BIRTH CONTROL: METHODS OF STERILIZATIONMALE
1. Vasectomy is the surgical procedure of cutting and tying the semen-carrying ducts, the vas deferens. A small incision is made in the scrotum, and the vas deferens is lifted out so that about an inch of the tiny tube can be cut out. The tube, or duct, is then tied at each end where the section was removed, preventing the sperm's passing from the testicles to the ejaculatory ducts. This procedure must be followed on each side of the body. The site of the incision is well above the testicles and in no way disturbs them or their functioning. The man remains potent but sterile, and the sperm he now produces are absorbed by his body.
A vasectomy is a simple operation and can be performed in a hospital or in a doctor's office, with either a local or general anesthetic. Afterwards, the patient should remain relatively inactive for about forty-eight hours; at least he should do no heavy work for that period of time, or longer. The doctor usually advises the use of a suspensory for several weeks in order to prevent any pulling of the testicles, and to minimize soreness during the healing process.
The patient remains in a state of fecundity (fertility) for several days following the vasectomy, because his first ejaculations after surgery will contain sperm that have been previously stored in the seminal vesicles. Sometimes sperm accumulate in a little sac at the site of the incision, causing a granuloma or lumpiness in the scrotum; the accumulation is usually harmless and dissipates in time. The effects of a vasectomy can be undone by surgery in which the ends of the tubes are rejoined. This operation is about 50% successful.
The "tying of tubes" in men is much simpler, quicker, cheaper, and less dangerous than its counterpart operation performed on women, the salpingectomy. Yet many men steadfastly refuse to have the operation performed on themselves, though they willingly consent to a salpingectomy for their wives. This selfishness probably can be accounted for, in the first place, by the fact that it is women who conceive and bear children, and hence suffer any pain or difficulty associated with the birth process. Women, therefore, should be "willing to pay the price" for the operation.
Secondly, men frequently associate any cutting near the testicles with castration and are fearful of such an operation, despite the fact that they know rationally that vasectomy does not decrease sexual drive or desire, or their ability to satisfy the drive and desire. In one investigation into the impact of vasectomy on 151 men who underwent the operation, 17.9% reported an increase in sexual appetite, 74.2% showed no change, and only 7.9% reported a slight diminishing of sexual desire; these results are fairly typical of such investigations.204 The increase in sexual drive is probably a consequence of psychological factors, such as a reduction of anxiety because the fear of impregnating the wife has been removed.
In a few cases of sterilization, there is an apparently spontaneous rejoining or recanalization of the severed vas deferens, despite the care and skill of the surgeon. In response to questionnaires sent to 1721 physicians, ninety-six reported that spontaneous recanalization had occurred among their patients. The percentage of recanalization after vasectomies is not known, but is thought to be exceedingly low.
Voluntary sterilization operations are fairly common in the United States. The Association for Voluntary Sterilization estimates that there are about two million men and women in this country who have been sterilized by surgical procedures, and that about 200,000 vasectomies are performed on American men each year.
2. Castration is a method of sterilization, known and used since ancient times, in which both testicles are surgically removed, producing sterility. If the man is an adult, castration does not necessarily mean impotence, although there is a gradual loss of sexual desire with the passage of time because of loss of male hormones produced by the testicles. Physiological changes may also result from loss of hormones, such as an increase in voice pitch, decrease in beard growth, and excess fat. The undesirable changes in secondary sexual characteristics following castration can, however, often be corrected with proper hormone therapy.
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Men's Health Erectile Dysfunction