Q. I am considering having a vasectomy. In speaking to friends and doing research on my own, I have discovered several potential problems with the procedure. These problems include everything from an increased risk of coronary artery disease to the production of antibodies against one's own sperm.
What, in fact, are the risks associated with having a vasectomy? Is there anything I can do to decrease my chances of having a complication?
A. Each year, more than half a million men have a vasectomy. This simple sterilization procedure is done in a physician's office and takes only 15 to 20 minutes. It has a low rate of complications. In this operation, a physician injects a local anesthetic in the scrotum and around each vas deferens, the tiny tube that carries sperm from each testicle. After making a small incision in the scrotum, the physician cuts the tube and treats it to keep it from joining back together.
Complications include bleeding, infection and painful lumps in the scrotum called granulomas. These problems, which happen in fewer than one in 20 men, are usually minor and readily treatable. Vasectomies fail to work in about one in 400 men.
Years ago, researchers thought that men who had had a vasectomy were more prone to coronary artery disease -- hardening of the arteries around the heart. But this association hasn't stood the test of time in later studies.
It's true that some men form antibodies against their own sperm after the procedure. The sperm are still produced in the testicles, but they can't escape to reach their normal route of exit. These antibodies don't seem to be harmful to the man's health in any way; however, they can decrease your fertility should you ever decide to have the vasectomy reversed.
Likewise, concerns that vasectomies were linked to slightly increased rates of prostate cancer or prostate enlargement haven't proved true. Some researchers have found subtle changes in hormone levels, but these haven't been tied to any specific health problem.
One possible complication is infertility, and not just the infertility that results from the procedure itself. Although vasectomies can be reversed in more than 90 percent of the cases with modern surgical techniques, some men have had difficulty fathering a child afterward. In general, between 50 and 70 percent of men who have had their vasectomies reversed are fertile.
Probably the best thing you can do to decrease your risk of complications, low as it is to begin with, is to have your vasectomy performed by a physician who does them frequently. One study showed that physicians who did 10 or fewer vasectomies per year had a higher rate of complications than those who did more.
Jay Siwek, a family physician from Georgetown University, practices at the Fort Lincoln Family Medicine Center and Providence Hospital in Northeast Washington.
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