 million men worldwide have chosen to have one. They are the most widely used contraceptive method for men looking to achieve permanent sterility for family planning or personal reasons.
The procedure should be thought of as irreversible. It has a low complications rate and failure is very infrequent. A vasectomy does not begin to work immediately and couples need to continue to use contraceptives until absolute sterility has been achieved. Vasectomies are safe and do not have any side effects or cause serious illness in the long term. It is a method that is used for avoiding pregnancy in long standing relationships but also as a personal sterility method in men who are not in a relationship (those who have separated, divorcees or widowers) but who do have sexual intercourse or, even when they are in a relationship, do not wish to have more children.
Vasectomies are the most common urological intervention carried out in Spain with around 100,000 men voluntarily undergoing the surgery each year. 30,000 of these are treated by specialists other than urologists in family panning centres, gynaecology clinics or clinics of other kinds and in areas which are often not operating theatres but treatment rooms, clinics, etc. In these cases, there is implicit risk for the patient.
Vasectomy surgery is simple and carried out under local anaesthetic in the space of 20-30 minutes and it does not require an overnight stay in hospital. However, sterility is not immediate and the patient may still father children for the following 3 to 6 months due to the leftover sperm trapped in the ejaculatory ducts but which will eventually be eliminated.
Vasectomies are a reliable method of contraception since in almost 100% of cases, patients are sterilised. However, there are a small number of cases in which spontaneous recanalisation can occur between the two ends of the vas deferens. This happens in between 0.16% and 2% of all cases.
The pros and cons of vasectomies are also a matter of controversy since it is not a question of illness. There are personal reasons (voluntary), medical reasons (genetic advice or risk to the mother), social reasons and even, very rarely, legal reasons for carrying out a vasectomy.
It is generally a decision taken by a couple. When it is a personal choice, a vasectomy is generally requested by stable couples who do not wish to have more children with their first or second partner.
On other occasions, vasectomies are carried out under medical guidance when the female has an illness and pregnancy is not advisable because of possible risks (for the baby or for the mother) when giving birth. Less frequently, a vasectomy is carried out further to genetics guidance because of a risk of transmission of hereditary illnesses to children: Down’s syndrome, hereditary bone malformations, heart and lung malformations, etc. Legal rulings are few and far between in Spain, although the Law could provide for them in cases of hypersexuality, Down’s syndrome, etc.. In these cases, there are bioethical implications.
There are many vasectomy techniques and no particular technique tends to be more beneficial than the others. According to those who carry out the procedure, the no-scalpel, or key-hole, vasectomy used to isolate the vas deferens tends to generate fewer complications such as infections, bruising and post-intervention discomfort early on and this is also used as a means of winning patients over. The different techniques include:
- U-shaped ligation with occlusion of both vas deferens but no resection
- Proximal and distal ligation with resection
- Proximal and distal ligation, burying the proximal end and spermatic fascia interposition
- Testicle double proximal ligation, simple distal ligation, resection and vas coagulation.
- Distal ligation (above) with no proximal ligation
- No-scalpel vasectomy or Li-type vasectomy
Healthcare following the procedure
Examination of the wound is not usually necessary. The patient should, however, be aware of who to contact in case of issues. It is important that the patient is clearly informed in person and in writing about the need to carry out a sperm analysis in the 3 to 6 months following a vasectomy. Sterility may be confirmed when no sperm are found in the semen. Where there are under 100,000 non-motile sperm per millimetre, it is also possible to give the all-clear 3 months following the procedure.
Consequences of the semen analysis results
In those cases where no sperm or only rare non-motile sperm are detected, no further analyses are necessary. The test should be repeated every 6 weeks if mobile sperm are detected or if there are over 100,000 sperm per millimetre. Further tests should continue until no further sperm are found or until there are under 10,000 non-motile sperm per millimetre and the semen can be given the all clear. If mobile sperm continue to be present in semen 6 months after the procedure, a further vasectomy is recommended. Sperm analysis results should be given to the patient over the phone or in writing. Results are recorded in files along with the consent form and vasectomy intervention report, conclusion summary and vasectomy recommendations.
Bibliography: European Association of Urology Guidelines on Vasectomy
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