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Vasectomy Safety - National Institute of Health
FACTS ABOUT: VASECTOMY SAFETY
Until recent years, few people questioned the long-term safety of
vasectomy. A couple considering vasectomy was more likely to ask
a doctor about the operation itself, its effectiveness, or how it
might change their sexual relationship.
Things have changed. Men considering vasectomy and their
partners now want to know about long-term side effects. Their
biggest concern is hardening of the arteries or heart disease
-issues raised by animal studies in the late 1970s. Researchers
speculated then that sperm antibodies, produced by many men
following vasectomy, could be responsible for these and other
health risks.
This concern prompted the National Institute of Child Health and
Human Development (NICHD), the nation's largest supporter of
research on birth control methods, to start a multimillion dollar
program of vasectomy research. Fortunately for the millions of
men with vasectomies and their families, the latest news about
its long-term safety is good.
Almost 40,000 men took part in four studies completed in recent
years under contracts with the Institute. The findings are
reassuringly similar: None show an increased risk of hardening of
the arteries or other forms of cardiovascular disease in men with
vasectomies. In fact, one study found that, for unknown reasons,
men who have had vasectomies are healthier in some ways than
those who have not.
While this is good news for men with vasectomies, those who are
considering it should still give the decision serious thought,
because vasectomy is generally permanent. Although new
techniques for reversing vasectomies may increase the odds that
fertility will return, there are no guarantees. Realizing this,
and being up-to-date on news about long-term safety, can help
couples today to make informed decisions about vasectomy.
After Decline,
Vasectomy Popularity
Jumps
Sterilization-including both vasectomy and female
sterilization-is now the most popular form of birth control in
the United States, chosen by four out of 10 couples who use
contraception.
Vasectomy is far simpler and less expensive than sterilization
for women. Yet today, fewer men than women undergo sterilization
procedures. Just a short while ago, this was not the case.
In the mid-1970s, men and women had sterilizations in nearly
equal numbers. Gradually, however, more and more couples opted
for female sterilization, until these procedures outnumbered
vasectomies by 2 to 1 in 1982.
Fears about the long-term safety of vasectomy were at least
partly responsible for a decline in vasectomies, experts believe,
along with easier and safer sterilization operations for women.
But now that trend seems to be reversing. The Association for
Voluntary Sterilization (AVS) noted a 50 percent jump in
vasectomies performed between 1982 and 1983. The AVS credits
this increase to "evidence from scientific studies that has
dispelled lingering doubts about the safety of vasectomy. "
Long-term Safety:
The Antibody
Question
Concern over the long-term safety of vasectomy first arose
several years ago when researchers discovered that many men
produce antibodies to sperm following the operation.
Fortunately, investigators have since found no evidence that
this immune response causes health problems in men.
Antibodies are disease-fighting substances that circulate in the
bloodstream. Normally they protect the body from invaders such
as viruses, bacteria, and foreign cells. In the case of many
vasectomized men, however, the body's immune system mistakes
sperm for foreign cells and forms antibodies against them.
This happens because early in infancy, the immune system learns
what is native to the body and what is foreign. Sperm cells are
not produced until years later, at puberty. But at that time,
they are essentially hidden from the immune system by barriers in
the reproductive tract, so antibodies are not formed.
After vasectomy, however, the protective barriers can be broken.
The testicles still produce sperm, which the body absorbs. In
the process, antibodies often form.
One-half to two-thirds of men who have had vasectomies develop
antibodies to sperm after the procedure. It is not known why
some men produce more or fewer antibodies than others, and some
none at all. A very small percent of men without vasectomies
also develop sperm antibodies because of surgery, infection, or
inborn abnormalities of the reproductive tract.
In men with vasectomies, the antibodies may persist for 10 years
or more after surgery. Doctors became concerned about this
immune response because they felt that, in theory, it might have
adverse consequences.
The most serious side effect that was suggested by studies in
monkeys is a worsening of hardening of the arteries. When these
studies were reported in the late 1970s, the investigators
thought the antibodies might play a part in damaging inner walls
of arteries. Nevertheless, research to date has not demonstrated
that these findings apply to men.
As an example, one study showed that the level of sperm
antibodies in a man's bloodstream does not affect his risk of
developing coronary heart disease. At the Battelle Human Affairs
Research Centers in Seattle, WA, a group of scientists found that
high levels of sperm antibodies were equally common in men with
and without heart disease. There was no evidence, moreover, that
the antibody levels increase over time.
Largest Study
on Vasectomy:
Healthier Men
Even before the findings from the monkey studies were reported,
the NICHD started a project that became the largest study on
vasectomy performed to date. The study, involving more than
20,000 men in four U.S. cities, was designed to find out if the
immune reaction following vasectomy could lead to any health
problems.
In announcing the study, health officials stated that because it
is the most comprehensive assessment ever performed on this
topic, the results are especially encouraging. In almost every
category of illness, the men with vasectomies were either no more
prone to disease than the other men, or even less likely to
become ill.
In this study, based at the University of California at Los
Angeles, scientists compared the rates of more than 100 diseases
in 10,590 men who had vasectomies and an equal number who had
not. When the study began in 1976, they were mainly interested
in diseases that might be related to an immune response, such as
rheumatoid arthritis. But when early results from the monkey
studies appeared the next year, they added a special focus on
cardiovascular disease.
The study's results, reported widely in 1983, showed that men
with vasectomies have no more health problems than other
men-including diseases involving the immune system,
cardiovascular disease, cancer, and impotence. This held true
for specific diseases that had been cited as possible
complications of vasectomy, including hardening of the arteries,
rheumatoid arthritis, blood clotting disorders, gout, and
multiple sclerosis.
The only condition seen markedly more often in the vasectomized
men was epididymitis, a local inflammation near the site of the
operation. This complication, which was previously known, occurs
mostly within the first year after vasectomy. Treated with heat,
it usually clears up in a week.
Otherwise, men with vasectomies were just as healthy as
other men, if not more so. Besides having fewer cases of cancer
and heart disease, the men with vasectomies also had one-third
fewer deaths. The lower death rate was found for all causes of
death except accidents and violence, which killed the same number
of men with and without vasectomies. The researchers do not
know why men with vasectomies had better survival rates overall.
Other Major Studies:
Consistent
Findings
While the UCLA project looked at the rates of all possible
diseases in men, other studies in the NICHD's program of
vasectomy research have taken a more specialized approach. Three
large studies in men have focused on the question raised in
animal studies about hardening of the arteries and heart disease.
Again, the findings for men with vasectomies are favorable.
One study involved more than 7,000 men who had hardening of the
coronary arteries, which supply the heart muscle with blood.
Researchers at the Medical College of Wisconsin looked for
factors that might influence the severity of coronary blockage.
They found no connection between vasectomy and the disease, but
they did confirm that age, smoking, and high blood pressure all
make coronary blockage more severe.
The question of long-term safety was tackled in another
study-this one involving 5,000 men-based at the Battelle Human
Affairs Research Centers in Seattle, WA. Many men in the study
had had vasectomies for more than 25 years, while the average
time since vasectomy was 15 years, the longest in any study to
date.
Regardless of the length of time since the procedure, the men
with vasectomies did not have a greater risk of heart disease.
The researchers reported that "this finding strengthens the
results of all previous studies in humans," which also found no
relation between vasectomy and heart disease.
Similarly reassuring findings have come from the latest study, a
Boston University project involving about 6,000 men. Results
show no higher risk of heart attack in men with vasectomies.
In all, the NICHD and other organizations have sponsored more
than a dozen large studies on vasectomy involving more than
100,000 men. None show a greater risk of any serious illness in
men with vasectomies. And contrary to the findings in monkeys,
none demonstrate an increased risk of hardening of the arteries
or heart disease.
When Permanence
is a Problem
While safety is a major consideration in choosing a birth control
method, another important factor is convenience. Vasectomy's
permanence makes it convenient; within a few weeks after the
operation, no other steps must be taken to prevent pregnancy.
Although this is an advantage to most men who have the operation,
it is a drawback for a very small percent of them.
Approximately 2 in 1000 men who have vasectomies regret it later
and wish to have the operation reversed.
The main reasons for requesting a reversal are remarriage, death
of a child, or an improvement in finances followed by a wish for
another child. Fewer than 10 percent of men who request
reversals do so because of physical or psychological problems
following vasectomy.
Reversal Operations:
No Guarantees
In contrast to the original operation, the vasectomy reversal is
a complicated, delicate and expensive procedure that is not
covered by medical insurance. The difficulty lies in trying to
reconnect the sperm-carrying tube's inner canal, which is the
size of a pinpoint. And although new surgical techniques are
improving the chances of success, no doctor can guarantee that a
reversal operation will result in both the reappearance of sperm
in the semen and, ultimately, the achievement of pregnancy.
Pregnancy rates following vasectomy reversal range from 16 to 85
percent. Success depends on several factors, including the
ability of the surgeon performing the reversal, the way in which
the original operation was performed, and the time lapsed since
vasectomy.
Some reports show that when reversal is performed within 2 years
of the original operation, men can expect sperm counts eventually
to return to normal. If it is done between 2 and 10 years later,
they have about a 90 percent chance, and if it is more than 10
years they have only a 35 percent chance of regaining normal
sperm counts.
But returning sperm counts to normal is only half the battle; the
other half is achieving pregnancy. Here, the fertility of the
woman must be considered as well. Another factor in question is
whether men with high levels of antibodies to sperm are less
likely to regain fertility following a reversal operation.
Physicians are often asked about the possibility of storing
frozen semen in sperm banks before vasectomy, as a safety
measure. Few men follow up on this, however. While it is
possible to bank sperm and later establish pregnancy, it works an
estimated one time out of four. Some experts believe that
individuals who want to bank sperm probably shouldn't have a
vasectomy, because they most likely have doubts about giving up
their ability to father a child.
Counseling - A Must
Before a man has a vasectomy, it is very important that he and
his partner receive thorough counseling that permits them to ask
questions and express any fears they may have. This forces a
couple to become sure of their decision; without it, some
anxieties are likely to remain. Vasectomy counselors are urged
to explain all other methods of birth control, in addition to
giving full details on the benefits and possible drawbacks of
vasectomy.
Quick Operation, Rapid Recovery
The vasectomy operation is quick, safe, and inexpensive. Usually
it is performed in a doctor's office or clinic and takes only 10
to 15 minutes.
After giving the patient a local anesthetic, a doctor generally
makes two small incisions, one on either side of the scrotum,
then locates the two thin tubes that carry sperm, seals them off,
and closes the incisions. The patient rests for an hour or two
before going home.
The cost for vasectomy averaged $240 in 1982, a price one-fifth
that of female sterilization.
Recovery from the vasectomy operation is rapid, and serious
complications are rare. Swelling, bruising, and pain-the most
common complaints-occur in about half of men after vasectomy.
The discomfort subsides within a week or two and usually responds
to treatment with ice packs, mild pain killers, scrotal support
and rest. Men are generally advised to avoid strenuous work or
exercise for about 2 days after the operation.
A minority of men develop a small lump of inflammatory tissue
called a granuloma near the incision site. Granulomas, caused by
sperm leaking into surrounding tissues, usually stay so small
that they don't cause symptoms. If they do cause pain, it is
generally treated with bed rest and mild pain killers.
Fewer than 3 in 100 men develop complications such as infection,
hematoma (bleeding under the skin), or epididymitis (inflammation
of the tube that collects sperm from the testes). All can be
treated, and no deaths from vasectomy have been reported in the
United States.
Delayed Effectiveness
Vasectomy is one of the most effective means of birth control,
with a less than 1 in 100 chance of failure. It does not offer
immediate protection from unwanted pregnancy, however.
The reproductive tract is not clear of sperm for several weeks,
and other forms of birth control must be used until a semen
sample, generally checked at 6 to 8 weeks, shows no
sperm. The most common reason for vasectomy failure is probably
unprotected intercourse before all sperm have cleared the
reproductive tract.
Sex After Vasectomy: No Difference
After vasectomy, a man can safely resume having sex (using
another form of birth control until his semen is free of sperm)
as soon as he feels comfortable. Because the sperm and fluids
from the area sealed off by vasectomy make up only a small
fraction of the total fluid ejaculated, he should notice no
difference in the amount of fluid nor in its appearance. The
size of the testicles remains unchanged as well.
Two common worries about vasectomy are that it will reduce a
man's sex hormone levels or take away his ability to have sex.
These myths have no biological basis, however, because vasectomy
only prevents the escape of sperm from the reproductive system,
not the release of testosterone, the male sex hormone,
into the bloodstream.
Both sperm and testosterone are produced in the testicles, but
they leave by different routes. Sperm move through a series of
ducts that channel through the reproductive organs to the outside
of the body, while tiny veins in the testicles transport
testosterone into the bloodstream.
So when vasectomy seals the tubes that carry sperm, it doesn't
affect the transfer of testosterone into the bloodstream.
Therefore there is no physical reason for a loss of sex drive or
other sexual characteristics. A small percentage of men-less
than 1 to 5 percent-have psychological problems after
vasectomy that can include a drop in sex drive. But according to
a report from the Johns Hopkins University Population Information
Program, reactions like these can be reduced with careful
counseling before the operation.
Serious marital, psychological, or sexual instability should be
treated as possible reasons for not having a vasectomy, according
to the report. It also states that "vasectomized men and their
wives usually report either no change or an improvement in
marital happiness and sexual satisfaction.
Peace of
Mind
For most men with vasectomies, though, the permanence is a
benefit; it frees them from worries of unwanted pregnancies and
the hassles of other forms of birth control. And now they can
also take reassurance from findings of current research on
vasectomy's long-term safety.
More information on vasectomy is available from the following
sources:
Association for Voluntary Sterilization
122 East 42nd Street
New York, NY 10168
(Brochures for men and women interested in sterilization)
Population Information Program
Johns Hopkins University
Hampton House
624 North Broadway
Baltimore, MD 21205
(In-depth reports on vasectomy and other forms of birth
control)
National Clearinghouse for Family Planning Information
P.O. Box 12921
Arlington, VA 22209
(Bibliography on male and female sterilization; other birth
control information)
Planned Parenthood
Publications Department
810 7th Avenue
New York, NY 10019
(Send 501 for brochure called "All About Vasectomy")
"Facts About Vasectomy Safety" was written by Maureen B. Gardner,
Office of Research Reporting, National Institute of Child Health
and Human Development (NICHD).
The NICHD, part of the Federal Government's National Institutes
of Health, conducts and supports research on the processes that
determine the health of children and adults. For copies of this
fact sheet or others in this series, write to the National
Institute of Child Health and Human Development, P.O. Box 29111,
Washington, D.C., 20040.
Other publications in this series:
Facts About Anorexia Nervosa
Facts About Cesarean Childbirth
Facts About Childhood Hyperactivity
Facts About Dyslexia
Facts About Premenstrual Syndrome
Facts About Oral Contraceptives
Facts About Precocious Puberty
Facts About Pregnancy and Smoking
Facts About Premature Birth
National Institute of Child Health and Human Development
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