Is a vasectomy right for you?

You attend a meeting organised by family planning professionals to listen to data about spacing children, contraception and birth control methods. It is all going well until one speaker comes along and says something that just leaves everyone open-mouthed. He shares his experience giving a vasectomy to a 23-year-old father of one. The whole assembly gasps in shock. Silence follows. The speaker repeats what he just said and everyone starts murmuring incessantly. 

You shift in your seat in utter bewilderment. You cannot help but wonder how a 23-year-old man could possibly reach such a radical decision as to get a vasectomy.

Granted, the economy is bad and tuition is more expensive than gold these days, but vasectomy? To me, this is akin to trying to cure hunger by suicide. A little over the top, if you ask anyone. 

The reality

But a quick chat with Dr Vincent Medeyi, a urologist at Kampala International Hospital C-Care, reveals it is not unheard of for men in their 20s to seek for vasectomies .

“I recently saw a 22-year-old man from Chad in Central Africa who wanted to get vasectomy. By his side was his fiancée. The young couple told me none of them had ever had any children but although they were in love and getting married in September, they were in complete agreement that they did not want to have children. 

“They said they love travelling and having children would stop them from doing what they love. I counselled them, gave them all the information they needed to know about the procedure and gave them three months to think about the decision,” Dr Medeyi says. 

This, he adds, is an indirect refusal on his part to carry out a vasectomy, especially given the man’s young age. He fears the young man could be experiencing temporary madness of young love, making it unethical for him to perform the procedure on a someone that is not thinking clearly. His fear is that in future, as the hormones normalise, the man might regret his decision.  The vast majority never return after thinking it through, Dr Medeyi says. 

However, for some, it is an easy decision. Bernard Muganga, a 51-year-old farmer from Lubowa, Wakiso District, had a vasectomy seven years ago. To him, the decision was easy because he had seven children already and was divorced from their mother. So, when he got a girlfriend of child-bearing age, it was prudent he undergoes the procedure to avoid having any more children. Besides, he says, his income is not sufficient to take care of a young child and mother sufficiently.

Understanding vasectomy

Vasectomy is a form of male birth control that cuts the supply of sperm to your semen. It is done by cutting and sealing the tubes that carry sperm from the testicles. While that sounds as the end of ejaculation to a lay person, Dr Medeyi says it could not be farther from reality. 

“Many people assume semen is produced in the testicles and a vasectomy brings an end to orgasms and ejaculation. However, that is not the case. Semen, the fluid that carries sperm cells at ejaculation, is produced in the prostate gland. It is the sperm cells that are manufactured in the testicles. This means that after vasectomy, a man can still orgasm and ejaculate normally, except this time, there is no sperm in the semen,” Dr Medeyi says. 

The procedure takes between 20 and 30 minutes and involves minimal pain. Dr Medeyi says the procedure is so simple that there is no need for stitches after the surgery. It takes between three to five days to fully heal.

“It is so simple that many non-governmental organisations do it free of charge. If performed in a hospital, it will cost you as little as Shs300,000, depending on where you go,” he says.  

Vasectomy vs castration

To allay the fears of those who equate a vasectomy to castration, the urologist explains, “After a vasectomy, testicles can still produce testosterone, the male hormone that regulates sex drive (libido), bone mass and beard growth, among others. Testicles continue producing testosterone long after a vasectomy because they are still active. 

“On the other hand, however, castration takes away the testicles and puts an end to testosterone production, resulting in an end to sex drive, orgasm, ejaculation, masculinity and fertility,” he says. 

Reversal

Dr Medeyi says urologists are always cautious when it comes to vasectomies since while all the birth control methods available to women are temporary, reversing a vasectomy is very complicated, expensive and unreliable. 

“It is very hard to reverse a vasectomy. So, giving it to a young, childless man, is not advisable most of the time. I have seen patients seeking reversal after divorcing and remarrying. The man may have considered the many children he had with the ex-wife but it is only fair that the new wife also has children of her own,” he says.

While vasectomy is meant to be a permanent option, some men come seeking for reversal for one reason or another. The problem is,  reversing it is much more complicated and expensive since, Dr Medeyi adds, it takes many more experts, time and resources.  For instance, while a vasectomy takes a maximum of 30 minutes to perform, it takes more than eight hours to reverse it. 

“And even after reversal, scarring from the surgery may act as a barrier for sperms to pass from the testicles to the prostate. And if it happens 15 years or more after the vasectomy, sperm production will already be so minimal that you may fail to regain fertility,” he says, adding that some of the common reasons for reversal include, remarrying and having sickly children. 

Pregnant after vasectomy

Just as any birth control method, a vasectomy is not 100 percent fail-proof. So, if you ever hear bitter fights where a man accuses his wife of cheating because she became pregnant after he underwent the procedure, there is a tiny possibility the woman is not playing games. 

Several studies have showed that at least one in 1,000 men that have had a vasectomy can impregnate a woman. 

“In rare occasions, there is a chance of recanalisation, where the severed tubes reconnect, making the man fertile once again,” Medeyi says.

The other time when a man may prove fertile after getting a vasectomy is if he engages in sexual intercourse too soon after the surgery. It takes many ejaculations for all sperm to clear from the semen after the operation, Dr  Medeyi says, adding that doctors usually advise one to use condoms for at least three months after the procedure.

Who is most likely to get it?

Dr  Medeyi says those aged between 40 and 50 years mostly seek vasectomies. But even for these middle aged individuals, urologists ensure the patient has fully understood the ramifications of the procedure before they go ahead with it. 

So, several months are given to help someone to make a decision. Some of the reasons men usually choose vasectomies include the feeling that they have had the desired number of children and divorce.