WHERE DOES IT ALL GO? FTER A VASECTOMY
This is a common question asked by men about to have a vasectomy. They have been assured that following the operation they will continue to produce copious quantities of sperm but are concerned about what happens to them.
There are two possibilities. If a man has an open-ended vasectomy, the sperm fall into his scrotum instead of hurtling out into the world. In the scrotum they are broken down and, like all dead cells, removed by the body’s scavenger system.
If a man has a closed vasectomy, which involves tying off the tube in two places, the sperm are trapped in the testicles, where they are eventually broken down and reabsorbed.
Following a successful vasectomy, men should experience no long-term discomfort. In less than a week, tenderness should be gone and intercourse can be resumed.
In rare cases, however, men can be left with a persistent ache in the testicles. This ache is probably caused by a backup of sperm in the 6 metres of fine tubing that twines behind each testicle. This tubing has fragile walls that can easily be burst by a backlog of trapped sperm.
About 4 per cent of men who have a closed vasectomy develop mild testicular pain. This can be relieved with drugs, with surgery or by rejoining the vas.
If the man has an open-ended vasectomy, he is three times less likely to experience post-operative testicular pain. Cutting the vas higher up also reduces the likelihood of pain.
Vasectomy is not just for young men. Older men with wives of childbearing age line up for the operation too. Between 5 and 10 per cent of men who have had a vasectomy seek a reversal at some later stage. A successful reversal cannot be guaranteed, and during the routine pre-operative counselling, men are told their operation may well be permanent.
To cover this contingency, some take out ‘fertility insurance’ and have their own sperm frozen and stored. Human sperm have been successfully stored for 18 years, and it is known that 50 per cent of women who receive thawed sperm become pregnant within 6 months. But fertility insurance is fairly uncommon, and only vasectomy patients request it.
There is a simple technique that can be used as an alternative to surgery for men who ask to have vasectomies reversed. It involves a single injection into the testicular area under local anaesthetic to remove sperm. In vitro, single sperm are then introduced into the partner’s egg.
There is much concern about the side effects of vasectomy. Short-term effects of bleeding, infection, bruising, swelling and discomfort usually resolve in between 4 and 7 days. After the operation, about one in 400 develop a haematoma (large clot) or abscess and need to be hospitalised.
Men should be alerted to the possibility of the long-term side effects of testicular pain and to the controversy about prostate cancer, although there is no substantial, sound evidence to support or not support a statistical link between vasectomy and this cancer. Scares about heart disease and testicular cancer linked to vasectomy are now considered largely baseless.
When vasectomy is voluntary, there is virtually no adverse psychological reaction. In places such as India, where there is coercion, the ‘regret’ factor is high.
Genuine sexual dysfunction after vasectomy is rare because the operation does not affect testosterone production or libido. Some men are, however, uncomfortable at the idea of shooting blanks.
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