Prostate Restored
Prostate Restored
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Family planning experts say one of the major hurdles to promoting vasectomies is men's fear of emasculation. "There's a great deal of fear about having any kind of operation performed on the scrotum," Schlegel said. "It's a common misconception that vasectomy involves castration.
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Learn More »Despite recent innovations that have made the vasectomy safer, simpler and less painful than ever before, far fewer American men than women consistently undergo surgical sterilization each year. Although vasectomies are a relatively inexpensive and highly effective form of contraception long touted by family planning advocates, an apparently steady 490,000 U.S. men get vasectomies each year. In comparison, more than 600,000 women sought sterilization last year with tubal ligations, a procedure that can require abdominal surgery and is more risky and difficult than vasectomy. The vasectomy's appeal remains limited because the procedure is often permanent and offers no protection against sexually transmitted diseases like AIDS, experts say. But even many men with only one sex partner who are at low risk of disease and who do not want more children shun the procedure. The best explanation, according to the experts, is that men are notoriously skittish about tinkering with their sexuality and many cling to the misconception that vasectomies reduce sexual prowess and enjoyment. While that's a myth, experts say, vasectomies also have been shadowed by lingering suggestions that the procedure may inexplicably increase the risk of problems later in life, notably prostate cancer. The World Health Organization convened a special meeting of experts in 1991 to review the evidence about the link to prostate cancer. Citing weaknesses in the studies and the lack of any biological explanation for why a vasectomy would boost the risk for prostate cancer, the WHO concluded there was no reason to stop recommending vasectomies. But two large studies at Harvard University in Boston may rekindle this debate. One study involved more than 23,000 husbands of women in the Nurses' Health Study, which is a long-term study of women's health. Researchers followed the men from 1976 until 1989, comparing those who had vasectomies to those who had not to see which group was more likely to develop prostate cancer. A preliminary analysis found that having a vasectomy appears to increase the risk for prostate cancer by 37 percent, according to Edward Giovannucci of the Harvard Medical School, who conducted the analyses. The second study involved more than 51,000 men in the Health Professionals Follow-up Study, another long-term study of general health. Similarly, preliminary analysis of that data, said Giovannucci, who also analyzed it, indicated that men who had a vasectomy appear to have a 21 percent increased risk for prostate cancer. The final results of the studies are being reviewed by a major medical journal. Giovannucci would not discuss the final results until they have been published, but he said they found a slightly greater risk of prostate cancer than the preliminary findings. Even so, the risk for prostate cancer in these studies is lower than that found by some previous studies and is considered moderate. It may still cause concern, however, since 4 million American men have had the procedure. "We're not saying men who have vasectomies should be greatly concerned about dying of cancer," Giovannucci said. "But it is a concern."
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Read More »Amy Pollack, medical director of the New York-based Association for Voluntary Surgical Contraception, and other experts are cautious about the results. Men who have had vasectomies simply may be more likely to be diagnosed because they see doctors more frequently, she suggested. "I think one should always be concerned when a well-done study suggests an association between cancer and a procedure. But one has to look at it in context. One has to weigh far more than one or two studies," Pollack said. "When these studies get published, people will again re-look at the issue." Giovannucci said that his analysis had accounted for the question of whether these men were diagnosed more frequently because they saw doctors more often. He said additional research is needed. But he stressed that any risk from vasectomies must be weighed against the risks a man's partner may face from other forms of birth control -- or from an unplanned pregnancy. "This could be an excuse not to have a vasectomy for someone who is looking for a reason not to have one," Giovannucci said. "At this point, all we can do is present the data and make it clear that this is something to consider in deciding whether to have a vasectomy. It shouldn't be the sole factor." A vasectomy involves severing each vas deferens, the spaghetti-size tubes in the scrotum that carry sperm from the testicles into the penis. In a standard vasectomy, a doctor numbs the scrotum with an anesthetic injection, makes one or two small incisions and lifts out a small section of each vas deferens. The doctor then blocks each vas deferens, either by cutting or cauterizing, and returns them to the scrotum before stitching closed the incisions. In the new technique, the "no-scalpel" vasectomy, the doctor feels for the vasa under the skin and holds them in place with a special clamp. Instead of making two incisions, the doctor makes one tiny puncture. The physician gently stretches the opening so the vasa can be pulled out and sealed. Because the incision is so small, it requires no stitches. "The bottom line for the patient is . . . less swelling and less bleeding," says Peter Schlegel of the New York Hospital-Cornell Medical Center. Schlegel is one of at least 300 U.S. doctors trained to perform the procedure, which was invented in China. Kenneth Crauter, one of Schlegel's patients, opted for a no-scalpel vasectomy this year after he and his wife decided they didn't want any more children and were uncomfortable with other contraception options.
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Read More »Lying on a table, Crauter could feel the doctor swab his scrotum with antiseptic, followed by a bee-sting-like pinch from the shot of anesthetic. "Then there was this sort of tugging and pulling," Crauter said. "That's all you feel. No pain." Within 15 minutes, it was over. Crauter spent the rest of the day at home with an ice pack to minimize swelling. "There's some manipulation of the testicles that results in the feeling that someone kicked you in the groin," he said. But within six hours, Crauter felt well enough to go out to dinner. Schlegel advised Crauter to avoid strenuous activity for a few days and abstain from sex for one week. Crauter has about a one in 1,000 chance that his vasectomy will fail -- a high rate of effectiveness that is equivalent to the birth control pill when used perfectly. Failure usually occurs because the vasa reconnect by themselves or men don't wait long enough after the procedure before having unprotected sex. The short-term risk is also extremely low, with only a small percentage of men experiencing complications, most commonly excess bleeding or infections. Family planning experts say one of the major hurdles to promoting vasectomies is men's fear of emasculation. "There's a great deal of fear about having any kind of operation performed on the scrotum," Schlegel said. "It's a common misconception that vasectomy involves castration. In fact, there is no effect on sexual function whatsoever. "In terms of overall risk-benefits, for a couple, vasectomy is probably one of the safest and least involved methods of contraception," he added. Advances in microsurgical techniques give doctors about a 98 percent chance of reconnecting the vasa for men seeking a reversal of the procedure. But only about half of those who attempt such a reversal actually succeed in fathering children. The reason that only about half of men with reconnected vasa can father children remains unclear. But experts speculate that it may be because after a vasectomy, the immune system often produces antibodies to rid the body of the unejaculated sperm and those antibodies may interfere with the sperm even after reversal surgery. Researchers are working to overcome this disadvantage, but men must assume that their vasectomy is permanent.
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