Scientists have been investigating possible benefits of vasectomy for many years. Some of the ideas from the past are quite amusing! Way back in 1889, Harry Sharp, the physician in a penal institution in Indiana had a 19 year old male patient who complained of “Excessive masturbation”, and insisted on castration. Sharp ruled out castration as it was deemed too mutilating, so advised vasectomy. 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”.2 I’m not totally sure exactly who benefitted from the vasectomy!
In 1918 Steinach performed the first vasectomy on humans for “Rejuvenation”. The idea was that the testosterone would forcibly be reabsorbed into the body, causing physical and mental improvements in elderly men. It was based on an experiment in which he observed that senile rats were “Transformed after obstructing the outflow from the testes by vasectomy”. It became quite fashionable, with notable characters such as Sigmund Freud and WB Yeats having a vasectomy for rejuvenation.2
With the benefit of hindsight, these are amusing anecdotes from a bygone era, and I think opinions have moved on a bit since then!
Why do we elect to have a vasectomy performed today? I think the honest answer to that one is so that we can enjoy the benefits of worry free, unprotected sex. A lot of this site is devoted to discussing possible risks and complications of vasectomy. This page is something different. Here we take a look at what the benefits are, some of the statistics involved and who is most likely to (and least likely to) benefit from vasectomy.
Welcome to the most reliable form of contraception available!
Many studies have been done into the reliability of all methods of birth control. As vasectomy has been around for decades, the data on this is very extensive. To take a recent example, the UK national sterilisation guidelines (2004) analysed many studies, and came to the conclusion that “The failure rate of vasectomy should be quoted as approximately 1 in 2000 (0.05%) after clearance has been given”.4 Vasectomy can reverse itself, but it is a very rare event. It develops in only about .025% or one in 4,000 vasectomies.1
To compare vasectomy with the most used methods of birth control, female sterilisation caries a “lifetime failure risk estimated at 1 in 200 (0.5%)”4, the pill has a failure rate of 0.16% – 3%3 and the condom has a failure rate of 1% – 33%.3 The average rate of pregnancy for couples who rely only on condoms for protection is 12%, and in adolescents the risk with condoms is even higher – 18%. Even for those who use a good-quality condom correctly, the annual risk for pregnancy is 3%.1
Freedom from fear of unwanted pregnancy.
Most men who have a vasectomy feel relieved that they don’t have to worry about their partner getting pregnant accidentally. Also, most couples enjoy their new-found contraceptive freedom and feel that their sex life has improved because of the removal of worry. Approximately 40% of couples have a vasectomy as a result of a failure of other methods of non-permanent birth control.1.
Improved sex life
Most men say that after a vasectomy they experience either no change to frequency and enjoyment of sex, or they have sex more often and enjoy it more. Few men report negative effects on their sex life. A study published in 195013 remarked that few men reported any sexual changes, but of those that did, both libido and frequency of intercourse were slightly increased. A more recent study finds that about 30% of couples have sex more often, and enjoy it more.1. Satisfaction with vasectomy in these studies was 99.5%15, and 94%1.
Positive effects on marriage
According to Harvard Medical School, 30% of couples consider their marriages stronger, feel healthier, are more relaxed, and have no regrets about the operation. Younger and older couples, with or without children, were all equally likely to have favourable reactions to vasectomy1. Another study reports that “The majority of marriages improved in quality following vasectomy. This was the case in all age groups”5. The study above1 also found that “the majority of requests came from successful marriages, in some of which strains apparent before vasectomy were not observed afterwards”. They also looked at marriages showing minor strains, and found that following vasectomy, these marriages improved. Minor sexual problems disappeared, and tensions were eased. In 1968, a long term study of 2000 men found that benefits included improved physical and mental health, and that as a result of vasectomy a more contented married life was being enjoyed by both partners in most cases.12 Some women fear that vasectomy may make their partner more attractive and encourage outside affairs. Research from the 1970s indicates that married men who have a vasectomy are no more likely to indulge in extramarital sex than fertile men.1
Improved female health
Half of men reported choosing vasectomy over a reversible method because it is the most secure means of preventing pregnancy, and 62% chose vasectomy over tubal ligation because the procedure is simpler and safer.6
According to the FDA7, the risks of taking the pill include “Dizziness, nausea, changes in menstruation, mood, and weight. Rarely:- cardiovascular disease (including high blood pressure), blood clots, heart attack, and strokes”.
The risks of the mini-pill include “Irregular bleeding, weight gain, breast tenderness, less protection against ectopic pregnancy”.7
The IUD can cause “Cramps, bleeding, pelvic inflammatory disease, infertility, perforation of uterus”.7
The risks of female sterilisation include “Pain, bleeding, infection, other post-surgical complications, ectopic (tubal) pregnancy. Even the new Essure device has a risk of ectopic pregnancy.7
For many couples, vasectomy represents the least risk, and most reliable option.
You *might* live longer!
Studies throw up odd statistics sometimes. Back in the early 1990’s, a couple of large studies found “lower mortality amongst men with vasectomies as opposed to age matched comtrols”.16 However, the most likely explanation for the results is that men that volunteer for vasectomy are more likely to look after their general health and have regular medical checks.
Most likely to benefit
Couples in long term, stable relationships – typically having been together 10 years or more.1
Couples who both agree they have all the children they want. Childfree couples are equally likely to have a positive reaction to vasectomy as couples with children.1
Couples that have been carefully counselled, discussed the risks and benefits fully and have not made a rushed decision under pressure. In one study, couples that took an average of 22 months to decide reported 99.7% satisfaction with vasectomy.10
Where other methods of birth control are unsuitable, or the wife/partner has health problems that make pregnancy unsafe.
Least likely to benefit
- Men in couples in which one partner is unsure about his or her desire to have children in the future.
- Men whose relationships are unstable or going through a stressful phase. In one study, women who reported substantial conflict with their husbands before vasectomy were more than 40 times more likely to request that their husband have a reversal than women who didn’t report such conflict.14
- Men who are considering the operation just to please their partners, or are being pressurised by their partner.
- Men who are counting on having children later by storing sperm or by surgical reversal of the vasectomy.
- Men who are single, divorced or separated at the time of vasectomy. The reason 90% of men request a reversal is a change in partner7.
- Young men under 30. Younger men have many life changes and choices ahead, and may regret the decision later. Men who had a vasectomy in their 20’s are 12.5 times more likely to have a reversal than older men9, and are also more likely to undergo reversal in a significantly shorter period of time8.
1. Harvard Medical School “Well connected”, 2001.
3. Adapted from Trussell J, Hatcher RA, Cates W, Stewart FH, Kost K. A Guide to Interpreting Contraceptive Efficacy Studies. Obstetrics and Gynecology 1990; 76:558-67.
4. RCOG. UK national sterilisation guidelines 2004.
5. The quality of marriage before and after vasectomy. Howard G. Br J Sex Med. 1979.
6. Characteristics of men receiving vasectomies in the United States, 1998-1999. Barone MA, Johnson CH, Luick MA, Teutonico DL, Magnani RJ. Perspect Sex Reprod Health. 2004.
7. FDA. Birth control guide – updated December 2003.
8. The trends of vasectomy reversal in the forces. Shah ZH, Ganta SB, Morgans BT. J R Army Med Corps. 2003.
9. Patient characteristics associated with vasectomy reversal. Potts JM, Pasqualotto FF, Nelson D, Thomas AJ Jr, Agarwal A. J Urol. 1999 Jun.
10. Vasectomy as a contraceptive method. Orr D, Moore B. Ir Med J. 1989.
11. Voluntary male sterilization: a psychological evaluation. Goethals A, Thiery M. Tijdschr Geneeskd. 1985.
12. Vasectomy: a follow-up of two thousand men. Jackson LN, Avant P. J R Coll Gen Pract. 1982.
13. Sexual effects of vasectomy. Garrison PL, Gamble CJ. J Am Med Assoc. 1950.
14. A comparison of women’s regret after vasectomy versus tubal sterilization. Jamieson DJ, Kaufman SC, Costello C, Hillis SD, Marchbanks PA, Peterson HB; US Collaborative Review of Sterilization Working Group. Obstet Gynecol. 2002.
15. Attitudes of patients one year after vasectomy: results of 355 of 1,000 questionnaires. Moss WM. Urology. 1975.
16. Safety and effectiveness of vasectomy. Schwingl PJ, Guess HA. Fertil Steril. 2000.