By Dr. Frank D’Amico
The pill. The patch. The sponge. The ring. The tube-tying.
Most contraceptive choices revolve around women. This approach to pregnancy prevention is reflected in a recent Harris poll, in which nearly three out of four women said men cannot be counted on to choose a birth control method. Men agreed in almost equal numbers.
But while male birth control drugs are still a prescription for the future, men do have a surgical option to prevent pregnancy. Proponents laud vasectomies as affordable, painless and 99.9 percent effective.
As birth control options expand and improve, couples should remember that “this is not a battle of the sexes thing,” said Dr. Richard Crispino, an OB/GYN with Women First Obstetrics and Gynecology in Lower Paxton Twp. “Each couple has to weigh the options independently and choose for themselves.”
Some couples want to delay pregnancy for a few years while others are convinced that their family is complete and want something permanent. In the latter case, the advantages of a vasectomy are many, said Dr. Frank C. D’Amico, urologist and president of Urology of Central PA in Lower Paxton Twp.
The procedure takes 20 minutes and is done in the doctor’s office while the patient is awake, D’Amico said. It involves snipping and tying off the pair of tubes known as the vas deferens, the sperm-carrying pathways that originate at the base of the penis in the scrotum.
D’Amico said these tubes are easy to get to, making a vasectomy less expensive than traditional female tubal ligation. Insurance companies set the payment for a vasectomy at between $500 and $700, D’Amico said.
When performing a vasectomy, a urologist makes one small incision — about three-eighths of an inch in length — in the scrotum. The area is numbed with instant-acting lidocaine, and patients are often given Valium to ease anxiety. Once the tubes are tied off, the sac is stitched closed.
“The vast majority of men are pleasantly surprised that it is over” so quickly, D’Amico said.
Recovery usually only takes a few days, D’Amico said. Many men schedule the procedure for a Friday so they can recover over a weekend. Post-surgery, they are encouraged to ice the area, wear a tight-fitting jock strap, take pain medication if needed, protect the region from injury and “take it easy for a few days.”
Seven to 10 percent of married couples in the United States opt for vasectomy as birth control, D’Amico said. “Fear is preventing this procedure from being a more popular method.”
Crispino agreed that many men may decide upon a vasectomy but are prone to delay.
D’Amico said vasectomies are often driven by wives, who are pushing it on their gynecologist’s advice or out of fear of the pill’s rising risk of stroke and blood clots as they age.
The emotional aspect of making such a permanent decision is a “very important part of the procedure,” D’Amico said, leading his practice to carefully counsel patients beforehand. Men who seek a vasectomy when their wives are pregnant are usually advised to wait until their wife delivers and the stress of pregnancy dissipates.
D’Amico warns patients that the vasectomy does not work immediately. It may take a few months — or eight to 15 ejaculations — before the sperm is totally emptied from the tube.
Many fear that vasectomies will cause long-term problems, but these are rare, D’Amico said.
The complication rate is drastically lower for patients who select doctors who have done the procedure more than 50 times, said D’Amico, who has performed hundreds each year over the course of his 18-year career. He usually does three or four vasectomies each Friday.
D’Amico said about 1 percent to 1.5 percent of patients will develop severe bruising. The risk of infection is about 3 percent, with antibiotics given to reduce that risk.
Other risks are chronic pain, such as from pressure on the epididymis, the storage tank for sperm, which happens in about one in 1,000 cases. In these cases, doctors can treat the condition by removing the epididymis or reversing the vasectomy, D’Amico said.
Another rare complication is the formation of sperm granulomas, bumps on the end of the vas deferens, which can often be felt but not seen, D’Amico said.
The failure rate for vasectomy is 0.01 percent, but pregnancy is a risk. The tube can re-channel and grow a new tract that could carry sperm to a waiting egg.
If a patient later decides he wants children, often prompted by the unexpected death of a child or partner, a divorce or a new relationship, vasectomies can be reversed, but the procedure is not always successful, D’Amico warned.
The biggest factor in the reversal’s success is how long it’s been since the vasectomy because a blockage can form in the reproductive tract and men can develop anti-sperm antibodies over time.
Vasectomy reversal costs between $5,000 and $20,000 and is a three-hour microscopic procedure. “It doesn’t always work and is more tedious to do,” with a fully equipped operating room required, D’Amico said. He has done only two reversals.
The vasectomy procedure has not changed much in the past few decades. Although a new “no-scalpel” technique was developed in China in the mid-1970s and has been used in the U.S. since the mid 1980s, D’Amico said it was designed as a cost-saver and he sees little advantage. However, some physicians believe the no-scalpel technique is gentler and reduces bruising and scarring.
A vasectomy is verifiable, D’Amico said. Doctors routinely check a semen sample at eight and 12 weeks after the procedure to confirm that it is clear of sperm.
If the vasectomy fails, it can result in a normal pregnancy. If a female tubal ligation fails, a life-threatening tubal pregnancy can occur.
Crispino noted, however, that while the old-school tubal ligation was considered more dangerous than a vasectomy, female sterilization has evolved.
For example, the new Essure, is a non-surgical, non-hormonal, silicone-free catheter inserted into the Fallopian tubes in a 10-minute, anesthesia-free procedure that is “as safe as vasectomy and as effective,” Crispino said. The new Mirena IUD, a soft, flexible intrauterine device that releases small amounts of hormone into the uterus, is also highly effective, done in the office, it can last up to five years and has the added benefit of treating heavy periods.
“Vasectomies are excellent, no question about it,” said Crispino, “but failures occur with everything and you must weigh all the options. There have been improvements everywhere.”