A Sept. 27 Health article incorrectly said that recanalization involves the return of sterility after a vasectomy. Recanalization involves the accidental return of fertility after the procedure. (Published 9/28/2005)
When you are considering a vasectomy, you tend to mention it to other people to get their reaction.
You don't do this to actually get their opinion, of course. You do this to sound it out, to get used to the idea yourself. After all, the doctor is going to be messing around, you know, down there with surgical tools. You don't want to go into this unconvinced it's the best thing. So you ask around.
When you do, you hear a lot of euphemisms for the procedure. The most common one is "snip," as in, "Oh, so you're going to get snipped." This is comforting; it sounds like something you do to a loose thread, or a hair that's sprouted from your nose.
The problem is, nobody tells you that the procedure essentially involves not a mere snip, but the withdrawal of sensitive tissues from your scrotum, cutting them so they can no longer carry sperm from your testicles to outside, burning their ends with a searing tool, and then sticking them back inside and sewing everything back up.
Perhaps this is for the best.
Vasectomy Joke No. 1: A guy wakes up from a vasectomy and the doctor tells him he has good news and bad news. "The good news is we were able to save your testicles. The bad news is they're under your pillow."
The idea to get a vasectomy was mine, actually. It dawned on me two years ago that my children -- then 8 and 6 and now 10 and 7 (he's falling behind!) -- were wearing me out and that any additional siblings could send me to a very early grave.
I'm an at-home father with a penchant for keeping the kids active. That wasn't such a challenge when their idea of activity was watching "DragonTales," but now that they're fully immersed in the juvenile-sports-and-arts industrial complex, there's a lot of driving around and playing catch involved, not to mention increasingly difficult homework.
The idea of having again to change diapers and training pants (not mine, theirs) for years -- and reassemble the world's most complex crib -- did not warm my heart. In fact, it made my blood run cold.
But every time I'd mention getting neutered, my 39-forever wife would get a wistful look in her eye and gaze off into the near distance and say, "Not yet. I think there may be another little miracle waiting to happen between us."
So it was to my infinite delight that one day a few months ago my wife announced she was going off the pill and, basically, should I ever want to get extra friendly again, it would be my turn to shoulder the burden of contraception.
I was all too happy to oblige. So I started asking around.
"Well, you know Mark, he had his thing snipped and Kathy ended up giving birth to twins!"
"Bart got whacked and lost his sex drive. And he was single! Talk about a waste of money!"
"Louie, he got snipped at 10 in the morning and he drove home in time for lunch!"
"Our friend went back to have his semen tested six weeks later like the doctor said and he had paint chips in this specimen!"
True, every one of these tales, and all of them with good explanations (including the last one).
The Cut That Refreshes
Throughout the ages, vasectomies have been performed, along with castrations, as punishment.
But in 1918 Eugen Steinach got the idea that "senile" rats, cats and dogs in his labs were "rejuvenated" by the sterilization procedure. Of course, humans were quickly drawn to this idea. Prominent men including (we're not making this up) Sigmund Freud and William Butler Yeats had their sperm exits blocked in hopes it would produce youthful energy.
"Of course, it didn't," said Arnold Belker, clinical professor in the division of urology at the University of Louisville School of Medicine and the American Urological Association's go-to guy on vasectomies. While rejuvenation claims were snake oil, the procedure was deemed a safe and effective form of voluntary sterilization. Vasectomies became popular as a form of birth control in the mid-20th century, Belker said. Fears that it causes cancer have been disproved.
But, I wondered, just how many guys do this?
"The figure commonly bandied about is a half-million" per year in the United States, Belker said. "But it's almost impossible to get a real handle on it because so many are done in the office" rather than hospitals or clinics. "It's hard to track them." Besides urologists, family doctors and others in the medical profession can do the deed.
"You can train a monkey to do a vasectomy," said Belker. "It's pretty straightforward. It's minor surgery -- except from the patient's view."
Any vasectomy is preceded days or weeks earlier by a conference with the doctor who will do the operation. During our initial meeting my surgeon, Daniel Laurent, asked about my background and family and made sure the reasons for getting sterilized were legit.
"You can sometimes sense when [the man] isn't a willing participant in this decision," he said. "There may be family or marital issues that are bringing them to your office; he may be in a position where he's forced into it, and vice versa -- where he wants the procedure and she doesn't.
"There are some situations where I've turned some patients away. They act a little indignant, but I tell them the guys who don't do well after this procedure are not really the guys who have a physical problem, it's the guys who weren't ready for this decision.
"You can pick up when the guy is ticked off at being there in the first place."
Vasectomy joke No. 2: A man comes to the doctor and says, "Doc, I want a vasectomy." The doctor says, "Well, that's a big decision; have you discussed this with your family?" And he replies, "Yes, and they're in favor, 11 to 3."
After describing the procedure and informing me of possible side effects, Laurent explains that I will be required to return six weeks after the operation with a semen specimen, which will be examined to see if I'm clear of sperm. Other docs say anywhere from 10 to 20 ejaculations is adequate, but Laurent is more cautious.
"Some guys never come back and assume with time everything is clear," Laurent said. "I've had a guy come back four months out and still had a few non-moving sperm. You usually see it in a guy who isn't very sexually active. Maybe his wife is in the last trimester of a pregnancy and he's not having intercourse or ejaculating frequently; you really do have to go with time as well as frequency of ejaculation."
Before leaving Laurent I have to ask: Everyone calls it "snip" and "snipped" and "snipping." Is there any actual snipping involved?
"Well," he said, "there are surgical scissors involved -- you're removing a half-inch segment so the two ends [of the vas deferens] don't come back together. So, yes, there is some snipping."
Welcome to My Operation
Most vasectomies are done with the patient numbed by a local anesthetic. But Laurent finds it easier to sedate.
"I like to focus on what I'm doing," he said. "I like to have someone else monitor the patient. I have more comfort level using sedation."
Hey, if it's good for him it's good for me.
When I arrived at Reston Surgery Center for my operation I spoke with Tammy Sparks, who is very slim and plays ice hockey when she isn't chemically knocking people out. She is the medical director and chief anesthesiologist for the center. Of the eight urologists who practice there, she said, most do their vasectomies on Fridays.
"Did you see all those men in the waiting room wearing sweat pants with their legs crossed?" she asked me as she prepared my propofol drip. (Propofol is the drug of choice for short periods of unconsciousness and rapid awakening -- better even than beer.)
"That's why they're here. We do about 20 vasectomies every Friday. The guys like Fridays because they can take the weekend off."
One of the few things you are not allowed to do in the days after your procedure is lift anything heavier than 15 pounds or otherwise exert yourself -- a perfect setup for weekend goldbricking. Even better, one thing you are allowed to do a week after your procedure is have sex, as much as you want, as long as you are comfortable (and provided you don't lift anything heavier than 15 pounds). Any sooner than a week, Laurent says, could cause a blowout; although that's rare, it does happen sometimes. Ejaculations speed up the clearing of recalcitrant sperm from the system.
Besides the propofol, Sparks topped off my intravenous cocktail with 50 micrograms of phentanyl to kill pain, and two milligrams of midazolam, a very wonderful head-spinning hypnotic sedative that relieves preoperative anxiety and causes operating room amnesia. I especially liked the idea of operating room amnesia.
"Is this the part where I count down from 10?" I asked as she administered the elixir just before wheeling me into the OR.
"You can try," Sparks said. I got to "nine," and then it was whee whee whoa, who turned off the room?
While I was dreaming about fish and bananas, Laurent was a busy man, as I later learned. He shaved away a few tufts of pubic hair and made a tiny incision on the top of my scrotum. He pulled out the vas deferens, which looks like a thick strand of spaghetti. He cut away a small section, then cauterized the ends. Which is to say, he burned them shut with a hot iron.
That done, he pushed the spaghetti back inside and moved on to the other side. When that bit was snipped and sealed, he closed the incisions with a few small stitches.
For him, 20 minutes, tops. Hey, where are the golf clubs?
Vasectomy Joke No. 3: A man pulls up at the clinic, leaving his wife and kids in the car, and races inside. "We're leaving on vacation, and my wife says I need to be vasectomised immediately!" The doctor is surprised, but makes the guy happy. Snip, snip and it's done. So the guy shuffles back to the car and gingerly lowers himself back into the driver's seat. "So," asks his wife, "are you vaccinated, then?"
No One's Perfect
When the severed vas deferens accidentally reconnect and sterility returns, that's called "recanalization."
That's what happened to my buddy Mark in the scenario several paragraphs back, to cause the startling post-vasectomy twins. Belker says the rate of recanalization is "one in 2,000 to 2,500, according to a large British study, the best study available on the rate of reconnection. It usually occurs in first year but can occur five or six years down the road."
Bart, the guy mentioned above who lost his sex drive, had preexisting problems of the psychological type. It turned out that he equated fertility with masculinity; his loss of interest in sex after the snip job resulted from the notion that he'd been made "less male." But as Belker and others explain, a vasectomy has nothing to do with the process of getting an erection or the ability to ejaculate. It simply prevents sperm from entering the equation.
Big Louie, who drove home after his procedure, was not following orders. "We prefer someone else drive the patient home, simply because you have the rare guy who experiences some discomfort," Belker said.
The fellow with paint chips in his semen specimen: He was new at collecting such samples and, well, his aim was off, it hit the wall, but he didn't want to waste it, so. . . .
And then someone turned the room back on.
"How was your brain surgery?" Sparks asked.
Eight, seven, six . . . hey wait, you mean it's over? How long was I out? Is this dried drool on my chin?
"You were out only about 25 minutes," Sparks said. "You don't remember an hour. . . . Isn't it great?"
Then I remembered why I was here and I pulled my sheet down to have a look.
And what the . . . ? Who put me in a thong? I didn't have a thong when I came in here. Who's responsible for this?
Actually, it was an athletic supporter, and there was a leak-proof bag of ice on top of it. I lifted everything up a bit and saw my privates had been packed in cotton, like a bottle of wine ready for shipping. There were two little black wads of sutures, one on top of each testicle. Those would dissolve in about a week -- the sutures, not the testicles -- and after a week or so with no exertion, I'd be good to go.
Before I even left the surgical center -- driven by my wife, mind you -- I felt a surprising sensation of well-being. I was doing it for her, and us, and for the children I want to devote all my energy to for the rest of my life.
My gosh, I actually felt . . . rejuvenated.
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