Ask Dr. Craig: Should I Get a Vasectomy?

Good morning Doc,

I am a 43 year old accountant who has just moved to Lagos from Owerri for a new job. It’s a fantastic opportunity for us as a family. My wife and I have four children between us aged 18, 10, 8 and 3. Since taking up this new job, things have been quite good, our marriage is stronger, and although we have had a few bumps along the way we are happy and our life seemed to be going according to plan.

That was until last week, when my wife told me that she was pregnant AGAIN! We got into a huge argument about it because I told her emphatically after our second child together that I did not want any more children, and now she is pregnant? Our third child (who is my fourth child, my first was with a girlfriend from University) was born after my wife stopped using her contraceptives because of the negative side effects.  I love my wife and I was supportive of her choice to discontinue, but now that she is pregnant again. I can’t help but feel so angry about the whole situation because I feel
trapped.

I like to think of myself as a progressive man. I help out with bath time for the little one, I supervise homework, I pack school lunches and go for school activities. I love my kids and will do anything for them, but honestly, it is very time consuming and expensive to raise children in this economy.

Yesterday I tried to talk to my best friend about things and instead of seeing my point of view, he chastised me. He suggested I should have gotten a vasectomy after baby number 3 since I was so sure I didn’t want anymore children. I was shocked that he would even suggest such a thing! I am an African man! We don’t do such things. Then he went on to tell me that he himself had gotten one! I was very shocked! Vasectomy? Mba! I feel it is very emasculating. Who in their right mind will ever allow anyone near their something with a knife? Besides, will I still be able to call myself a man if I am infertile and shooting blanks? And doesn’t vasectomy mean that I will never be able to enjoy sex with my wife any more? I know I don’t want any more children but is there no other way around this?

Help! I don’t want to spend all of my time and money raising children but I also don’t want to be less of a man!
Angry and Confused
Banana Island

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Dear Angry*

First of all, allow me to offer my sincere congratulations on the new job and on the move. I trust you are all settling in fine and enjoying the energy and vibe of Lagos. Thank you for your question which I have asked the editors to post in its entirety because I sense there are quite a few nuanced themes which I feel would be beneficial for us to explore. I have divided these into sections with a take home message in bold at the end. Permit me to jump straight in.

Pregnancy & Contraception
I think it is safe to say that you were quite angry after finding out that you were expecting another child, but I couldn’t help but notice that some of your anger is directed at your wife too. It seems as though you blame her for getting pregnant, as if she could do it on her own!

Please remember that it takes two to get pregnant and it is as much the man’s responsibility to prevent pregnancy as it is the woman’s. If you both agreed that you do not want any more children, then I feel that it is your responsibility as the husband ( in agreement with your wife) to have ensured that your love making sessions were safe.

Could it be that you are really angry with yourself for not being more careful and perhaps the anger at your wife is simply transferred aggression?

How could you have prevented the pregnancy yourself you might ask?

Condoms are the most widely available form of barrier contraception and they are very effective in preventing pregnancy, if used correctly. The arguments against condom use, raised by most men, are due to concerns about sensation, satisfaction and spontaneity.
Modern condom design means that you can enjoy an almost skin to skin like sensation with added ridges and bumps for your partner’s pleasure as well. A lot of brands now include gels and creams that aid with stamina and prolonging erections to ensure that mutual satisfaction is guaranteed. Finally, it might be true the older condoms could be seen as an interruption of pleasure of sex, but nowadays with the introduction of different colours, textures and flavours, wearing a condom can now easily become an enjoyable part of foreplay.

You mentioned that your wife was taking some form of contraception but had to stop, due to some side effects. Hormonal contraceptives for women are sometimes said to cause undesirable side effects and some women complain of weight gain, mood changes, water retention and bad skin. Having said this, there is little evidence to support the thinking that taking the contraceptive pill will cause a woman to add weight. Most doctors advise that for a vast majority of women, things generally go back to normal – after a few months. If after 3-6 months there are still concerns about side effects, then please see your doctor to discuss the many alternatives available including the Mirena and Copper coils, the implant, patches or the contraceptive injection

Vasectomy

Vasectomy is a surgical form of male contraception which aims to prevent sperm from traveling from the testicles where they are produced to the penis where they can be released in semen into the female reproductive tract.

This is done by making an interruption in the vas deferens which is a tiny tube that connects the testes to the penis. Your doctor could do this by making a small cut in the tube and tying the ends, or by using a clip, or by using a laser/electrocautery device to seal the ends of the tubes. The incision site is usually so small that you may not need stitches or only a few. If stitches are used they will be dissolvable or steristrips – which are a type of surgical sellotape.

For most men this is a day case procedure and takes about 15 minutes. This means that you should be able to go back home the same day. It is minimally invasive and so will not usually need general anaesthesia. Most men are able to go back to work in a few days with minimal down time. The most common immediate side effects are mild pain and swelling at the operation site, which tends to settle after a few days with adequate pain relief.

I have tried to answer some frequently asked questions below:

How effective is vasectomy?
Vasectomy is considered to be 99% effective in preventing pregnancy. It, however, does not protect from sexually transmitted infections.

Will it affect my sex drive?
No! Your sex drive is controlled by the hormone testosterone which is produced by the testicles and secreted into the blood. It is independent of the vas deferens and is not affected by it. Some men say that sex is more enjoyable because they are no longer worrying about pregnancy.

Will I still be able to ejaculate?
Yes! Semen which is the milky substance that is expelled from the penis at ejaculation is produced further down the line from where the vasectomy procedure is carried out so ejeculation can continue as normal after your operation. The sperm produced will be reabsorbed into the body

How soon after can I have sex?
You can be back to love making in as little as 48 hours after the procedure, although most men would likely need about 7 days before the soreness settles completely. You must remember, though, that you and your wife are still able to fall pregnant until about 12 weeks after the procedure. This is because although the connection to the sperm factory has been interrupted, there will still be some sperm in the pipeline which need to be cleared before we can say for certain that the procedure is complete.
For you to be able to rely on this for contraception, your doctor will want to collect three consecutive sperm samples and look under to microscope to confirm that there are no more sperm cells

Are there any complications?
As with every surgery there is a small risk of complications which will be mitigated for by proper surgical techniques, infection control and adequate post op care. Some complications include infection, pain, and failure of the procedure

What if I change my mind?
Vasectomy is considered permanent, but it can be reversed in certain circumstances. The operation to reverse a vasectomy can be difficult and does not always work, so patients are counselled very carefully to avoid regret.

And this brings me to a very important point. Because it is considered permanent, most doctors will provide at least one session of counselling before the procedure to explore some sensitive ethical scenarios with the patient or the couple.

It is not advisable to have a vasectomy unless you and your partner are sure that you do not want any more children. It is also not advisable to have a vasectomy immediately after or during any big life changes or relationship problems, as you may change your mind after things settle.

It is important to consider some hypothetical scenarios as well: for example if you were to lose all your children in an tragedy, would you regret not being able to have any more children? Or if you were to lose your wife or have to go through a divorce, would you want to have more children with a new partner?

Also some men have a notion that their masculinity is tied to their ability to have children and if this cannot be challenged before the procedure it is likely that it can psychologically affect their ability to enjoy love making with their partner even though biologically, there is no effect on virility.

In conclusion:
As you can see, there are a lot of variables to consider, but on the whole, vasectomies are one of the most effective forms of birth control. It is increasingly becoming one of the more common methods of contraception in developed countries. I encourage you to give this some thought, and to discuss it with your partner and then see your doctor to determine if this is procedure is suitable for you.

Points to remember:

• Men need to take responsibility to ensure that they and their partners are avoiding unwanted pregnancy.
• Condoms are 85-98% effective at preventing pregnancy and modern design means there is no compromise on Sensation, Satisfaction and Spontaneity.
• There is no evidence to suggest that using contraceptives will make a woman add weight.
• Vasectomy is 99% effective at preventing pregnancy. It is a small surgical procedure but requires thoughtful consideration and counselling.

**Disclaimer: This column is written for patient education. It is not intended to diagnose or prescribe treatment and does not replace the advice of your physician. It in no means attempts to cover the full medical scope of this condition.