Vasectomy: an appraisal for the obstetrician-gynecologist

Article Abstract:

A review of the health effects of vasectomy is provided. Vasectomy, performed to render the male infertile, is a minor procedure that requires no more than 20 minutes. Different methods for occluding (blocking) the vas, the tube through which sperm travel, are described; at present, little information exists regarding the relative efficacy of these approaches. Most studies report failure rates of less than 1 percent, and many such failures are the result of unprotected intercourse too soon after the vasectomy. The severed ends of the vas deferens can also grow together again (spontaneous re-anastomosis), restoring fertility. This appears to be less frequent after coagulation than after ligation (tying) of the vas. Death after vasectomy is extremely rare (two out of 160,000 procedures performed), as are serious complications. Usually, mild swelling, bruising, or pain are the worse consequences of the procedure, and infection rates are low. The possibility that an increased incidence of atherosclerosis (deposition of plaque in the lining of arteries) follows vasectomy has received careful attention, and appears unfounded. The relevant epidemiological studies are reviewed. Reversal of the procedure, should the patient later desire children, is a complicated surgical procedure, made more difficult if larger segments of the vas were initially removed. Careful selection of patients for vasectomy is important, to prevent regrets. Reversals performed within 10 years of the initial operation are more successful. Overall, the pregnancy rate after reversal operations ranges between 30 and 60 percent. Death and serious illness after tubal ligation (in the female) are more frequent than after vasectomy; thus, for the couple concerned only with safety and effectiveness, vasectomy is preferable. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Evaluation, Sterilization (Birth control), Sexual sterilization

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Characteristics of women who considered or obtained tubal reanastomosis: results from a prospective study of tubal sterilization

Article Abstract:

Women undergoing sterilization were studied as part of the Collaborative Review of Sterilization (CREST) program, which seeks to enroll all women who enter designated medical centers requesting tubal sterilization. The goal of this part of the study was to identify characteristics of women who either sought information about reversing tubal ligation by tubal reanastomosis (rejoining the ends of the fallopian tubes) or attempted to have tubal reanastomosis within three to five years after the initial surgical procedure. Of the 5,817 subjects who met inclusion criteria, 358 (6.2 percent) said they had requested information on tubal reanastomosis. Women who were younger than 30 when sterilized were more likely than women 30 to 34 to have sought such information, and women with less than 12 years of education were more likely to have sought it than those with more education. For all women, the factor most highly correlated with subsequent requests for information was a change in marital status after sterilization. Thirteen women, nine of whom had changed their marital status, were successful in obtaining reanastomosis. The subjects increased their rates of requesting information as time went on, with the highest proportion of requests during the fifth year of follow-up. These results indicate that, although most women do not seek information about reanastomosis, young women may need more medical advice and counseling prior to undergoing the procedure. In addition, all women should understand that changes in their marital status may contribute to their desire for reanastomosis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Statistics, Demographic aspects, Sterilization reversal

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Vasectomy and prostate cancer: chance, bias, or a causal relationship?

Article Abstract:

An association may exist between undergoing a vasectomy and an increased risk of prostate cancer. Two research studies found that the relative risk of prostate cancer was higher in men who underwent a vasectomy compared with those who had not. It is possible that this association may be due to chance or bias, more probably bias. Part of this bias could come from selection factors, in that men who have undergone a vasectomy are more likely to be examined by a urologist and therefore diagnosed with prostate cancer. Another consideration is that many men develop prostate cancer regardless of any other risk factors. Other epidemiology studies did not find an association between vasectomies and prostate cancer. The World Health Organization (WHO) has recommended that men should not be deterred from undergoing a vasectomy by the possibly increased risk of prostate cancer. The WHO is not convinced a causal relationship between vasectomies and prostate cancer exists.

Editorial, Risk factors, Prostate cancer

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