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"No-Scalpel" Vasectomy


Even new, minimally invasive surgery to tie a woman's fallopian tubes isn't nearly as simple or painless as that. Yet it's still too scary for lots of guys.

Urologist Jay Sandlow, MD, is director of the male fertility clinic at the University of Iowa. He recently led a study that looked at the psychological issues of men who had decided to have vasectomies.

"Originally, I thought we would find that a certain number of guys would have concerns about the sudden loss of fertility -- one day you're fertile and the next day you're not," Sandlow tells WebMD. "I was surprised that the concerns about the finality of vasectomy weren't that much of an issue. Guys are much more concerned about pain and about their fear of the unknown."

Fried thinks the ultrasound device will address exactly this issue.

"It doesn't make much sense that female sterilization is still much more common than vasectomy," he says. "Presumably there is a psychology involved here in the sense of social or cultural issues of whether a couple chooses male or female sterilization -- and it falls on the female most often. If we can say we don't make any cuts in the scrotum, it may make it more popular for men."

There are still a certain number of men who regret having a vasectomy. Sandlow says this is most likely to happen when a couple finds that their financial and personal situations make them think again about having children. Sometimes -- but not always -- a vasectomy can be undone.

Vasectomy reversal is much more complicated than vasectomy itself. It's also much more expensive and there's no guarantee of success.

Very few men report erection or ejaculation problems after vasectomy. In nearly every case, this is a psychological problem and not a physical one. Even so, these men suffer. Sandlow says that in his experience, these problems go away as the man adjusts to being infertile. Sometimes he makes a referral to psychological counseling. In rare cases -- when the men exhausted all other solutions -- he performed vasectomy reversals.

"You do have guys that come and say their sex drive is less, their erections are not as good. But I can find nothing physically wrong with them," Sandlow says. "If they don't get better after psychological counseling, they do get better with a reversal. The few guys for whom I've performed a reversal in that situation have done very well."

Sandlow agrees that vasectomy is the best choice for couples seeking sterilization -- and he says it's not just because it's safer, cheaper, and simpler than female sterilization.

"If nothing else, it gives the man some participation in the whole process," he says. "A lot of guys come in for a vasectomy because both conception and contraception have always been the woman's responsibility. Here's the guy's chance to contribute and take some responsibility of his own."


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