Vasectomy Risks and Benefits

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Once you’ve made up your mind that you never want to have any more children, there’s no more reliable form of contraception than vasectomy. But one precaution: To lower the risk of your vasectomy failing, make sure the surgeon who does yours is qualified and has a lot of experience.

When done correctly by an experienced physician, as few as 1 in 1,000 vasectomies fail to do their job — preventing you from ejaculating birth control for at least three months after vasectomy because sperm are still swimming around “downstream” of the cut. At 12 weeks, it is a good idea for men to get a follow-up test for sperm in their semen. A negative result generally confirms that the operation was successful.

“Still,” says Labrecque, “if the doctor tells you, ‘There are no sperm,’ there’s a 1 in 2,000 chance that you will later become fertile again. So if your wife gets pregnant, don’t assume she’s cheating on you. The first assumption should be that your body healed itself.”

Vasectomy pain

Most men fear pain more than any other aspect of a vasectomy, and with good reason. While the procedure, if done well, is almost painless, soreness for a few days afterward is common. Sexual intercourse and sports are best postponed for a week. “I had one guy who tried to have sex the day after the surgery,” recalls Labrecque. “He was in terrible pain and his scrotum was swollen.”

Estimates on the rates of chronic pain, however, range widely. In a variety of studies, anywhere between 1% and 50% of men complained of sore testicles, including epididymitis (“blue balls”) for up to a year. As many as 15% described the pain after vasectomy as seriously aggravating. Again, the surgeon’s technique and experience appeared to be key.

Do vasectomies increase the risk of prostate cancer and dementia?

A handful of studies in the early 1990s reported an association between vasectomy and prostate cancer, but a conclusive survey in New Zealand refuted the link.

In 2006, a group of Northwestern University researchers published a study that seemed to link vasectomy and dementia. The study was prompted by a patient at an Alzheimer’s disease clinic who told doctors that his —problems with speech—had begun shortly after a vasectomy. A survey of 47 clinic patients with early aphasia found that 19 had had a vasectomy.

The study caused some concern because there is a plausible, if unlikely, mechanism for a vasectomy to cause brain damage. Sperm normally doesn’t come in contact with the bloodstream, but antibodies to sperm form in the of about two-thirds of men who get vasectomies. (The sperm leaks into the normal tissue of the body after the vas is cut.) The theory put forward by the Northwestern study is that antibodies to sperm, which happen to have some proteins in common with brain cells, might cause an autoimmune attack on the brain.

But the study was small and hasn’t been replicated, so it’s too early to make much of it. For the time being, according to both Sokal and Labrecque, dementia is a hypothetical risk of vasectomy, though one that requires further research.

How effective are vasectomy reversals?

More importantly, both Sokal and Labrecque stress that it’s vital not to expect that a vasectomy can be undone. Labrecque says that he can successfully perform a vasectomy reversalabout half the time, but there are no guarantees.

“Before I give you a vasectomy,” says Labrecque, “you must be sure you don’t want kids anymore for the rest of your life, no matter what your personal situation is.”