What is a vasectomy?
Vasectomy is the interruption of the vas deferens in men to make sure that no sperm from entering the semen whereby the man is sterile.
Choice for vasectomy
When a heterosexual couple does not have children (more) exists, is increasingly being sought for an alternative to lifelong hormone swallowing tablets. Relatively safe alternatives than female sterilization, male sterilization, or an IUD. Of the two sterilization operations, which is much simpler than in the man and with less risk to the woman.
In the Netherlands and the United States chooses 11% of heterosexual couples who use contraception for a vasectomy. In many hospitals the operation thereby assembly-line work. In percentage are only the United Kingdom and New Zealand even higher, with 18%. Also in China vasectomy widely used. In France, sterilization was long banned and it is now (2005) is still difficult to find a urologist with experience.
Operation
A vasectomy is a minor outpatient surgery. It starts with looking up the vas deferens on both sides in the scrotum. Where this leader is found, with a small injection administered a local anesthetic. On both sides of the vas deferens through a small incision exposed and removed about 1 cm of the leader. Thereafter, on both sides of the vas deferens is folded and sealed. A self-dissolving suture closes the wound.
The whole operation takes no more than 20 minutes. After surgery, the man advised a few days to do heavy physical work in order not to burden the sutures. Furthermore, it is normal movement is possible, as long as it does not hurt. Bicycles can for instance be painful. How many charge a man after surgery is still on, however, varies from person to person. Sexual intercourse and masturbation are just possible again, although it still can be painful shortly after surgery.
Variations
There are other procedures than the one that is described above.
One technique is to make a single incision in the middle of the scrotum and by that one hole to interrupt the two vas deferens.
In still another technique, there is no incision made with a scalpel, but it is the vas deferens with a special pair of tongs by a very small hole in the skin removed to the outside. This procedure is not even necessary adhesion and supporters say the recovery is faster and there are fewer complications than the standard.
Furthermore, there is recent in the US allowed a new procedure in which the vas deferens is not cut, but be clamped with a small clip.
Fertility
After surgery the man was not immediately barren: there are still sperm in the system for some time to come after the vasectomy at ejaculation outside. In order to establish the sterility of the man after 6 weeks to 3 months have to be (depending on the hospital), and at least 20 discharges one seed or twice hand in a semen sample (again depending on the hospital). Only when no live sperm cells are found, the man is declared sterile in these samples.
It's possible, but very rare that ends spontaneously grow back together and re-creates fertility. The chance of pregnancy after one year of having sex with a (properly controlled!) Vasectomy is estimated at 0.02%, which is lower than any other form of contraception.
Complications
Vasectomy is a very safe operation. There complications occur only rarely. Due to the location of the surgery can, however, be temporarily very unpleasant side effects. The most common complication is that sperm leaking from the vas deferens may form a lump. This is usually not so very annoying and resolves itself naturally again.
During the operation can be hit a blood vessel, causing internal bleeding (bruising). This can cause discomfort to some weeks. Sometimes, then a re-operation is necessary. Much less common for an infection occurs. If an infection occurs, it can be treated with antibiotics and a few weeks of rest. A small percentage of the men who have undergone vasectomy for a longer period a nagging feeling of burden in the area of operations ("scrotalgie '). This can have several causes, but not always, there is an apparent reason.
A small number of men to keep the operation on chronic pain. This may be solved with a epididymovasectomie, but does not guarantee it.
Differences in sexuality
A vasectomy has nothing to do with castration. The sole purpose of the vas deferens have to bring the sperm cells in the seminal fluid of the prostate. With the cutting of the leaders of the man with the hormone is not affected and there is no change in the erection mechanism. The most frequently reported difference in sexuality after vasectomy is that it feels better, probably because the reservations that the man can have when having sexual contact (there will be no problem with the birth control?) Disappear.
The sperm cells are just a very small part of the sperm (a few percent). Even with careful study you will be able to identify any differences without a microscope.
Vasectomy Reversal
When a sterilized man still wants to conceive a child can be tried in order to make the operation undone by connecting both ends of the vas deferens back together (vaso-vasostomy). The reversal operation, wherein, in a procedure, the vas deferens to be put back to each other, is a much more difficult operation than the vasectomy. Even if the recovery operation technically successful (ie, there is a doorgankelijke vas deferens created), the guy does not, however, be more fruitful.
The purely technical intervention succeeds in about 9 out of 10 cases. The longer ago the vasectomy was done, the smaller the chance of a successful recovery. In principle, the sperm cells should therefore be able to pass again, but the fertility is thus not always recovered. In practice, only 5 to 10 men apparently able subsequently to conceive a child.
Whether the fertility will recover, depends on several factors, such as:
- Fertility prior to sterilization;
- The length of the removed part of the vas deferens;
- The number of years since the sterilization: the chance that sperm will again appear in the semen decreases by 4% per year.
- The presence of a spermagranuloom, a nodule which is formed as a reaction to the material that was used to seal the vas deferens or passed-on sperm cells;
- Swelling of the vas deferens which still hangs from the testicle. This swelling can be hard to make a perfect reconnection.
- Antibodies: sometimes make men after sterilization antibodies against their own sperm. These antibodies to the quality of the sperm cells and thus may affect their fertilization potential. During the years that the vas deferens were suspended body has developed a defense against their own sperm; often a result of sperm that weakens the body abandoned after a reversal.
The surgery is performed under general anesthesia or with spinal anesthesia / epidural. The lower body is painless. After opening of the scrotum, it is possible to search for the ends of the vas deferens at the location of the sterilization. This is freshly cut and checked for patency. After massage of the epididymis / epididymis fresh semen will flow out of the opening. A reconnection will probably lead to success. Sometimes there are at massage only a paste-like substance emerges. Formed because the vas deferens was closed and seed production continues. The sperm is then accumulate in the vas deferens. If the closure is made longer, the accumulation can be more extensive. It is possible that this build-up somewhere by a small leakage occurs after the sterilization. There is then no congestion and the sperm remains liquid. The chances of recovery are better than clear.
The connection of the two ends, it is easiest if the sterilization was carried out in the straight, thick part of the vas deferens. Often the vasectomy has occurred in the thin and winding section just before the epididymis. The connection of the ends is a very precise job to another, the chances of success somewhat less. If the vas deferens to be connected to the epididymis (for example, as the vas deferens is packed with the paste-like substance), one speaks of a vaso-epidydimostomie. The success of this is again slightly less than the connection to the straight.
The vaso-vasostomy and the vasoepididymostomy be surgery performed with microscopic techniques. In the meantime, it has become clear that the chances of success are co-dependent on the experience of the surgeon. It originated in Europe specialized clinics where there are more than 50 procedures per year.
It is common to about three months after such an operation to be checked by a semen sample. However, it is possible that the fertility only recovers later. If there be in the semen any viable sperm after ejaculation, one can possibly look for not fully developed sperm in the testicle or epididymis, and still achieve a pregnancy through IVF techniques.
Spontaneous recovery
Besides a reversal is also the chance of a "spontaneous recovery" According to doctors the chance this is around 3%. It is however not take into account the men who never get behind that recovery has taken place since vasectomy often occurs at an age above 40 years. Here, the woman is fertile and also less the chance of conception is less pronounced. In addition, there are people who never present with a recovery to a doctor. Hereby Estimates range from 20% to 40%.