The Unkindest Cut of All
Vasectomy is a seemingly simple operation, a real snip, which couldn't possibly go wrong - or could it? It is often presented as the ideal and infallible solution to family planning. What could be simpler than tying the vas, the narrow tubes carrying the sperm from the testicles to the prostate, where the seminal vesicles add the other ingredients of the seminal fluid making up the ejaculated semen? No sperm - No problems.
Unfortunately, it's not quite that easy. The testicles, as any man will testify, are very delicate and sensitive structures. They are very complex organs, with a rich nerve, blood and lymphatic supply. Also they are under intricate hormonal and temperature control to regulate sperm and testosterone production. So that the man doesn't produce antibodies to his own sperm, which to the rest of the body is foreign protein, there are important defences keeping the sperm isolated from the immune system. All these systems can be disrupted, even when the vasectomy seems to have gone smoothly, and there can be an alarming variety of short and long term complications, which can sometimes be serious1.
Short Term Complications
Post vasectomy pain syndrome - This fortunately rare complication can turn a previously fit man into a chronic invalid. Even if the operation was painless, and not accompanied by the bruising and immediate post-operative discomfort which is quite common, weeks, months or or years after the operation, nagging pain begins at the site2. Sometimes tender cysts, or lumps called granulomas, can arise around the cut ends of the vas, and even if further surgery is performed to cut them out, the pain persists3. This can be one of the most difficult problems in andrology to treat, especially as the precise cause is usually unknown. More research is urgently needed to prevent and treat the condition - doctors please contact us if you have any advice or experience in treating these problems.
Long Term Complications
Even though vasectomy first became popular in the 1920's, because Ludvig Steinach, a Viennese surgeon suggested it stimulated rejuvenating testosterone production in the testicles by removing redundant sperm producing cells, the more recent evidence is that it may eventually reduce production of this key hormone and contribute to onset of the male menopause.
Certainly my experience, and that of other doctors giving testosterone treatment, is that vasectomy makes it more likely that a man will develop the male menopause, and at an earlier age4. In a series of over 1,000 cases of the condition seen in my Harley Street Clinic over the past ten years, 25% had had vasectomy, about twice the level in the general population. In our global web survey, 35% of men who completed the Andropause Check List reported vasectomy, and at impotence clinics in Australia the rate was reported as 45%.
Though again the mechanism of this reduced hormonal production is unclear, the most likely cause seems to be an auto-immunity to sperm released into the tissues after the vasectomy5, a immunological time-bomb ticking away. Again more research is needed to prove how this happens and can be treated. Reversing the vasectomy does not seem a good idea, as the damage is done early on, and attempts at reconstructing the vas may only stir up further trouble, more pain or more antibodies.
The evidence on whether vasectomy may contribute to higher levels of testicular cancer a few years after the operation, and give rise to prostate cancer and heart disease, especially in diabetics, is sharply divided and reviewed in chapter five of the book "Maximising Manhood: Beating the Male Menopause".
Conclusions About Vasectomy
Personally I would strongly advise against vasectomy, which is a major trauma to the testis, a delicate and complex organ producing a variety of external secretions and hormones, including testosterone. Any oral contraceptive, used either with men or women, with an equivalent range of short and long term complications, would surely have been taken off the market by now and the manufacturers heavily sued. Why not apply to same stringent conditions to vasectomy?
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http://www.androscreen.com/androscreen/vasectomy.htm
http://webmd.lycos.com/content/article/1680.50799