Vasectomy should not be confused with castration: vasectomy does not involve removal of the testicles and it affects neither the production of male sex hormones (mainly testosterone) nor their secretion into the bloodstream. Therefore sexual desire (libido) and the ability to have an erection and an orgasm with an ejaculation are not affected. Because the sperm itself makes up a very small proportion of the ejaculate, vasectomy does not affect the volume, appearance, texture or flavor of the ejaculate.
When the vasectomy is complete, sperm can no longer exit the body through the penis. They are broken down and absorbed by the body. Fluid content is absorbed by membranes in the epididymis, and solid content is broken down by macrophages and re-absorbed via the blood stream. Sperm is matured in the epididymis for about a month once it leaves the testicles, and approximately 50% of the sperm produced never make it to ejaculation in a non-vasectomized man. After vasectomy, the membranes increase in size to absorb more fluid, and more macrophages are recruited to break down and re-absorb the solid content.
Safety and effectiveness
Early failure rates of vasectomy are below 1%, but the effectiveness of the operation and rates of complications vary with the level of experience of the surgeon performing the operation and the surgical technique used. Early complications, including hematoma, infection, sperm granulomas, epididymitis-orchitis, and congestive epididymitis, occur in 1%–6% of men undergoing vasectomy. The incidence of chronic epididymal pain is poorly documented. Animal and human data indicate that vasectomy does not increase atherosclerosis and that increases in circulating immune complexes after vasectomy are transient. The weight of the evidence regarding prostate and testicular cancer suggests that men with vasectomy are not at increased risk of these cancers.
Although late failure (caused by recanalization of the vasa deferentia) is very rare, it has been documented.
Vasectomy is the most effective long-term contraceptive method, and is among the safest options for family planning. How popular sterilization is as a birth control method varies by age, with men in their mid 30's to mid 40's being most likely to have a vasectomy. The rate of vasectomies to tubal ligations worldwide is extremely variable, and the statistics are mostly based on questionaire studies rather than actual counts of procedures performed. In 2005, the CDC published state by state details of birth control usage by method and age group. Overall, tubal ligation is ahead of vasectomy but not by a large factor. In Britain vasectomy is more popular than tubal ligation, though this statistic may be as a result of the statistical data gathering methodology. Couples who opt for tubal ligation do so for a number of reasons, including:
- Convenience of coupling the procedure with delivery at a hospital
- Refusal of the man to undergo vasectomy due to fear of possible side effects
Couples who choose vasectomy are motivated by, among other factors:
- Fear of surgery in the woman
- Knowing men who have had the procedure and are satisfied with the results
- A stronger motivation for sterilization in the man
- The lower cost and simplicity of vasectomy
- The lower mortality of vasectomy
Reversal
In order to allow for reproduction (via artificial insemination) after vasectomy, some men opt for cryostorage of sperm before sterilization. However, the long term viability of spermatozoa in cryostorage is questionable.
Although men considering vasectomies should not think of them as reversible, and most men and their spouses are satisfied with the operation, there is a procedure to reverse vasectomies using vasovasostomy (a form of microsurgery). It is, however, not effective in all cases, with the success rate depending on such factors as the method used for the vasectomy and the length of time that has passed since the vasectomy was performed.
Various temporary male contraceptives are being researched but not yet available, such as male oral contraceptives and the intra vas device. There has been at least one documented case of a vasectomy being reversed on a dog, which then fathered puppies after the reversal.
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