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Surgery and Family Planning (1960 Paper by Dr. P. S. Jhaver)

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  • Retired account

    Note: This article was originally published in 1960. While some information may still be relevant today, it does not represent a modern understanding of vasectomy and should be viewed primarily as a historical document.

    Posting this here for archival purposes.

    By Dr. P.S. Jhaver MS FICS
    Article originally published in the Times Of India, September 25, 1960

    To have children when needed, not to have them when no more are desired, or to be able to postpone conception till the convenient time – these are the main objects aimed at by most of the people who practice family planning. Surgery can be of help in achieving all these with least inconvenience, maximum certainty and the greatest safety.

    In the operation of sterilization in the male, the channel, which carries sperms in, beached, thus preventing them from joining the semen. Experimental work to study the effects of such a breach of this duct (vas deferens) was carried out by various scientists over a period of 67 years, before clinical work was undertaken. Clinical work has now been thoroughly studied over 60 years and no bad effects were ever reported except when the operation was performed by inexperienced men or when there was a lack of care.

    The experimental work to study the effects of the breach in the channel was first started in the year 1930 by Sir Astley Cooper. The work was then studied by various workers in America and Europe. This subject was studied by the author from 1952 to 1954. All the workers, including the author, found that the field responsible for the production of the semen goes into inactivity and functions again as soon as the operation is undone.

    Regarding the hormone there has been no general agreement that more hormones are produced after the operation and leads to rejuvenation. Nevertheless, no one has reported that hormone production is in any way adversely affected.

    Surgeons impressed

    Dr. Oschaner of Chicago first performed the operation of sterilization in the human in 1897. He published an account of the operation, which impressed many other surgeons.

    Undoing it

    In 1907 an operation to undo vasectomy (incidental to a hernia operation) was undertaken. Since that time many workers have successfully performed it (vasorraphy). In India many such operations have been successfully performed. The success rate has been 50 percent to 80 percent. Further work is being done to make this a cent percent successful operation.

    Besides reversing the operation (vasorraphy) the author is also working on a variation of the sterilization operation, which will get reversed of its own (without a second operation) after the desired period. This will enable us to extend the use of this operation for spacing the children.

    The question on the place of surgery in the family planning program in India has been discussed at large. There was a great controversy over this at the Sixth International Conference of the Planned Parenthood Federation at New Delhi in February 1959. Many pleaded in favor of surgery for family planning. Strong opposition was voiced by Mrs. Havarti Ramah Rau who was against the inclusion of sterilization in the family planning program.

    The facts given below will help in an assessment of what should be the place of surgery.

    53.5 percent of the population of the world is in the age group of 15 to 35 (reproductive age) 8.2 percent above the age of 55, and the rest below the age of 14 years.

    In India, out of this 53.5 percent in the reproductive age, not more than 5 percent have fewer than three children and are looking for measures, which will give them the desired. The rest (i.e. 48 percent of the total population) has already achieved an ideal family of 5 to 6 and desire no more children.

    The facts, which affect this early attainment of a family of 5 to 6, are as follows:

    Higher fertility of Indian women. Fertility rises sharply up to the age of 24 and the average Indian woman becomes the mother of six to seven children during her reproductive period.
    Marriage is universal in India. No physical disability of disease prevents marriages. Even lepers and the physically handicapped get married and produce children.
    Early marriage (before or at the age of 14 in girls and 18 in boys) is prevalent all over India except in the higher strata of the society.

    Oral Contraceptives

    The inadequacy of the methods advocated for family planning in the first and second five-year plan periods has led us to look for other methods. Those who advocated the rhythm method and contraceptive tablets, which have yet to appear and prove their efficacy. Those who have been conducting research to evolve sure oral contraceptive tablets have started that these tablets will affect the hormone in the body.

    From 1952 (Dr. Seive was the first to experiment on this subject) till today no body has been able to perfect a tablet, which will be a hundred percent effective and at the same time cause no ill effects from their prolonged use. In the absence of such a miracle tablet, are we to wait and keep on producing children? Even when such a tablet is found, how many would like their wives swallow such tablets that might tamper with hormonal system of the human body in this cancer age? And how many people would like to take these tablets every day, like a chronic tuberculosis patient, throughout their life-time?

    In contrast, surgery for family planning is a subject that has been carefully studied over 130 years and no bad effects whatsoever have been seen.

    Many people want to know details of the vasectomy operation and there are a hundred queries in their minds. They seek information, but because of shyness do not come forward to ask for facts from authentic sources. People are often told things, which are incorrect. They form so many wrong ideas about the subject.

    The questions often been asked by the people who come for the operation to the author are answered below.

    How will this operation affect the physique, the mind and the sexual faculties?

    Those who undergo this operation are physically better and their sexual faculties improve, and there are no ill effects on the mind.

    After the operation will there be semen discharge as before?

    Yes, it will be exactly as before, but there will be no sperms.

    Can the operation be undone?

    Yes, The success so far is 50 to 80 percent. Such operations have been and are being successfully performed by those specialize in this subject.

    Is there any pain during or after the operation?

    No, The only “pain” is that of a needle-prick when local anesthetic is injected, to make the site for the operation insensitive.

    Is it necessary to stay in the hospital after the operation?

    No, A person walks out after the operation and goes for his work or to his home as he wishes.

    What about dressings at the hospital?

    Only a second visit to the hospital for the removal of the skin stitch is necessary after 24 hours. The author performs this operation through one single cut of about one centimeter and only one stitch is needed on the skin.

    How long does it take?

    About five to ten minutes. I often tell my clients: “You light a cigarette when the operation begins and the operation will be over before the cigarette is finished.” There is no exaggeration in this statement. Many who did smoke on the operation table have confirmed it.

    Are there any complications after this operation?

    Yes, complications are always possible, but they are due to faults in the operation. These faulty operations are not uncommon, but in inexperienced hands only. The operation is a minor surgical procedure, but with major consequences if complications occur.

    Surgery can help to prevent conception and can also restart the ability for procreation. Surgery provides help for such men, as do not have children because of an obstruction in the channel carrying sperms. Surgery may also help to space the children.

    If all this is possible by surgery and when nearly 50 percent of the population in the country needs prevention of further conception, surgery will surely have an important place in the program for family planning.

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