Medical Meanderings 9 January 2008
This was the most unkindest cut of all.
William Shakespeare, “Julius Caesar,” Act III, scene ii
Vasectomy is a safe, permanent method of birth control for men. It is also one of the few suggestions that will send the most macho, grizzled tough guy running for the door. Still, it’s not uncommon: one in five American men over age 35 have had vasectomies, and about four million are performed each year worldwide.
But before we get into details, a quick anatomy review. Sperm are made in the testicles, which hang out (literally) in the scrotum. New sperm move into the epididymis, a convoluted network of tubes on top and behind the testicle. In the epididymis, the sperm are mixed with fluid from the seminal vesicles to make semen. During ejaculation, the semen is pushed out of the epididymis, up the vas deferens, through the prostate and out. The vas deferens (or “vas,” but never “the v.d.”!) is a long, thin tube, about the size and consistency of a piece of half-cooked spaghetti. It runs from the epididymis, into the pelvis, behind the bladder, through the prostate and, finally, into the urethra and out. Long trip, but the section through the scrotum without exits or U-turns gives us a great spot to put in a roadblock.
During a vasectomy, a small amount of anesthetic is injected with a tiny needle into part of the skin of the scrotum. When the skin’s numb, the doctor finds the vas and holds it steady with one hand while making a tiny incision in the skin over the vas. A loop of the spaghetti-like vas is brought up through this tiny hole and a section clipped out. The ends are then either clipped with small staples or burned with electrical current (which doesn’t hurt). Then, the vas is put back and the skin closed up if needed (sometimes a stitch isn’t even necessary). It all takes about 30-45 minutes. The man is then sent home wearing a jock strap to hold his equipment steady (and to help his sense of manliness). Most guys can go back to work the next day with some limits, and are back to normal in a week.
Now for the weird part. In the eight weeks following the procedure there are still some sperm in the plumbing. So, another form of birth control has to be used. To clean out the pipes, the fellow has to ejaculate about 20 times before his follow-up visit. Then, he goes to the doctor where he gives a semen sample to make sure no sperm are left.
Once the plumbing is clear, vasectomy is a highly effective form of birth control—the failure rate (that is, pregnancy rate) is less than one in a thousand. For those guys not persuaded by statistics, how about money? Vasectomy costs half as much as tying a woman’s tubes (not to mention being a safer procedure), and is about the same cost as a two-year supply of birth control pills.
So, guys…think about it. It’s quick, cheap, effective and not all that painful. It won’t make you sing soprano, hurt your sex drive or make you more likely to ask for directions. Real men get vasectomies.