I'm Getting a Vasectomy in Spite of These Anecdotes
by Eric Hall
May 31, 2014
The world will now have a piece of very personal information about me: last week, I had a vasectomy. Though I was confident in the statistics and my doctor, I had a certain visceral fear approaching the surgery. I had to reassure myself that the research I read plus my doctor's knowledge all agreed this was the best choice for my wife and I to avoid an unexpected increase to the size of our family. My recovery has gone well, even considering I contracted a cold the day after my surgery. Coughing and sneezing is not a suggested activity after having a vasectomy.
Out of curiosity, I thought I would see what people had to say against vasectomies. I am no longer surprised by the presence of websites being against any medical procedure, and I think the personal nature of this topic makes it ripe to be subjected to anecdote and downright woo. I want to address some of the legitimate concerns, the not-so-legitimate concerns, and how I reached the conclusion that this was the best choice.
Beyond the almost instinctual fear of someone messing around with the genitalia with needles and other sharp objects, there are a few concerns in the days after the procedure. The most severe of these are the risk of an infection, and the risk of bleeding or a hematoma in the scrotum. Infection, bleeding, and blood clots are risks with pretty much any procedure in which there is any cutting and blood involved. Because of this, it is important to carefully follow the pre- and post-operative directions from the doctor and monitor your condition after any procedure. This should greatly reduce those risks.
Other concerns in the near-term include (via Mayo Clinic):
?Blood in your semen
?Bruising of your scrotum
?Mild pain or discomfort
I don't even really consider these to be concerning as I think things like pain and swelling are expected from any procedure. Mild pain relievers as directed by your doctor as well as ice can usually take care of these minor symptoms.
Longer-term effects include:
?Chronic pain (rare)
?Fluid buildup in the testicle, which can cause a dull ache that gets worse with ejaculation
?Inflammation caused by leaking sperm (granuloma)
?Pregnancy, in the event that your vasectomy fails (rare)
Most statistics on post-vasectomy complications point to approximately 60% of men get some type of granuloma, but only 3-5% do not resolve on their own and require additional medical care. Any pain associated with fluid buildup or granuloma resolves as time passes.
The Mayo Clinic also provides a list of unfounded concerns, which I will address here just so everyone is clear: vasectomies are safe and studies have not shown any link to cancer, heart disease, severe pain, autoimmune diseases, or any other serious conditions. If you have any of those issues, do not chase false hope in the vasectomy as the cause. It is most likely something else.
Not So Legitimate Concerns
One of the first links that appears in searches for "is a vasectomy bad for you" has all of the classic hallmarks of a pseudoscience website. After asking the question "Do you care to be a lab rat?" they list the following conditions as being caused by vasectomies:
Life-long autoimmune (allergic) responses, Chronic testicular pain (Post-Vasectomy Pain Syndrome), Decreased testicular function including changes in testosterone production, Chronic inflammation including the formation of sperm granulomas, Scrotal and epididymal cyst formation including Spermatocele and Hydrocele cysts, Congestive and infectious epididymitis, Prostatitis, Prostate cancer, Testicular atrophy (shrinking of the testicles), Lung cancer, Non-Hodgkins lymphoma, Testicular cancer, Erectile dysfunction/impotence, Circulatory problems including phlebitis, Rheumatoid arthritis, Pulmonary embolism, Lupus, Atheosclerosis (hardening of the arteries leading to heart disease), Autoimmune orchitis (degeneration of testicular tissues due to antibody action), Staph infections including infections of the heart valves, Gangrene of the scrotum and other serious infections, Vasitis nodosa (chronic inflammation of the vas deferens), Loss of libido, Multiple myeloma, Personality disturbances, Diabetes, Multiple sclerosis, Adrenal gland dysfunction, Migraine and other related headaches, Hypoglycemia, Narcolepsy, Generalized lymph node enlargement, Liver dysfunctionI thought non-organic food caused this. Or was it milk? Vaccines? Fluoride? High fructose corn syrup? (Note: In case you didn't notice, I am making fun of the pseudoscience promoters here.)
Most of the conditions on the list above are complete nonsense. Any of the concerns in the list that have some sort of plausibility are addressed by the science. Complications are very rare — so much so that it was one of the reasons I chose to have the procedure. Though complications are very rare for female sterilization procedures as well; it seems the rate is slightly higher than for vasectomy. My doctor agreed with that assessment and agreed a vasectomy is a good choice. Most of the above is nonsense, and the ones that are legitimate occur rarely.
Another link is a personal anecdote from someone who then promotes a scare-mongering book about his experience. He experienced pain long after his procedure. I have a few issues with his story. First is he admits he drove to and from his procedure. We have no idea if he followed the post-operative advice of his doctor. He describes his "blood soaked jock" and the "jolts of electric pain" he was having. Something certainly seems out of place, but it doesn't tell us the complete story.
For my procedure, my doctor told me to have someone drive me home, whether I took the calming medication or not. He said basically to do as little as I can for two days and take it easy for a couple weeks. The only complications he ever sees are when people try to do too much in the first week or so of recovery. This, of course, is just his anecdotal evidence. However, coming from a doctor I give them a little bit of weight. I also heard other personal anecdotes of people having issues, all usually involving lifting something heavy a few days after the procedure. While these are anecdotes, I think they serve as examples of established data: doing strenuous activity too soon after surgery can cause injury.
A personal story from The Telegraph talks about the pain during surgery and makes an off-handed remark about cancer in men with vasectomies. I mention this story because the author doesn't seem overly concerned about having the procedure, but then makes a casual remark that spreads a piece of false information. He also seems very cavalier in how he prepares for his procedure and the care after. It is important to not only make sure you are prepared, but "do your research." And I don't mean go to Google University and believe the first links you click. Instead, ask the doctor questions. Look at legitimate medical websites. Most large hospitals have websites that you can check for proper before and after care. Don't skip this step!
The next article is one of those that mixes a bit of misunderstanding, a tiny bit of fear, and a bit of woo. I will say it is fairly measured in the response, but it is trying to sell you something — namely the book What the Doctors Don't Tell You. It reminds me of all the crappy titles that get spread on social media. The article uses a device I hate: using big numbers as a scare tactic. They cite an early study which showed an increase in cancer risk for men with vasectomies from 7 in 1000 to 11 in 1000. As they state, it is "an increase of more than 60 per cent." It is like saying I have 50 cents in my pocket, and then I got an increase of 60%. I still don't have enough for the vending machine. In the end, the article concludes that later studies show no significant increase in risk of cancer, but you should drink tea and such to "fight cancer." The citations included for that advice are mostly bunk.
I next came across another personal anecdote from a stay-at-home dad and blogger. Chris describes his experience and some of the issues he has experienced since his vasectomy and then picks bits and pieces of information to blame his vasectomy. His first statistic is that 60% of men experience sperm granuloma. While this is true, most are not painful and only 3% or so of those require any additional action to resolve (usually a course of oral steroids). He also brings up the cancer risks, which, again, are not shown to have any link. It turns out he also developed prostatitis, which he feels in his late 30s is too young. However, the NIH estimates 25% of all office visits of young and middle-aged males are due to prostatitis, and 50% of males will deal with it at some point in their lives. So it is common and not specific to vasectomies. In an update in the comments section, Chris reveals that his issues have resolved, which makes sense as even for those with complications it seems most of those resolve within a few years.
Did I Make The Right Choice?
I am not that far out from my procedure, so I can't make a final determination in how my personal experience fits the statistics. However, I feel confident in the decision based on all of the medical data. It was the lowest risk of all birth control methods for me and my wife, if abstinence (um, no) and condoms are excluded. It also has a very high degree of success, thus giving us peace of mind we won't have any surprises. The data shows it is safe. The data also tells us serious complications are rare.
If you are trying to decide if this is the right choice for you, don't ask the Internet as a whole. Visit legitimate medical websites. Talk to your doctor about it. That should be how you base your decision. That is how I make my medical decisions, and you can see what the data brought me to decide.
by Eric Hall
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