The history of Vasectomy

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OK - question time. If you were asked when vasectomy started, what would be your answer? My guess is that most people would say vasectomy came in during the late 1950's/1960's as a male birth control method. This to an extent is true. However, the history of vasectomy is long and interesting. It's also not been used purely as a lifestyle choice as it is today. This page is a history of the procedure - political and clinical, and you will probably find it more interesting than you might think!

1470-1530

The vas deferens was named by Berengarius of Carpi (1470–1530) from the Latin for "Vessel", and the Latin "Deferre" - to carry down. He was under the misapprehension that sperm passes down the vas. John Hunter chanced across a blocked vas deferens during the dissection of a corpse, but the vas deferens otherwise seems to have been ignored until Sir Ashley Cooper presented a comprehensive study "Observations on the Structure and Diseases of the Testis"3. Cooper's experiments were on dogs - it's not certain who first attempted the operation in humans.

1640

The oldest condoms were found in the foundations of Dudley Castle near Birmingham, England. They were made of fish and animal intestine and dated back to 1640. They were probably used to prevent transmission of sexually transmitted infections during the war between the forces of Oliver Cromwell and soldiers loyal to King Charles I.

1830

Sir Ashley Cooper's "Observations on the Structure and Diseases of the Testis" published in London.1. Based on the ligation of one of a dog's testicles in 1822 where the artery and vein were tied24. It was observed that no issue followed coitus. The conclusion after killing and dissecting the testicle was that merely closing the outlet duct of the testicle had no effect on the germinal portion of the organ, and did not stop generation of sperm, but the epidermis was much enlarged to accommodate the products of germinal cell activity. Sperm generation continued for 6 years (when the dog was killed).

1844

Goodyear and Hancock began to mass produce condoms made out of vulcanized rubber. Vulcanization is a process which turns crude rubber into a strong elastic material.

1847

Gosselin4 whilst dissecting human corpses noticed cases in which the vas deferens was entirely blocked, and had undoubtedly been so for many years. He observed that the enlarged epididymis contained quantities of spermatozoa and undertook the experimental study of effects of ligation and resection of the vas deferens, using dogs as experimental material.

1861

The first advertisement for condoms was published in an American newspaper when The New York Times printed an ad. for "Dr. Power's French Preventatives."

1873

USA - The Comstock Law was passed. Named after Anthony Comstock, the Comstock Law made illegal the advertising of any sort of birth control, and it also allowed the postal service to confiscate condoms sold through the mail.

1884

Brissaud5 and Griffiths25, working on rabbits and dogs respectively, observed that blocking the outlet of the vas deferens duct had no influence on spermatogenesis. IE sperm are still produced after sealing off the vas deferens. Like Cooper (1830) they also observed no testicular degeneration and an enlarged epidermis due to the immense amount of spermatozoa carried to it.

Moullin14 publishes a paper describing the effect of castration on the prostate that was occasionally performed by surgeons for "Symptoms of severe prostatic hypertrophy". The purpose being that after removal of the testes, the enlarged prostate quickly shrank. He noted that "In a large proportion of cases, following removal of the testes there is a rapid absorption of the enlarged prostate. The gland entirely disappears leaving a fibrous mass".

1890

Vasectomy suggested as an alternative to castration by Ewing Mears for the treatment of severe symptoms of prostatic hypertrophy.

1899

Ochsner9 (future professor of Surgery at the University of Illinois) publishes his paper "Surgical treatment of habitual criminals", which kick-starts the Eugenics movement. More information on the Eugenics movements.

According to Jhaver, Harry Sharp, the physician in a penal institution in Indiana had a 19 year old male patient who complained of "Excessive masturbation" who insisted on castration. Sharp ruled out castration as it was deemed too mutilating, so advised vasectomy24. After a few weeks despite no spermatozoa in the ejaculate there was no improvement, so the vasectomy was repeated. Several months later he was reported to have stopped masturbating and was making good progress in the prison school. Sharp claimed to have seen no unfavourable symptoms of vasectomy in the patient. "On the contrary he became more of a sunny disposition, brighter of intellect and ceased to masturbate". The patient then subsequently "advised his fellows to submit to the operation for their own good". Sharp also claimed that "The man's mind and nervous system - especially the centres of self restraint are strengthened by re-absorption of sperm"3.

1900

Harrison16, 3 publishes a paper based on over 100 cases where "Vasectomy was the primary procedure or an adjunct to facilitate removal of bladder stones". Claims of rapid and substantial improvement with minimal morbidity led to the treatment being fashionable for a short time for management of BPH (see 2003), but fell into disrepute quickly due to being based on rather dubious reports. Wood17 publishes a case study of 193 patients undergoing vasectomy as treatment for enlarged prostate. 15% had improved urination, but 67% manifested some "General improvement".

1902

According to Jhaver42 The operation of Epilidyno-vasotomy was introduced by Martin in 1902. The technique of the operation bears a close resemblance to the same operation by the name of Vaso-epididmostomy, as described by Phadke in 1953. Later to be known as Epididymectomy. It was practiced as a cure for Tuberculosis.

1904

Bilateral Vasectomy first established to be effective in reducing the incidence of epididymitis after prostatectomy.8 The medical profession had sought hard to find an alternative to the existing practice of castration for enlarged prostate, and it was established by White25 that vasectomy was an effective treatment. One of the reasons alternatives were sought is the reputed case whereby a disgruntled patient murdered a surgeon3! Vasectomy remained in common use as a cure for post-prostate surgery until antibiotics were common place.

Wallace26 reviewed the results of vas deferens ligation in man. He commented on the practice of vasectomy to relieve the symptoms of BPH. He remarked that bearing in mind that rest had good results on prostate enlargement, it was an open question as to if the results in the vasectomy research on the condition may have been (in part) due to rest. Also see 2003. He also performed vasectomy on cats and dogs to test the result obtained on animals by Bouin & Ancel25 in their experiments 1903 onwards. Unlike them, he found that the testes in such cases were perfectly normal many months later than Bouin & Ancel would imply was "Sufficient time" to expect degeneration. He concluded that "Single or double vasectomy has no effect on the spermatogenic function of the testes, with them continuing to produce spermatozoa months or years after total occlusion of both vas deferens"24.

Shattock & Seligman34 performed double vasectomy on Hardwick Rams. 18 months after the vasectomy they observed that the testes were normal sized and spermatogenesis continued. As with others, they noted that the epididymis was larger than normal, and they also noted that if the blood vessels were included in the ligation, then the testes may be abnormal2.

1907

Indiana introduces a bill authorising "Compulsory sterilisation of any confirmed criminal, idiot, rapist or imbecile in a state institution". Eventually 29 other states followed.3 In the UK, the Eugenics Education Society was formed, but failed to do little more than influencing various committees12.

Parlovechoi first attempted to reverse an accidental vasectomy that occurred in a hernia operation. Later authors describe the technique under the names of Vasorraphy or vasovasal anastomis39.

1908

In a series of studies from 1903 - 1908, Bouin & Ancel25 examined the effect on sex glands in animals after vasectomy. They concluded that vasectomy in post-puberty animals causes degeneration of the germinal tissues of the testes. The dismissed earlier researchers contrary findings by presuming an "Insufficient length of time after the operation before the animals were killed".

Belfield10 publishes his paper "Race suicide for social parasites". He was one of the proponents of enforced vasectomy for criminals. More information on the Eugenics movements.

1909

Sharp11 publishes "Vasectomy as a means of preventing procreation in defectives". He urged colleagues to lobby legislative bodies for laws to allow clinicians to sterilise every male in all state institutions.

1910

Russian Government sends a delegation to the American Prison Association conference to witness a sterilisation procedure. Sharp duly obliged with a "consenting" prison inmate.3

1918

Steinach performs the first vasectomy on humans for "Rejuvenation"3. Based an experiment on a rat he believed so old to have lost it's germ cell production capacity24, he observed that senile rats were "Transformed after obstructing the outflow from the testes by vasectomy". Papers were not published on the effects of vasectomy on rats until 192020, 192127 and 192321. Notable characters such as Sigmund Freud and WB Yeats had vasectomy for rejuvenation.

1920

A paper on "Testicle Transplantation" published19. It had been observed by Sharp11, 3 that a hormone boost by injecting an extract fresh from the testes under the skin had a remarkable influence on various conditions. In the paper, transplanting testicles19 from executed prisoners was shown to have a beneficial effect. "A mentally dull 25 year old received a double transplant from a Negro, after which he became more active, talked more, wrote better letters, comprehended jokes and had more sexual activity".

1921

Simmonds6 in human autopsies, found blocking of the vas deferens that had been there for many years without any injury to the generative part. Neither testicular degeneration nor loss of the germinal epithelium had occurred, and the epididymis was enlarged by the immense number of spermatozoa carried to it. Tiedje28 followed Steinarch in believing that vasectomy rejuvenated germinal epithelium cells, and Wheelon29 found in dogs that nine months after vasectomy the testis contained all elements of germinal epithelium. He believed that either all the tubules did not degenerate, or that some rejuvenation had indeed happened24.

1922

Benjamin22, 23 publishes papers describing the scientific principles, theory and practice of the Steinarch operation. The theory was that the back pressure in the testicle caused by cutting the vas deferens led to an increase of male hormone production. The closer to the testicle the ligation, the more hormone stimulation. He reported a series of cases where patients reported regrowth of hair, better colour, better erections less premature ejaculation and increased libido. He recommended that men with two healthy testicles should have the operation done on one testicle only, leaving room to do the operation again on the other side at a later date for another boost of rejuvenation.

1924

Moore & Quick30 tested the hypothesis of early degeneration of the testes on a series of rabbits. They found no degeneration of the testes, and as with others an enlarged epididymis. They found no evidence to lead them to assume an early degeneration of germinal epithelium followed by regeneration.

1927

Virginia sterilisation law challenged, but upheld in the case of an inmate in the state colony for epileptics. The inmate had a mentally subnormal mother and daughter, and the judge felt that "Three generations of imbeciles are enough". Many of the early laws were quickly overturned following legal challenges, however between 1909 and 1924 over 6000 people were forcibly sterilised - half of them in California.

In Germany, the Kaiser Wilhelm Institute for Anthropology, Human Genetics and Eugenics was established. It experimented into how to "Discriminate race on the basis of blood group, shape of tongue and outer ear, and the half moon at the base of fingernails".3

1928

Switzerland introduces the first European eugenics law.3

1931

In the UK Major A.G. Church of the Committee for legalising Eugenic Sterilisation attempted to introduce a bill to Parliament. It was defeated because of opposition from the Labour party who said it was fundamentally against the working classes.3

1932

In Germany, a Reich Sterilisation law was drafted. This was before Hitler's Chancellorship started in January 19333

1933

In Germany, a law was passed requiring certification of fitness to marry issued by the local health office. Unsuccessful candidates were considered candidates and tried in "Hereditary health courts".3, 13

1936

Abeshouse18 publishes "Vasectomy for prevention of epididymitis in prostatic surgery". A common complication of prostate surgery at the time was epididymo-orchitis, presumed due to the retrograde flow of infected urine. The technique remained in common usage until the advent of anti-biotics.

1938

Twyman & Nelson32 reported a successful case of Vasectomy Anastomosis (reversal). The patient underwent the Anastomosis procedure 4 years after elective vasectomy was performed. The operation was recommended by reason of emotional depression due to the desire to father children. The patient's emotional condition improved considerably, and he has subsequently had normal offspring."

1945

German enforced sterilisation under the "Fitness to marry" legislation ceases after Allied victory in Europe. 320,000 people were sterilised during the period 1933 to 1945 under the law3, 13.

Cameron31 reports "A case of a 26-year-old man who had been sterilized via ligation and cutting of the spermatic cords underwent vasorrhaphy and anastomosis of the vas deferens in an attempt to be able to conceive. 3 months after the operation a sperm count was 2,500,000 sperm/cc semen indicating a successful patency".

1948

O'Connor lists the indications for vasectomy as being "(i) Prevention of the insane, criminal or perverse producing offspring, (ii) If the wife has precarious health and is unable or refuses to undergo tubal ligation, (iii) an agreement between husband and wife to prevent pregnancy, (iv) to prevent epididymitis following prostate surgery, (v) rejuvenation (Steinarch procedure), (v1) mass sterilisation for the purpose of racial limitation/extermination3.

1950

Garrison & Gamble58 publish a paper in the US titled Sexual effects of vasectomy. The report based on a sample size of 50 finds that 47 were satisfied and would do it again. They remark that few men reported any sexual changes, but of those that did, both libido and frequency of intercourse were slightly increased.

1951

Handley33 reports a case where vassoraphy (repair) war performed ten years after the original vasectomy with a complete recovery of function. His wife became pregnant about 6 months after the operation.

1952

Phadke36 reads a paper at the Third international conference on planned parenthood commenting "Favourably" on the use of vasectomy for sterilisation.

1953

Walker35 stared that "It can be said with confidence that vasectomy has no adverse effects on the physical or mental welfare of the patient. Operative patients have now been watched for a period of 30 years and no delayed adverse effects have been noted". He followed up the cases at varying intervals. It was observed that complications occurred as a result of technical surgical errors2.

1955

Jhaver39 introduces the single incision, single stitch approach. His paper on the technique was published in 1958. The advantage of the technique being that a bilateral vasectomy was possible using one incision, therefore less surgical trauma and post operative care.

1956

Evridge-Vernon37 publish a paper on "Natural reunion and canalization" following the division of the vas deferens in humans and animals. The authors did a follow up two years later and observed natural reunion in some cases2.

Gregory Pincus, his colleague Dr. Min Chuh Chang and Dr. John Rock, gynaecologist from Harvard, conduct the first trials of the oral contraceptive with 60 female volunteers. Pincus carries out the first large trial with 6,000 participants in Puerto Rico and Haiti – successfully. Full article

1960

Enovid®, produced by US company Searle, is registered as a female contraceptive in the United States. Full article

1963

In California, Poffenberger59 publishes his report on 2000 voluntary vasectomies performed between 1956 - 1961. He reports that "Not only were men pleased with the result of the operation but they talked about its advantages freely and attempted, often with success, to convince others to have it done. In some cases, men came several hundred miles to have the operation. 85.6% of the men there was no medical problem stated as a reason for requesting vasectomy". At the time, vasectomy was often used as a cure for other conditions, and not for family planning.

1964

In India, Phadke60 publishes a paper titled "Vasectomy: sterilization of the male". He reports on who is a suitable candidate, the procedure including after care and known problems.

1965

On June 7 the U.S. Supreme Court, in Griswold v. Connecticut, struck down state laws that had made the use of birth control by married couples illegal. The court's landmark decision — coming five years after oral contraceptives became available to American women and 49 years after Margaret Sanger opened the first birth control clinic in the U.S. — legalized the use of birth control and paved the way for the nearly unanimous acceptance of contraception that now exists in this country.

In China, Lal61 published a study pointing out that third pregnancies were routinely "Interrupted" and the woman sterilised. It calculated that 43 million sterilizations were needed to depress the population's growth rate to 1%. It queried if the Government would ever follow a policy that was "So contrary to Confucian ideals and Marxist dogmatism".

1966

In the UK, the "Simon Population Trust" project was announced in "The Lancet"40. The Trust's sterilization project first function was to make known how voluntary sterilization can help to solve or prevent family problems and to facilitate its practice in Britain. The project was also concerned to correct the erroneous belief, still held by a dwindling number of medical and law persons, that sterilization was against the law. At the time of the report, at least 2000 men have already been sterilized through the mediation of this Project.

1967

In India, Kothari & Pardanani41 demonstrate that it's possible to produce a subfertile sperm count by using a synthetic thread to temporarily obstruct the vas deferens with the idea of removing it to restore fertility. Based on two cases, the authors say that the thread was left in for 20 weeks, and six weeks later fertility had returned to previous levels.

Bergen62 published a report detailing the legality of sterilization in the US. He reported that sterilization for therapeutic purposes was not prohibited in any state, and was still prohibited for birth control purposes in Connecticut, Kansas, and Utah. Sterilization for certain eugenic purposes was authorized in 28 states. Voluntary sterilization for any reason (with limitation concerning age and consent) was permitted by statute in Georgia, North Carolina, and Virginia.

1968

Article published in the Journal of American Medicine63 reports that lower income males often have great difficulty in obtaining sterilization operations because physicians are concerned about the opposition of the Catholic Church, the question of legality, and the possibility of civil damages.

1969

In Bangladesh a study was undertaken by Quddus, Ratcliffe & Croley64 to inquire into the background of individuals known as "vasectomy agents". These commission paid individuals acted by bringing men into the East Pakistan (Bangladesh) Family Planning Clinics for vasectomy. Their activities have caused the number of vasectomies to rise beyond expectation. About 40% had undergone vasectomy themselves. Due to the success of these unofficial agents, the government decided that they should be given official recognition. Partly so that recruiting activities could be supervised.

1970

An article published in the Journal of the American Medical Association entitled "Vaccine against sperm?"65 finds that the autoimmune response in vasectomised men may suggest a path for development of a male contraceptive vaccine.

1971

"Family planning festival" in Cochin city, Kerala, India. Cash incentives offered for participants. 62,913 vasectomies performed in one month as a result of the campaign. Total estimated cost was 9 million Rupees, total estimated saving to the government 162 million Rupees.

Jhaver et all38 evaluate the use of tantalum clips placed around the vas with the hypothesis that the procedure would lend itself to more successful reversibility.

1972

Gujurat state (India) carries out 222,000 in a two moth period. This campaign was less successful than the 1971 Kerala program, as that program offered rewards for officials and volunteers.

Swiss program to control Gypsy population ended13.

An article by Prucell66 profiling D. Pai of Bombay attributes the lower birthrate in Bombay to his sterilization program. 3 old buses, equipped with the best medical equipment and manned by trained physicians, tour Bombay. Each has been the site of 10,000 vasectomies. In addition, free condom distribution centers and vasectomy clinics have been set up in Bombay railroad stations. Pai and his doctors also approach women who have just delivered their second child. Nearly 30% accept tubectomy.

On March 22, the US Supreme Court ruled on the historic Baird vs. Eisenstadt case, which legalized birth control for non-married people and established the primary precedent for Roe vs. Wade (1/21/73).

In the UK, the The National Health Service (Family Planning) Amendment Act 1972 authorises the performing of vasectomy operations for contraceptive purposes. Prior to this, the law was unclear - especially in Scotland. A retired Scottish surgeon posting to the newsgroup said:-
"Being a Canny Scot, I asked about the legality from the legal advisors in the health department and was told that it would be dangerous (in 1970) as there had not been a test case in the courts, and that such surgery would under the legal systems inherited from England, come under the act of "mayhem"! i.e. under the feudal laws still standing, I would be altering the ability of a fighting man to respond to his overlord's (or government nowadays) possible request to be called to arms!"

A similar argument in France meant the law was not clarified there until 2001. Prior to that, under the existing Napoleonic code vasectomy was regarded as "mutilation", with a similar inference that messing with a man's testicles makes him particularly unfit as a soldier.

1973

Over 7 million vasectomies performed in India to date due to cash initiative schemes.

The term "vasectomania" coined in a report by D & H Wolfers67. At the time, various countries governments were using incentives to promote vasectomy, and the term originally referred to these political initiatives. However, the term got misused in later years. The report said that men should NOT be pressured to undergo the procedure, and that "The free, unprompted, informed decision of a man to terminate his own fertility is the only legitimate reason for vasectomy. The following should NOT be given as reasons for vasectomy:-
1) that it is the best present they can give to their wives
2) that it is reversible
3) that men experience greater libido or feelings of better general health
4) that it was ever used for rejuvenation
5) that it is a way to contribute to the solution of the world's problems."

An article published in Biomed News entitled "Implants seen as reversible contraceptives."68 discusses an implant that may offer a reversible contraceptive. The device (not yet tested on humans) plugs the entrance to the Fallopian tube without surgery using a new instrument (steerable hysteroscope). It is hoped to offer better protection that the IUD 2% pregnancy rate. Removal is accomplished with an attached string.

1974

No-Scalpel vasectomy developed in China by Dr. Li Shunqiang of the Chongqing Family Planning Research Institute, Sichuan province. At the time, vasectomy was unpopular with Chinese men, and tubal ligation was the most commonly used method of voluntary sterilisation. The procedure was minimally invasive with a much lower complication than conventional vasectomy, especially in extremely rural areas with limited medical facilities.

It was reported43 that in the richer parts of the world, vasectomy became more widespread due to adverse publicity about the pill and a feminist campaign to encourage greater male responsibility in sexual matters.

1975

A ruling69 is made in Germany when a man tried to sue for a child born after a failed vasectomy. The case was dismissed on the grounds that the consent form signed by the patient mentioned failure as a possibility, and the Doctor had performed the service "as per contract".

A study by Wagenaar70 into the usefulness of vasectomy in prostatic surgery finds that vasectomy does not reduce the incidence of epididymitis, and concludes that "vasectomy as a routine in prostatic surgery is not indicated". It lists sterility as a "possible complication"!

A study by Kaplan & Huether71 into failed vasectomy finds that the length of excised vas deferens is crucial. Less than 15mm had up to a 25-fold greater incidence of failure.

Drueschke, Zaneveld, Burns, Rodzen, Wingfield & Maness72 publish a paper detailing their research into "Rigid, reversible, vas deferens occlusive devices" similar to plumbing valves.

In the Philippines, a program sponsored by Churches and hospitals reports the growing popularity of voluntary sterilisation since the criminal penalties against it have been removed.73

1977

The Family Planning Association of Hong Kong launches a TV campaign to encourage men to "do their bit". the "Mr Family Planning" campaign had television personalities portraying two characters, Mr Birth Control and Mr Vasectomy. More information (and scary photo's!)

1983

Male and Female sterilization legalized in Turkey

1985

First US No-scalpel vasectomy performed by D. Mark Goldstein at the New York Presbyterian Hospital Cornell Medical Center. Dr. Goldstein was a member of the international team sponsored by the Association of Voluntary Surgical Contraception (Now Engender health) to go to China to learn the procedure. The procedure was introduced to other countries of the world by other team members.

1990

FDA gives the female implant contraceptive "Norplant" approval.

1997

Male and Female sterilization legalized in Brazil

1999

No-Needle vasectomy introduced in August (after six years of preparation) using a "hypospray" jet injector for anesthesia. The technique was developed by Charles L. Wilson, M.D of Seattle, USA in consultation with the late Ralph Adam, M.D. - the inventor of the MadaJet device used in the technique77.

April - "Norplant" ceases to be available in the UK due to virtually no demand for the product. August - It was reported that the maker of Norplant will pay over $50 million to more than 36,000 women to settle claims that the implantable contraceptive device caused headaches, irregular menstrual bleeding, nausea and depression. Wyeth-Ayerst Laboratories said the move to end five years of litigation was "purely a business decision." Full article

2001

The law in France was changed to allow sterilization (male and female). More information on the original law, and the change to it.

2003

A study published in China74 into the long term effects of vasectomy on BPH concludes that "Vasectomy reduces the incidence rate of BPH significantly." See 1904 also. BPH stands for Benign prostatic hyperplasia (benign enlargement of the prostate). More information on BPH.

"Vasclip" given FDA approval.

2004

Robotic vasectomy reversal first performed on rats. In a study by Schiff, Li & Goldstein75 a new microsurgical robot that had FDA approval in 2000 was used to perform two types of reversal procedures on rats. The robot does not have the shake that human hands do. Initial results were that patency was higher in the robotic group than the group where humans performed the operation, and the incidence of granuloma's was significantly lower in one of the robotic groups.

2005

Publication of further research into the technique of using a high pressure injector to administer the anaesthetic results in less discomfort for patients, and is faster acting that needle administered local anaesthesia known as "No Needle". The technique was introduced into practice by in Canada by Dr. Ronald Weiss of the University of Ottawa.

2006

The first independant study into the effectiveness and short term complications of Vasclip published.76

2007

Vasclip website dead as from June 2007. If this means the device has been withdrawn, or the company folded I'm not able to ascertain.

Page last updated February 3, 2008

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References

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2 P.S. Jhaver, M.S., F.I.C.S. & B.B. Ohri, M.S. F.R.C.S., F.A.C.S., F.I.C.S The history of experimental & clinical work on vasectomy 1959.

3 M.J. Drake, I.W. Mills and D. Cranston - The chequered history of vasectomy. ©British Journal of Urology

4 Gosselin, P. Memoire sur les obliterations devoies spermatique. Arch. Gen. De Med. (4th series) 1847.

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7 Simmonds Deutsch. Med. Wschibschr. xlvil, 665 Cited by Moore. 1921.

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43 No authors listed. Vasectomy - techniques old and new. Med Gynaecol Androl Sociol 1974.

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