Unlike women, men don’t have nearly as many choices when it comes to contraception. Condoms aside, a vasectomy is the only other option that guarantees healthy contraception for men – a procedure that is picking up in popularity.
Dr Leslie Gellman is a urologist based in Morningside, Sandton, Johannesburg. He has been practicing since 1994.
Gellman explained that vasectomies are becoming more common among men of all races and backgrounds. He said he has four to five men who come in for consultations within a week, averaging 10 a month.
With his specialisation and interest in men’s sexual reproductive health, Gellman talked us through a vasectomy procedure.
How does a vasectomy work?
A vasectomy requires going to the hospital as a day patient. Either general anaesthetic or sedation together with local anaesthetic will be administered for pain throughout the procedure.
A patient may also not have anything to drink for about six hours before the procedure and won’t be able to drive home.
“The procedure involves making a little incision over the scrotum (sac of skin containing the testicles which are responsible for producing and storing sperm). We make one little cut on the left side and one little cut on the right side. Each cut is less than a centimeter in size. And then we get to the vas (duct responsible for carrying sperm to the testes) to do the procedure. Finally, we do the operation through the incision and close it up with dissolving stitches and the patient can go home on the same day.”
A vasectomy is to interrupt the vas, we block it, cut it, so that sperm cannot go from the testes up into the semen mixture. So, when there is no sperm in it, then it cannot cause a pregnancy. The obstruction of the vas prevents the sperm from mixing with the semen. So, the only semen that is ejaculated, is semen without sperm.
Where can men go for the procedure?
Vasectomies are offered in private and public health facilities.
“The urologists at the public hospitals can do these procedures, but it’s such a low priority and it always has been a low priority,” said Gellman.
This means that a patient can be on the waiting list for a vasectomy for about six months to a year.
How much does it cost?
The average cost of a vasectomy is between R15 000 to R16 000. The option to do the procedure with sedation or anesthetic is available and the costs vary based on a patient’s decision.
Is it permanent?
Gellman recommends that patients accept the procedure as an irreversible form of sterilization and not a form of contraception.
“In practice, we do get asked to reverse vasectomies. It’s usually due to a family situation like a divorce, or some other tragedy which then leads to the man deciding to have another child and it may become a problem. Although technically, you can reverse it, you can join the tubes together again, but the success rate is not 100%. You cannot tell which patient it will work on,” he explained.
The chances of a successful pregnancy three years after a patient has had a vasectomy and then doing a reversal is probably about 70%. Whereas if you wait 15 years, it’s about 30%.
Will medical aid cover it?
Yes. Most medical aids do cover vasectomy procedures.
“There is a diagnosis code and procedure code indicating what the medical aid is going to cover for their client, at the rate available to them. You usually don’t have to motivate for a vasectomy.”
Surgery to reverse a vasectomy is not covered by any medical aids as it’s considered an infertility procedure.
How long after the procedure can I have sex?
A patient has to wait seven days before he can ejaculate.
“The sexual function of the penis and any other sexual features remain the same. The orgasm, ejaculation itself is not affected.”
Does it work immediately?
No, a man is not sterile for usually three months after the procedure. The only way to be sure that there is no sperm remaining in the tubes is by ejaculation and testing the semen.
“The sperm blocked in the vessel can’t get to the partner. But the sperm in the rest of the tube, can. The only way to clear that sperm is by ejaculation. It takes an average of 18 to 20 ejaculations to achieve this.”
Are there any other options for male contraception?
No. The only options that men have available to them for contraception are condoms and a vasectomy.
Gellman said that hormonal treatments for males are not an option because the side-effects are too great.
What are the side-effects?
Side-effects include light bleeding. Gellman explained that this blood comes from the blood vessels in the scrotum wall. When one of those blood vessels are cut during the procedure, the blood contracts all the way up to the scrotum and it can look blue. He said that it is not painful and clears up within 10 days.
“To get significant bleeding from a vasectomy is unusual. An infection can also occur, but if it’s done in a sterile theatre, it is extremely unusual. Research shows that the complication rates of a vasectomy are between 1% and 2%. Ongoing pain is also a concern for some patients. This is caused by the build-up of sperm collecting in the tubules of the epidermis (thin layer of outer skin), but is successfully treated with anti-inflammatories and goes away,” he said.
Another side-effect is the decrease in the amount of fluid that is released during ejaculation – it may be a little bit less than before the procedure.
Is the procedure painful?
Gellman describes the procedure as being a small one, and therefore, having minimal pain. He said the patient may feel better within a day and will be able to resume normal activities.
What are the benefits of a vasectomy?
It is a safe and effective form of contraception. It is a small procedure, allows a patient to resume their daily activities quickly and recover quickly. – Health-e News