Myth: Vasectomies Limit Your Sex Life

This myth is about vasectomy – that vasectomy is harmful, either sexually or health-wise or both. Now, vasectomy is the simple cutting of the tubes through which the sperm travel, from the testes, or the gonads, or the balls, to the penis, and then out to the environment. It’s a simple procedure, and it just takes a short time and is usually done in a physician’s office. There are many myths surrounding its potential effects on men’s sexual functioning, and even some regarding the effects on men’s general health, and we’re going to take care of those today during this Myth-a-Month. Of course, the outcome of vasectomy, in terms of both discomfort and contraception, depends very much on the experience and skill of the physician that the man chooses to do the procedure. You want to choose a urologist who has done hundreds of vasectomies because he is likely to do the best, most comfortable, and most successful job. It is also essential to complete and follow all the steps that happen after you’ve had the procedure because the semen-carrying tubes can occasionally reconnect, and sometimes have not been successfully disconnected in the first place during the vasectomy, despite the best efforts of the surgeon. Now, these follow-up steps will involve several sperm samples some months after the procedure, and you’re going to need to use some other kind of contraceptive method until you’re ABSOLUTELY sure that there are no more sperm emerging in your semen when you ejaculate. The fact is that nature, or the body, seems to be quite intent on keeping men fertile. However, the fact that sperm do continue to happen and emerge after vasectomy is pretty rare. To give you an example, in one study of 14,041 men who underwent vasectomy for contraception, under local anesthetic at a clinic, after 3 years only 6 of their wives became pregnant. Now that’s a very, very tiny percentage – but if you’re one of those six wives and husbands, that can really affect your life. So it’s worthwhile to make sure that you have no sperm in your ejaculate before you abandon other contraceptive techniques, and it does take several months of checking your semen at the doctor’s before you can be absolutely sure that this reconnection, which is called re-anastomosis, hasn’t taken place.

Now, I want to tell you about a very revealing Swiss study about the effects of vasectomy and sexual functioning. Two groups of men were evaluated. The first set was 18 men who were patients at a clinic for the treatment of erectile dysfunction. And they chose these 18 men out of their big sample of men with different kinds of sexual dysfunctions, particularly erectile problems, because they attributed their sexual problems to the fact that they had had a vasectomy. So these 18 men said they came to the clinic for sexual problems because they had sexual problems, and they said their sexual problems derived from the fact that they had had a vasectomy. Their average age at vasectomy was 56 years old, and they ranged in age from 52 to 71. These men were compared to a control group of 45 men who were randomly chosen out of 254 men who had had vasectomies and were part of a group that did not come to any clinic for any problems with their sexual functioning. This second group, this control group, their average age was 39 years at vasectomy, and they ranged in age from 23 to 59 years of age. Now all these men’s vasectomies dated back an average of 19 years, so they had been vasectomized on an average of 19 years ago. Now the purpose of this study was to discover whether there was any relationship between vasectomy and sexual problems or dysfunctions. The men in the clinic group that attributed their dysfunction to their vasectomies were medically evaluated to see if there were any organic problems – that is, physical problems – that might be causing their dysfunction. And after very careful testing and evaluation, their difficulties were judged to be psychological, not physical. 98% of the participants in both groups were married or were living in a steady relationship. There were no differences between the groups in whether they experienced the operation as traumatic or whether they feared that they would be de-masculinized or lose their virility as a result of this operation, so that was not what the issue was for the men from the dysfunctions group. However, there was a significant difference between the groups, and that difference was in whether the decision to undergo the vasectomy was imposed by their partner, or whether the decision was made by the man himself. I want you to keep that in mind as we now go through what other differences they found. Because that was a major difference – whether the man himself made the decision to have the vasectomy, for his own reasons, or whether he felt that it was an imposed decision on him by his partner.

Let’s look at what else they found. 22% of the men in the sexual dysfunctions clinic group said that their vasectomy, which was imposed upon them, reduced their libido or desire within 2 years of having the vasectomy, as compared to only 4% of the control group. So if your vasectomy was imposed upon you, it was likely that your libido or your desire was reduced. 27% of the clinic group reported that they had less frequent or weaker erections after their vasectomy, as compared to only 2% of the control group. Remember, all these men are aging along the way. 28% of the clinic group reported a decreased frequency of orgasm after their vasectomy, as compared to none of the control group. Interestingly, ejaculation quality and the quality of orgasm resulting from masturbation after the vasectomy remained the same in both groups and was unchanged in both groups – both the clinic group and the control group. The men were asked if the sexuality of their partners, of their female partners, was affected after their vasectomy. 28% of the group who said their vasectomy was coerced by their partners reported that her sexual activity had decreased, while only 4% of the control group reported that their partners’ sexuality had changed. And 39% had changed their partners during the follow-up period – that is, 39% of the clinic group had changed their partners after the vasectomy, while only 4% of the control group had changed their partners after their vasectomy. Finally, 28% of the group that felt they had been coerced believed that there was a connection between their post-vasectomy sexual difficulties and having the vasectomy, while only 4% of the control group made any kind of connection between the vasectomy and whatever difficulties they might have had in the years following the vasectomy. The obvious conclusion from this research is that the vasectomy itself does not affect sexual functioning in men.

What does make a difference is whether the man himself makes the decision, willingly, to have a vasectomy, and has good information about the facts, and how this procedure does not affect the male sexuality. And that’s really very much the responsibility of the physician. So it’s very important that you get a physician who’s sensitive to men’s concerns about vasectomy. Cutting these tubes does not affect your hormones in any way, does not affect anything at all except the transport of sperm from the testes to the outer connection, through the penis to the outer world. It has some small effect on antibodies, as I’ll tell you in a few minutes, but has no effect on the man’s health. It is also important for physicians who carry out this procedure to systematically question their patients who request vasectomy, separately from their partners, obviously, about their motivation and the manner in which this decision was reached. And if you go to a physician for a vasectomy, and he doesn’t ask you, alone, away from your partner, why you want to do this and how you came to this decision, then you know right away he’s the wrong physician to go to, and you should leave his office and find another physician.

Now, another study investigated the effect of vasectomy on the quality of relationships. Did assuring contraception without future concerns on either partner have any effect for better or worse on the quality of committed relationships? 145 couples were interviewed at the time that vasectomy was requested, and then seen 18 months later, whether or not the vasectomy was performed. All the interviewing physicians in this study were trained in dealing with sexual problems. As a part of the evaluation, the relationship was assessed using the following scale – they evaluated the relationships and you could fall in one of these categories: one was a joint, warm, reciprocal, rewarding, showing loving concern kind of relationships; or, the relationship was judged to be fair, strains, but a bearably modest success; or three – real strained, contained, but with difficulty. Four was major strains for both, and marital or major apathy. Five was impending disaster – breakdown by illness, breakup, divorce, or other case. Now, using this scale it was clear that the majority of marriages improved following vasectomy. In the first two groups, which was the joint warm group and the fair, strains there but still modestly successful, some of the strains which were apparent before vasectomy were not observed at all or even reported a year of 18 months after the vasectomy. Absolute protection from pregnancy was a major reliever of anxiety and strain and seemed to enhance sexual pleasure and satisfaction, as reported by the couples. Marriages that had these concerns particularly – that is, about pregnancy or about getting pregnant by accident – improved after vasectomy. Or people who were having difficulty or didn’t like the concerns about contraception and dealing with it, or even the expense of it – their relationships improved. Relationships engaged in longstanding marital warfare or that had severe sexual difficulties, especially when the husband believed that his wife’s dislike or lack of interest in sex would improve, those were not helped at all, and remained unchanged after the vasectomy. But lesser degrees of sexual difficulty seemed to improve, especially when they were based on extreme fears of pregnancy, so that erectile problems or lack of sexual desire were the result of these fears, those marriages or those sexual relationships did appear to improve after vasectomy.

Now, why do men choose or decide to have vasectomy? Top reason was to guarantee contraception with high effectiveness, and low cost, and efficiency, all of which is true for vasectomy. Also, because there were no side effects for female partners. And, of course, it’s permanent.

One question you might ask is, what if a man changes his mind? Can it be reversed? Now although when vasectomies first came into being, they were seen as being irreversible. But microsurgery techniques have improved dramatically. This was true even in 1981, when reversals of vasectomies were already quite successful. For example, I’m going to tell you about one study that was done way back then. And this was in 1981, a study of 21 men in Brazil – so it wasn’t even done in the United States – who underwent reconnection of their semen ducts. And the name of that surgery is called re-anastomosis, if you want to know the name – and it means reconnection of a tube in the body. And you can do it with blood vessels, you can do it with all kinds of things – but it can also be done with the ducts that connect the gonads, or testes, or balls, to the tube that goes through the penis. There were 21 men in the study, and they were between 22 and 53 years of age, and they had all been vasectomized an average of 2 to 7 years before they had their sperm ducts reconnected on both sides. Remember there are two – there are two testes so there are two sperm ducts, and you have to disconnect both of them. Now, this is not as easy a procedure as vasectomy, which just takes a few minutes and can be done in the office. It’s more expensive, and it has to be done under general anesthesia, whereas a vasectomy can be done under local and it’s very quick. In this group there were no surgical complications to the procedure. 18 of the 21 men had normal sperm following the surgery, and 15 of their partners became pregnant within one year. And remember, we don’t know how many of their partners had fertility problems, so that’s a high amount. In fact, three out of four were successfully reversed, if the strict criteria of fertilization is used as the marker of success. Full success was more assured the younger the man was, and again, techniques have gotten even better since 1981.

Now, why do men ask for a reversal of a vasectomy? In another study, 76 men requesting vasectomy reversal were studied. When asked for their reasons for wanting the reversal, the majority answered that it was because they wished for another child. Another, smaller group stated that they wished to be “put back to normal,” and a few hoped reversal would help their marriage. And please let me remind you that having another child very rarely helps a marriage. But in these cases, sometimes it was a new marriage, and that can be a different situation. It was likely that the group that believed it would make them “normal” again were like those in the earlier study that we just discussed, in which they had really not made the choice for vasectomy, that they had been coerced somehow into that decision. And the men who thought perhaps it would help their marriage, were men who maybe had had the procedure without consulting their wives in the first place. And again, this should be a decision made by the husband, or the man, but it also should then be in consultation with the partner, if you plan to stay with your partner, because it really should be a decision first made by the individual and then by the couple. Now, 59% of these men were divorced or separated and felt disadvantaged in courtship or in remarriage by being unable to impregnate a woman. Many new wives or partners were reported to be “desperate” to become pregnant. So, that’s a good reason for getting reconnected. The greatest number of reversals came from men who had been under 35 when they underwent vasectomy, and who had gotten divorced, since their vasectomy, and were either remarried or planning to be remarried. This was especially true for men who had been involved in a teenage pregnancy. So, immaturity at the time of making the decision for vasectomy seemed to be a major, major factor in wanting a reversal later on. Results were similar in a more recent study from one physician’s practice, in which age at surgery was the most important factor considering a reversal.

Overall satisfaction, by the way, with vasectomy in general, is very, very high. Out of another study, out of 1275 men, average age of the men was 37 years, less than 1 percent – that is, 9 out of 1275 men – subsequently considered reversal. Over a 10 year period, 98.4% had an uneventful postoperative experience with their vasectomies. It was concluded that overall satisfaction in appropriately counseled – oh, let’s underline that! – in appropriately counseled men, is very high.

Now I want to talk about effects on health in general, because there have been some rumors that there are negative effects from vasectomy on some aspects of men’s general health. Although 20 years ago there were some erroneous reports that there might be some general health risks associated with vasectomy, a large, large number of recent studies evaluating the health of thousands of men has clearly shown that such claims are erroneous and unfounded. No increased health risks for a host of diseases including cancers of all kinds and cardiovascular disease have been found. And in fact one of the benefits is that a significantly lower risk of cervical cancer has been found in women whose partners have had vasectomies. The relative risk for cervical cancer in women with un-vasectomized men is over 4 times greater than for women whose partners have undergone a vasectomy. The reason for this still has not been identified, but if your husband has been vasectomized you have a 4 times lower risk for cervical cancer. So that’s a good thing.

OK – so what are my conclusions now for this myth? We can conclude, regarding vasectomy and sexuality, that they are false. That is, it is false that there are any negative consequences to vasectomy, both with regard to sexuality – whether it’s virility or sexual behavior or sexual response – and vasectomy. They’re false. A vasectomy does not have any negative effects on male sexuality, male sexual behavior, masculinity, virility, as long – and this is important – as the man makes the decision to have the procedure himself, and then consults with his partner to understand her feelings about it. Then he needs to find a good physician with a good amount of experience in doing vasectomies. And I emphasize that you should not be afraid to ask the physician about how many he’s done, and if he doesn’t answer that question directly, leave the office. And you have the right even to ask if you can speak to several of his past patients, because he will have some patients that will be willing to talk to you. And if that will help you to allay your fears, do that! Ask him to speak to patients, because he should have patients who are willing to share with you. The physician should answer all your questions and give you a clear description of what is going to happen to you and what he’s going to do, not only during the procedure but after the procedure, and what the followups will be. If you don’t feel comfortable or satisfied that you’ve had a clear and full explanation, get up, leave the office, and find another doctor. Here’s a way to find a doctor: you can call the state of county urological society, or your closest university hospital’s urological department, and ask for a referral. Be assured that the vast majority of men, almost 100%, who decide to use vasectomy as their form of contraceptive are very well satisfied, as are their partners, as long as they have completed their families. And often their sex lives, and those of their partners, improve in pleasure and satisfaction after the procedure.

But here’s one thing that I want you to absolutely focus on as we close and remember. That although fertility and pregnancy are no longer a concern after vasectomy, you have no protection against sexually transmitted diseases, and it is so important that you use a condom when you have sex with a new or casual partner, or any partner that you are not absolutely assured that you are their only sexual partner. So, we’ve now busted another myth.

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