Economy Down, Vasectomy Up

From the FMS Global and UK News Desk of Jeanne Hambleton

More Men Choosing Permanent Sterilization in Trying Economic Times
Courtesy of WebMD.com
By Daniel J. DeNoon – Reviewed by Louise Chang, MD – WebMD Health News

March 26, 2009 — In these tough economic times, more men are making a tough decision: vasectomy.

Urologists across the country are reporting that nearly twice as many men have been seeking permanent sterilization via vasectomy since the economic crisis began.

There is no official count but it is clearly a trend, says Lawrence Ross, MD, professor of urology at the University of Illinois at Chicago and a past president of the American Urological Association.

“We are definitely, in our experience in Chicago, seeing increasing numbers of patients requesting vasectomy. A rough estimate is perhaps twice the number per week we saw a year ago,” Ross tells WebMD.

“Since mid-November we have gone from 40 or 45 to about 70 or 75 a month,” J. Stephen Jones, MD, chairman of the Cleveland Clinic’s department of regional urology, tells WebMD.

“I am seeing a lot more men coming in for vasectomy, and they are saying the reason they are doing it now is they are losing their insurance,” David Shin, MD, chief of the Center for Sexual Health and Fertility at Hackensack University Medical Center, N.J., tells WebMD.

One of those men is Peter Collum of Upper Saddle River, N.J. Three months ago, Collum was laid off from his job as an investment banker. His severance package runs out next month.

“It is not like being out of work was the only driver for getting a vasectomy,” Collum tells WebMD. “But it is a lot easier having this done while I am unemployed.”

Collum’s third child was born four months ago. He and his wife had planned on two to four kids; when the third was born they knew their family was big enough.

Like other urologists, Shin always counsels men before performing the sterilization procedure. In previous years, he says, men simply told him they did not want another child.

“But now economics plays a role,” Shin says. “We live in a time where people are saying, ‘Times are tough, and there is not going to be the disposable income to pay for food and diapers and to save up for college tuition.'”

One of Jones’ patients did not have far to travel after losing his job.

“One very demonstrative patient was a gentleman who had a great job for three or four years, working on a federally funded road project just out the door from our clinic,” Jones says. “When the job went away, he came into my office and said, ‘In this environment, I do not feel I could have any more children.’ And I think there are a thousand more stories like that.”

Many of the men now coming into urologists’ offices had already decided on vasectomy, but were motivated to act by fear of losing their health insurance. Others had even more pragmatic concerns.

“Couples are finding ways of trying to save money, so they do not go out to a fancy dinner or an extravagant show,” Shin says. “And if they are staying home, what is the most common free activity? And what does it lead to? If sexual activity is on the rise, vasectomy is a sure way of preventing a mistake.”

Ross warns that the decision to have a vasectomy should not be made lightly. While the procedure is safe, inexpensive, and relatively minor — recovery is rapid and takes only a day — it should be considered permanent.

“Doing a vasectomy is simple and relatively inexpensive. Undoing it is very expensive and is not covered by any insurance,” Ross says. “”We have to make sure every patient we talk to knows this is permanent, and they have to be absolutely certain they do not want to father any more children.”

©2005-2009 WebMD, LLC. All rights reserved.(http://www.webmd.com/sex/news/20090326/economy_down_vasectomy_up?ecd=wnl_men_040709)

Vasectomy
A vasectomy is considered a permanent method of birth control. A vasectomy prevents the release of sperm when a man ejaculates.

During a vasectomy, the vas deferens from each testicle is clamped, cut, or otherwise sealed. This prevents sperm from mixing with the semen that is ejaculated from the penis. An egg cannot be fertilized when there are no sperm in the semen. The testicles continue to produce sperm, but the sperm are reabsorbed by the body. (This also happens to sperm that are not ejaculated after a while, regardless of whether you have had a vasectomy.) Because the tubes are blocked before the seminal vesicles and prostate, you still ejaculate about the same amount of fluid.

It usually takes several months after a vasectomy for all remaining sperm to be ejaculated or reabsorbed. You must use another method of birth control until you have a semen sample tested and it shows a zero sperm count. Otherwise, you can still get your partner pregnant.

During a vasectomy:

Your testicles and scrotum are cleaned with an antiseptic and possibly shaved.
You may be given an oral or intravenous (IV) medicine to reduce anxiety and make you sleepy. If you do take this medicine, you may not remember much about the procedure.

Each vas deferens is located by touch.

A local anesthetic is injected into the area.

Your doctor makes one or two small openings in your scrotum. Through an opening, the two vas deferens tubes are cut. The two ends of the vas deferens are tied, stitched, or sealed. Electrocautery may be used to seal the ends with heat. Scar tissue from the surgery helps block the tubes.

The vas deferens is then replaced inside the scrotum and the skin is closed with stitches that dissolve and do not have to be removed.

The procedure takes about 20 to 30 minutes and can be done in an office or clinic. It may be done by a family medicine doctor, a urologist, or a general surgeon.

No-scalpel vasectomy is a technique that uses a small clamp with pointed ends. Instead of using a scalpel to cut the skin, the clamp is poked through the skin of the scrotum and then opened. The benefits of this procedure include less bleeding, a smaller hole in the skin, and fewer complications. No-scalpel vasectomy is as effective as traditional vasectomy. 1

In the Vasclip implant procedure, the vas deferens is locked closed with a device called a Vasclip. The vas deferens is not cut, sutured, or cauterized (sealed by burning), which possibly reduces the potential for pain and complications. Some studies show that clipping is not as effective as other methods of sealing off the vas deferens. 2

What To Expect After Surgery

Your scrotum will be numb for 1 to 2 hours after a vasectomy. Apply cold packs to the area and lie on your back as much as possible for the rest of the day. Wearing snug underwear or a jockstrap will help ease discomfort and protect the area.

You may have some swelling and minor pain in your scrotum for several days after the surgery. Unless your work is strenuous, you will be able to return to work in 1 or 2 days. Avoid heavy lifting for a week.

You can resume sexual intercourse as soon as you are comfortable, usually in about a week. However, you can still get your partner pregnant until your sperm count is zero. You must use another method of birth control until you have a follow-up sperm count test 2 months after the vasectomy (or after 10 to 20 ejaculations over a shorter period of time). Once your sperm count is zero, no other birth control method is necessary.

A vasectomy will not interfere with your sex drive, ability to have erections, sensation of orgasm, or ability to ejaculate. You may have occasional mild aching in your testicles during sexual arousal for a few months after the surgery.

Why It Is Done

A vasectomy is a permanent method of birth control. Only consider this method when you are sure that you do not want to have a child in the future.

How Well It Works

Vasectomy is a very effective (99.85%) birth control method. Only 1 to 2 women out of 1,000 will have an unplanned pregnancy in the first year after their partners have had a vasectomy. 3

Risk of failure

Pregnancy may occur after vasectomy because of:

Failure to use another birth control method until the sperm count is confirmed to be zero. It usually takes 10 to 20 ejaculations to completely clear sperm from the semen.

Spontaneous reconnection of a vas deferens or an opening in one end that allows sperm to mix with the semen again. This is very rare.

Risks

The risk of complications after a vasectomy is very low. Complications may include:

Bleeding under the skin, which may cause swelling or bruising.

Infection at the site of the incision. In rare instances, an infection develops inside the scrotum.

Sperm leaking from a vas deferens into the tissue around it and forming a small lump (sperm granuloma). This condition is usually not painful, and it can be treated with rest and pain medication. Occasionally, surgery may be needed to remove the granuloma.

Inflammation of the tubes that move sperm from the testicles (congestive epididymitis).
In rare cases, the vas deferens grows back together (recanalization), and the man becomes fertile again.

What To Think About

Advantages

Vasectomy is a permanent method of birth control. Once your semen does not contain sperm, you do not need to worry about using other birth control methods.

Vasectomy is a safer, cheaper procedure that causes fewer complications than tubal ligation in women. 1

Although vasectomy can be expensive, it is a one-time cost and is often covered by medical insurance. The cost of other methods, such as birth control pills or condoms and spermicide, is likely to be greater over time.

Disadvantages

A vasectomy does not protect against sexually transmitted diseases (STDs), including infection with the human immunodeficiency virus (HIV). Condoms are the most effective method for preventing STDs. To protect yourself and your partner from STDs, use a condom every time you have sex.

Other considerations

If you are considering a vasectomy, be absolutely certain that you will never want to father a child. Think through whether this might change after any of the following life events:

One of your living children dies (if you are a father).

You divorce and lose custody of your children.

You have a new partner who wants children.

Your financial situation improves and you can afford another child.

Your children grow up and leave home.

A vasectomy is not usually recommended for men who are considering banking sperm in case they decide later to have children. Discuss other options with your partner and your health professional.

Surgery to reconnect the vas deferens (vasectomy reversal) is available. However, the reversal procedure is difficult. Sometimes a doctor can remove sperm from the testicle in men who have had a vasectomy or a reversal that did not work. The sperm can then be used for in vitro fertilization. Both vasectomy reversal and sperm retrieval can be expensive, may not be covered by insurance, and may not always work.

Some older studies showed a risk of prostate cancer in men who have had vasectomies. However, many years of research have found no clear evidence that vasectomy is linked to prostate cancer. 1

Some doctors or health insurance plans may require a waiting period from the time you request a vasectomy and the time the procedure is done. This time allows you to be certain about your decision.

Researchers are studying other male birth control methods, such as reversible vasectomy or hormonal methods. Reversible vasectomy involves plugging the vas deferens and then removing the plug when birth control is no longer wanted. Hormonal methods include pills or injections that the man would use to prevent sperm production. So far, no new method has been shown to be effective enough, with low side effects, to be marketed for men.

Citations
Pollack AE, et al. (2004). Female and male sterilization. In RA Hatcher et al., eds., Contraceptive Technology, 18th ed., pp. 531–573. New York: Ardent Media.
Labrecque M, et al. (2002). Effectiveness and complications associated with 2 vasectomy occlusion techniques. Journal of Urology, 168(6): 2495–2498.
Trussell J (2004). The essentials of contraception: Efficacy, safety, and personal considerations. In RA Hatcher et al., eds., Contraceptive Technology, 18th ed., pp. 221–252. New York: Ardent Media.

Author Bets Davis, MFA; Editor Maria G. Essig, MS, ELS; Associate Editor Michele Cronen;
Associate Editor Denele Ivins; Associate Editor Pat Truman, MATC; Primary Medical Reviewer Joy Melnikow, MD, MPH – Family Medicine; Specialist Medical Reviewer Kirtly Jones, MD – Obstetrics and Gynecology. Last Updated May 22, 2008.

©2005-2009 WebMD, LLC. All rights reserved.(http://www.webmd.com/sex/birth-control/vasectomy-14387)

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About jeanne hambleton

Journalist-wordsmith, former reporter, columnist, film critic, editor, Town Clerk and then fibromite and eventer with 5 conferences done and dusted. Interested in all health and well being issues, passionate about research to find a cure and cause for fibromyalgia. Member LinkedIn. Worked for 4 years with FMA UK as Regional Coordinator for SW and SE,and Chair for FMS SAS the Sussex and Surrey FM umbrella charity and Chair Folly Pogs Fibromyalgia Research UK - finding funding for our "cause for a cure" and President and co ordinator of National FM Conferences. Just finished last national annual Fibromyalgia Conference Weekend. This was another success with speakers from the States . Next year's conference in Chichester Park Hotel, West Sussex, will be April 24/27 2015 and bookings are coming in from those who raved about the event every year. I am very busy but happy to produce articles for publication. News Editor of FMS Global News on line but a bit behind due to conference. A workaholic beyond redemption! The future - who knows? Open to offers with payment. Versatile and looking for a regular paid column - you call the tune and I will play the pipes.
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