Attitudes to vasectomy

4 surveys were conducted in the United Kingdom in an attempt to determine the personal and social factors influencing the decision to have a vasectomy. The surveys differed from other vasectomy studies in that they represented couples requesting a vasectomy and not only those who obtained a vasectomy. They include, therefore, individuals who were refused and those who changed their minds, as well as those individuals on whom the operation was performed. The surveys showed that by 1978 the majority of requests came from couples who had 2 children or less (70%), who came from social class 3 (64%), and where the wife was under age 35. There was a relative absence of high-parity couples, of the least skilled, and of those of African or Asian origin. The husbands viewed vasectomy as a final act of male contraceptive responsibility. The reasons for choosing vasectomy were to prevent further pregnancies and to protect the wife from the health risks of the oral contraceptive or the IUD and from the dangers of childbearing or the fear of pregnancy. The findings of the first 3 surveys were similar. All surveys suggested that men of low parity preferred vasectomy and that men of high parity and those of African or Asian origin were often reluctant to undergo a vasectomy. All the marriages described as successful remained so after vasectomy. Minor degrees of impotence, frigidity or lack of libido appeared to improve. 11% of the couples withdrew from the operation following the counseling session. The 476 couples requesting vasectomy in the first 3 surveys produced a wide range of anxieties over health, life problems, sexual enjoyment, contraception, children, marriage, and the change of life. There appeared to be marked differences between couples who undergo vasectomy and those choosing tubal ligation.     

Vasectomy and non-fatal acute myocardial infarction: a hospital-based case-control study in Seoul, Korea

One hundred and sixty-three Korean men aged 35-64 who were admitted to a university-affiliated hospital diagnosed for the first time with acute myocardial infarction (AMI) were compared with 326 matched non-AMI patients hospitalized with a diagnosis considered unrelated to vasectomy. When other potentially confounding variables were controlled for, vasectomized men were found to be 2.6 times (adjusted odds ratio) more likely to have had an AMI as compared to the non-vasectomized men (95% CL: 1.1, 6.1). The adjusted odds ratio of AMI for subjects having had a vasectomy less than or equal to 9 years ago was the same as those who had a vasectomy greater than or equal to 15 years (OR = 2.5), although those who had had a vasectomy 10-14 years ago were associated with a higher odds ratio of 4.2. Among those subjects with vasectomies who were also cigarette-smokers and/or hypertensive, the risk of development of AMI increased multiplicatively compared with those with none of these conditions. We suspect that our finding of this positive association may be spurious due to possible bias introduced during selection of controls and during the process of data collection. Cancer patients may have been less likely to undergo an elective surgical procedure such as vasectomy prior to the admission. When multivariate analysis included only controls who were non-cancer patients (N = 241 controls), the adjusted odds ratio between vasectomy and hospitalization for AMI was reduced to 2.1, (95% CL: 0.8, 5.7), which is no longer statistically significant. When the analysis was further limited to only those control subjects admitted with a diagnosis of digestive system problems, the adjusted odds ratio was reduced to close to unity (1.1). Recognizing the importance of the study topic and the fact that all previous epidemiological studies showed no association between vasectomy and cardiovascular diseases, we urge further studies. A historical cohort study in the Korean setting is considered feasible and is recommended.     

Postvasectomy semen analysis: why patients don't follow-up.

Semen analysis following elective vasectomy is necessary to confirm that the procedure was successful. However, many patients fail to follow postoperative instructions to obtain semen analysis. One hundred forty-one patients who had undergone vasectomy at the Family Practice Center of the Medical College of Ohio were surveyed to assess reasons for a poor rate of follow-up after vasectomy. Only 26 percent of respondents had returned two or more semen samples following surgery. Forty-five percent had not returned any samples. The inconvenience and embarrassment of having to bring semen specimens to the laboratory were identified as factors that can affect patient adherence to instructions. Respondents who had not returned any semen specimens were more likely to answer that their spouse would not be very upset if the vasectomy failed and pregnancy resulted. Our survey results identify issues for improving patient care following vasectomy. These include patient education and postoperative protocols.     

Does vasectomy cause prostate cancer?

Vasectomy is the process in which a man's vas deferens are severed, with the cut ends folded back and tied off to prevent the release of sperm from his testicles to the urethra and out of the penis. The procedure may be conducted in a doctor's office under local anesthesia, is almost 100% effective in preventing pregnancy, and leaves sexual function fully intact. Since sperm comprise less than 5% of semen, even the amount of ejaculated fluid does not change noticeably. 20% of American men over age 35 years have had a vasectomy. Despite vasectomy's simplicity and effectiveness, debate exists over whether vasectomy may increase the risk of prostate cancer, the most common malignancy in men. Two large, well-designed Harvard studies were published in 1993 in the Journal of the American Medical Association which suggest that such a relationship may exist. The two studies compared the number of prostate-cancer diagnoses in almost 25,000 men who had undergone vasectomy with nearly 50,000 men who had not. Men who had undergone vasectomy more than 20 years earlier were almost twice as likely as their unsterilized counterparts to have been diagnosed with prostate cancer. Overall, the rate of such diagnoses was about 60% higher among the men who had been sterilized. These widely-reported studies rekindled earlier fears of a possible prostate-cancer risk and no doubt convinced some men to avoid the operation or to have it reversed if they had already gone through with it. Four earlier studies also suggested a link between prostate cancer and vasectomy. Seven other reports, however, have found no connection. Several studies even indicate that men who undergo vasectomy live longer than other men. Many researchers believe that the Harvard studies' findings are simply the result of earlier and better diagnosis of prostate cancer among sterilized men rather than due to an actual increased risk of the cancer.     

输精管绝育术与前列腺癌关系的Meta分析

目的：探讨输精管绝育术与前列腺癌的关系。方法：采用Meta分析方法对美国进行的输精管绝育术与前列腺癌关系的七项病例对照研究文献进行综合分析。结果：共收集前列腺癌病人4365例，对照14531例，合并OR＝1．10（95％CI：1．042，1．253），绝育不足20年OR＝0．923（95％CI：0．819，1．390），绝育20年以上者OR＝1．113（95％CI：1．096，1．358）。结论：输精管绝育术与前列腺癌存在一弱阳性联系，并且随着绝育年限的延长发病危险增加。     

Vasectomy: views of Latinos and white men

Vasectomy has gained wide acceptance as a safe, effective, and efficient method of birth control. Knowledge regarding the satisfaction of patients who have undergone the procedure has been well documented. In contrast, there is little data examining the attitude of men in general to the procedure or attempting to interpret these attitudes in a cultural context. Moreover, there appears to be widespread belief by providers that acceptance of the operation is poor among ethnic minorities such as Latinos and blacks. A questionnaire was distributed to 50 white and 50 Latino men at a large county hospital to determine ethnic differences in attitudes toward vasectomy. Only 54 percent of the Latino respondents stated they knew what a vasectomy was compared with 96 percent of the white respondents. Among respondents who knew what a vasectomy was, 50 percent of Latinos and 61 percent of whites stated they would not consider vasectomy in the event that they did not want more children. There was little support for the hypothesis that machismo played an important part in the negative responses by the Latino men or that fears of impotence played a role in the attitudes of both groups. This study suggests that a stronger emphasis on education regarding this procedure should be directed to the Latino male population.     

Vasectomy effectiveness in Nepal: a retrospective study

The main purpose of this retrospective, cross-sectional study was to evaluate the effectiveness of vasectomy in an ongoing public sector program in Nepal. We evaluated semen samples from men who had previously had a vasectomy, and asked about the occurrence of pregnancies in the men's partners. In addition, the surgeons who performed the vasectomies completed a questionnaire about their techniques. A two-stage stratified sampling procedure was used to select 1263 men from among over 30,000 men, who had previously undergone a no-scalpel vasectomy, mostly by ligation and excision, in 32 districts between July 1996 and June 1999. Semen samples were preserved and analyzed at a central laboratory. A US andrology laboratory validated the lab results. Twenty-three men (2.3%, 95% confidence interval [CI] 1.1-3.6) had >/=500,000 sperm/mL in their semen. Fifteen of those men reported pregnancies conceived after their vasectomy. In addition, six men with azoospermia reported pregnancies for which conception occurred within 3 months after vasectomy. Eleven men with azoospermia reported pregnancies for which conception occurred more than 3 months after vasectomy. Reported pregnancy was more likely in younger partners. The life table pregnancy rates for all men interviewed were 0.7 (95% CI 0.2-1.1), 1.7 (95% CI 1.4-2.1) and 4.2% (95% CI 3.2-5.2) at 3, 12 and 36 months, respectively. In low-resource, programmatic settings, vasectomy failure rates may be higher than commonly cited rates, especially in younger populations. Additional research is needed to determine if other occlusion techniques could reduce failure rates. Counseling on vasectomy should always convey the possibility of failure and partner pregnancy.     

Demographic consequences, client satisfaction, and reasons for selecting sterilization among vasectomy and tubectomy clients in Bangladesh

A follow-up study of vasectomy and tubectomy clients in Bangladesh showed that the mean ages of the vasectomy clients and their wives were significantly higher than the mean ages of the tubectomy clients. These findings suggest that the number of births averted by vasectomy is less than what might be expected from tubectomy. Between 20 and 60% of the tubectomy clients stated that they (or their husbands) had previously used contraception, while only 2% of the vasectomy clients indicated that they or their wives had previously used contraception. More than 95% of the tubectomy clients, compared to less than 48% of the vasectomy clients, were satisfied about having a sterilization procedure. A large proportion of the dissatisfied vasectomy clients indicated that they had chosen vasectomy rather than some other method of contraception primarily because of financial incentives. The small percentage of dissatisfied tubectomy clients indicated that their concern was about possibly having a child die and not being able to replace that child.

Further differences in the perceived satisfaction among vasectomy compared to tubectomy clients is evidenced by the fact that less than 30% of the vasectomy clients, compared to more than 70% of the tubectomy clients, indicated that they had recommended the procedure to another man (woman). While more than 80% of the tubectomy clients cited themselves, their husbands or a close family member as the most influential person in their decision to have a tubectomy, the vasectomy clients never mentioned their wives, rarely another family member, and in less than half the cases themselves.

This study suggests that client satisfaction with tubectomy in Bangladesh can be attributed to the desire of tubectomy clients to terminate childbearing. The positive responses of tubectomy clients appear to be consistent in spite of urban-rural, religious, and socioeconomic differences, as measured by education of the clients and their husbands' occupation. On the other hand, the lack of satisfaction of the vasectomy clients can be attributed in part to the use of the incentive system, causing recruitment of clients who were not primarily motivated by a desire to terminate childbearing, nor apparently in need of sterilization based on their limited reproductive potential.     

Vasectomy and prostate cancer risk

To assess the hypothesis that a history of vasectomy is a risk factor in the etiology of prostate cancer, the authors conducted a case-control study at Roswell Park Memorial Institute, Buffalo, NY, between 1982 and 1988. From epidemiologic data routinely collected from entering patients, information on vasectomy history and other data were obtained for 614 patients with prostate cancer and 2,588 comparable control subjects with cancer at another site. Age-specific and age-adjusted relative risks were calculated. Increased risk (relative risk = 1.7, 95% confidence interval 1.1-2.6) was found for reporting vasectomy at any age. Age-adjusted relative risk of 2.2 (95% confidence interval 1.0-4.6) was observed for men who reported vasectomy 13-18 years before diagnosis. A significant trend in the association of years since vasectomy and risk also was observed. Cases and controls were found to be nearly identical with respect to education, income, race, marital history, and number of children. A difference in smoking histories of cases and controls was found not to confound the observed associations. These data may suggest the importance of further epidemiologic and biologic research on vasectomy as a risk factor for prostate cancer.     

Organizing a public-sector vasectomy program in Brazil

Although models of high-quality family planning services for men exist in Latin America, few if any have been organized within the complex and resource-constrained national public health systems. This study provides evidence from the Santa Barbara project in southern Brazil showing how vasectomy was introduced into the municipal health system. It demonstrates that once the necessary operational and quality-of-care improvements were in place, and sufficient political and technical support existed to proceed, it was possible to establish low-cost, well-used, and sustainable vasectomy services free of charge. The findings show that careful attention to the development of strong technical competence and an informed choice process resulted in high user satisfaction. Focus-group discussions with men who underwent vasectomy indicate that they had no objection to being served in the context of a women's health center and that they act as opinion leaders who draw an increasing clientele to the service.     

Immunological Consequences of Vasectomy: I. Prospective Study through One-Year Postvasectomy

Autoimmunity to sperm developed in two-thirds of men within 1 year after vasectomy as measured by sperm agglutinating and sperm immobilizing antibody tests. Sperm antibody responses to vasectomy were greater in younger than in older men. A direct relationship was apparent between increasing incidence of sperm immobilizing antibody and genetic predisposition to autoimmune disease. Some vasectomized men developed immune responses to autoantigens other than spermatozoa. Increased antithyroglobulin activity was evenly divided between patients who formed sperm antibody and those who did not. Antinuclear activity was more frequent in patients who were sperm antibody responders.     

The relationship between vasectomy and angiographically determined atherosclerosis in men

Long-term prospective studies in monkeys have shown that vasectomy is associated with an increase in atherosclerotic disease. The purpose of the present investigation is to evaluate whether vasectomy in men is associated with atherosclerotic disease in the coronary arteries. In this study information was obtained on the vasectomy status in a series of 7,420 men who had previously been referred for coronary angiography because of cardiovascular symptomatology and have been followed for as long as 9 years to evaluate coronary artery bypass surgery and the natural history of the disease. It was found that 5.0% had a vasectomy prior to angiography. Two different data analysis procedures were used to determine whether the vasectomized men had a greater degree of angiographically determined coronary occlusive disease than the nonvasectomized men. Subgroups with minimal and extensive coronary artery disease were also analyzed. Results of all analyses show that the vasectomized men did not have more coronary occlusive disease. Possible patient selection biases in this study are discussed.     

输精管结扎术对远期心血管疾病的高危因素影响的调查及分析

目的了解输精管结扎术与中老年男性远期心血管疾病相关危险因素的关系。方法对湖北省和江苏省共2 352例中老年男性进行生殖健康现状调查,对其进行体格检查和心血管疾病相关高危因素的实验室检查,并调查参与者的输精管结扎情况。结果在50~60岁和60~70岁年龄段,结扎人群的血糖均值低于非结扎人群(P0.05);在50~60岁年龄段,结扎人群的血糖和高密度脂蛋白的异常率低于未结扎人群(P0.05);在≥70岁年龄段,结扎人群血糖的异常率低于未结扎人群(P0.05)。结论输精管结扎对心血管高危因素无不良影响,但可能对血糖有一定的影响,进一步研究有待开展。     

NIH statement on vasectomy and prostate cancer

Evidence linking vasectomy to prostate cancer is conflicting. Experts who met at the National Institutes of Health (NIH) in March 1993 to discuss the results of research to date, have issued a statement regarding future research. clinic and health practices, and vasectomy counseling. This is an amended version of that statement. First, because of inconsistent research findings and weak associations between vasectomy and prostate cancer, no change is recommended in clinical and public health practice. Providers should continue doing vasectomies; vasectomy reversals are not warranted to prevent prostate cancer; and screening for prostate cancer should be the same for all men; regardless of whether they have had vasectomies. Epidemiological and basic biological research is necessary to resolve questions concerning the relationship between vasectomy and prostate cancer. Such studies should be integrated and international. Epidemiological studies, which should cover men aged 20 years or older after vasectomy, should address the following methodological limitations: selection bias, detection bias, and problems with ascertaining exposure (vasectomy) and outcome (prostate cancer). They should also address implications of current trends in screening. Biological research should be directed at the end etiology and the pathogenesis of prostate cancer in men and experimental animals and at the relationship between vasectomy and prostate pathology, function, and cancer.     

The option for vasectomy and gender relations

A qualitative study was performed to: investigate the process that leads couples to decide for vasectomy; characterize the gender relations involved in this process; and identify sources of information on vasectomy. Semi-structured interviews were conducted with 20 couples who had requested vasectomy at the outpatient clinic of the Center for Integrated Women's Health Care, State University in Campinas, S?o Paulo, Brazil. A structured form was used to collect social, economic, and demographic data. The content analysis technique was used for data analysis. The majority of couples opted for vasectomy as a last resort after attempting numerous other contraceptive methods, not always successfully. The emerging gender relations showed fluctuation between: (1) a more rigid, quasi-patriarchal model characterized by male predominance in the family's decision-making and (2) a more ambiguous model in relation to reproductive decisions, whereby women assumed responsibility for contraception until the situation became untenable, at which point men faced up to the unavoidable necessity of sterilization. At this point the male partners felt they should collaborate.     

Long-term effect of vasectomy on coronary heart disease

We investigated the association between coronary heart disease (CHD) and vasectomy in a population of 10,632 men who were under surveillance for multiple CHD risk factors during participation in a university-based exercise testing program. We conducted a mail survey with telephone follow-up to determine the vasectomy status of individuals in the population. Responses were obtained from 6,159 individuals. The 4.944 males on whom information was complete enough to be included in the multivariate analysis comprised the study population. Among the 1,383 (28 per cent) vasectomized males in the study populations, the interval from vasectomy to the time of the survey ranged from less than one year to 37 years with a mean duration of 15 years. Although increased relative risks for CHD were found to be associated with family history of CHD, high blood pressure and smoking in this population, the relative risk of CHD associated with vasectomy was not increased in general, nor was it increased when the vasectomized males were classified by time since vasectomy. Likewise, serum antisperm-antibody titers were not predictive of CHD among vasectomized men. These studies support the findings from previous investigations of populations with shorter average post-vasectomy experience in which vasectomy has been shown to be unassociated with altered risk of CHD in humans.     

A comprehensive review of the sequelae of male sterilization

This study of the sequelae of vasectomy considers morphological and immunological changes, epidemiological studies, reversibility, and psychological aspects. The data on morphological changes after vasectomy are diverse and contradictory, as a wide range of experimental animals have been studied. The number of studies on men has been limited, but they suggest little histologic change in testicular morphology or spermatogenesis. Hormonal changes after vasectomy are difficult to assess because of the large fluctuations in semen levels of testosterone and gonadotropins. Most of the studies on this topic have been small and have lacked controls, with comparisons consisting of pre-post differences in the same subject group. The only prospective controlled study found no differences between vasectomized and control subjects on any of the hormones investigated. 2 large-scale studies have also produced conflicting results; 1 found no changes in hormone levels, and the other found that only follicle stimulating hormone levels did not change. It is apparent from the studies that any hormonal fluctuations after vasectomy remain within the normal range, and it has not been demonstrated that testicular endocrine function or the relationship of the pituitary to the testis are in any way adversely affected by vasectomy. It has been shown that after vasectomy 50-60% of men develop sperm agglutizating antibodies while 20-30% develop sperm immobilizing antibodies. The implications are 1) that if some of the antibodies are nonspecific or cross-reacting, the incidence of autoimmune disease may be increased in vasectomized men; and 2) the persistence of sperm antibodies may cause failure of reversal attempts despite anatomical patency. Studies of the incidence of atherosclerosis in vasectomized monkeys showed that they developed antisperm antibodies and much more extensive atherosclerosis than controls, causing concern because of the phylogenic closeness of monkeys to man. Epidemiologic studies as yet furnish insufficient evidence to extrapolate findings on postvasectomy atherosclerotic lesions in monkeys to man. There is no clinical evidence after several large studies to show that vasectomy is harmful to the circulatory system in man, but surveillance of men who have undergone vasectomy is indicated. Pregnancy rates after reversal attempts are not as high as success rates in terms of canalization and sperm appearance in the ejaculate, but it is not yet known what causes the difference. No adverse psychological effects of vasectomy have been demonstrated in developed countries, and the high incidence of regret and other psychological effects in developing countries may be due to a lack of truly voluntary consent.     

Evaluation of the effect of a patient decision aid about vasectomy on the decision-making process: a randomized trial

BackgroundBetween 7% and 10% of men who choose vasectomy as a contraceptive method regret their decision. This study evaluates the effect of a patient decision aid (PtDA) designed to help men decide whether or not to have a vasectomy.Study DesignMen considering vasectomy were randomized to an experimental group that received a full PtDA containing information and values guidance (n=32) or to a control group that received an abridged PtDA containing information only (n=31).ResultsMean Decisional Conflict Scale (DCS) scores before and after the intervention were 2.6±0.4 and 1.9±0.4 in the experimental group and 2.5±0.4 and 1.8±0.4 in the control group (p=.94), respectively. Mean knowledge of vasectomy scores before and after the intervention were 50%±16% and 72%±18% in the experimental group and 55%±18% and 71%±15% in the control group (p=.40), respectively. At baseline, all participants were undecided as to whether to have a vasectomy. After the intervention, 60% of experimental group participants and 53% of control group participants had made a definite decision (p=.58).ConclusionIn men considering vasectomy, both versions of the PtDAs improved the quality of decision-making process to a similar extent. Information alone may be sufficient to support good decision making in these patients.