The Unkindest Cut

Originally published in The Ottawa Citizen September 25, 2001

Ladies, you have borne your children and have been responsible for contraception. Now, when the time finally arrives to decide who will be the one to undergo sterilization your guy will be making himself scarce. In my office it is usually wives that ask about vasectomies on behalf of their husbands. They all have similar stories. Their husbands are concerned about prostate cancer, decreased libido, bleeding and grapefruit size swelling of the scrotum. As someone who recently has undergone this simple procedure, stand your ground ladies! Vasectomy has a lower failure rate than tubal ligation (getting your tubes tied). Aside from the potential of minor bleeding the other side effects just do not stand up to the facts.

Vasectomies are done in a doctor’s office in as little as 10 minutes. It is painless with few side effects and should be considered irreversible. Dr. Ron Weiss, an Ottawa family doctor introduced the No- Scalpel Vasectomy (NSV) technique to Canada in 1992. To date he has performed over 9000 in his career. He states that the infection rate and post operative bleeding (hematomas) into the scrotum are four per 1000 procedures. This compares to 32 per 1000 for the original surgical technique wherein a scalpel is used to cut through the scrotal skin.

In Dr. Weiss’ practice the failure rate is one in 9000. He states that published data reports one to three per 1000. He stresses that his data is specific to his practice.

The goal of vasectomy is to cut the tubes (Vas Deferens) which transport sperm from the testicles to specialized structures within the prostate gland. All patients are asked to purchase a soft athletic supporter and wear it on the day of the procedure. You must also shave the scrotal area. Some men are anxious and offered the option of an anti-anxiety medication like Valium to be taken prior to the NSV. Dr. Weiss escorted me to his consultation room where he described the procedure, the above mentioned risks and failure rates. With consent given we proceeded to the procedure room.

Your pants, underwear and athletic supporter are pulled down to your ankles. A loose elastic band is placed around the head of the penis. The band is clamped to a drape that rests upon the abdomen thereby lifting the penis up and away from the scrotum. A liberal amount of warm iodine disinfectant solution is applied over the scrotum which can tickle. Sterile drapes are placed over the area. A small needle is used to inject local anesthetic to freeze the skin. It feels like a small pinch or mosquito bite. The rest of the NSV is pain free.

The Vas deferens is located by palpating the skin. A specialized tool is used to poke a hole in the skin and grab the tube. The vas is then pulled out through the hole. A centimeter portion is cut and removed. The ends are cauterized and sealed with a tiny titanium clip. Only one hole is necessary to retrieve both tubes.

The average time to complete healing is about one month. There can be slight bruising but nothing of consequence. I was able to return to work the next day without pain. After the first week sporting activities and physical work can be resumed albeit slowly. If there is any pain, back off and go slow.

Avoid sexual activity for one week after vasectomy because intercourse may increase the risk of failure. There is no pain with the first ejaculation after the NSV. It takes about 15 to 20 ejaculations to achieve a zero sperm count for 80% of men. A sperm count should be done three months after the vasectomy to ensure it has been successful. An alternate method of birth control should be used until the count is proven to be zero.

Humour is a welcome part of the human condition. When I tell this story to my patients it serves to humanize the procedure for them. On one occasion, Dr. Weiss’ assistant was prepping a patient for the NSV. While she was applying the iodine solution the elastic band that held the penis snapped. The resulting slingshot effect forced the penis downward into the solution of iodine splashing the hapless assistant on her clothes and face. Needless to say she was startled and screamed. Dr. Weiss, in another exam room, ran over to the commotion, not knowing what was going on. The poor patient was ashen-faced and looked like a man seeking a rock to hide under. Any effect the valium had prior to this turn of events was long gone. After profuse apologies on the part of Dr. Weiss and his assistant, the poor man went ahead with the procedure. He did very well and was able to laugh about what happened afterwards.

Stories like these are rare. But it does serve its purpose. The laughter breaks the ice. Rarely do men decide against vasectomy once they are aware of the facts. Although there has been a run on heavy duty elastic bands at Home Depot!

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© Dr. Barry Dworkin 2001

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