Why I Won't Ask My Husband To Get A Vasectomy

My husband and I have two beautiful daughters and as much as I love, love, love them – we are done, done, done with having kids.

There are many options available to us and a vasectomy seemed a reasonable, reliable choice.

Before learning more about the procedure, I assumed vasectomies carried a low incidence of side effects with little overall risk.

MY husband and I didn’t know much about vasectomies, just what your average person would know I guess.  And in my experience, most men will not take sufficient effort and time to research the topic of vasectomies. However, this particular procedure influences a delicate function and sensitive area which should be regarded with additional respect, so I took it upon myself to learn on behalf of my husband.

After extensive reading, in my opinion, statistics and information that levels up to nearly 1 in 20 (5%) and higher of chronic conditions/disorders possible – this is too high a risk percentage for me to ask of my husband to carry out when there are other methods available.

Of course, I fully support every couple to make their own choice in such a private matter.

My goal in sharing this information is to create a greater awareness for men (and their partners) about the risks of vasectomy surgery, particularly such longer term pain-related side effects that may not be disclosed properly when prompted by a medical professional.

A Quick Once-Over on the Procedure

The surgical procedure for male sterilization (permanent male birth control) is known as a vasectomy. (Click here to review an interesting read about the history of vasectomies)

The procedure is considered a minor operation under local anesthesia which usually takes 20 to 30 minutes to carry out and involves cutting the tubes that carry the sperm (vas deferens) and sealing them off with sutures or surgical clips. This prevents sperm from mixing with the semen that is ejaculated from the penis.

…and for those of you wondering, an egg cannot be fertilized when there are no sperm in the semen.

After a short recovery at the doctor's office (usually an hour or less), the patient is free to go home and rest (bag of peas, please?).

Recovery usually takes a few days; however, patients are advised to avoid strenuous exercise for a week.

There is normally a two-month wait after the surgery when the semen is tested to confirm a negative sperm result.[*][*][*]

The cost of a vasectomy can range from $800 to $1000 in the US. In the event you change your mind, it will cost you even more – approximately around $6,000-$15,000.[*]  

The Short of It

Short term post procedure complications

Allergic reaction to the anaesthesia used during procedure[*]

A few men will develop itching & hives due to an allergic reaction to anaesthesia[*]

Post-operative pain[*]

All men experience some form of pain in the scrotum, it usually disappears within 2 days, but the scrotum will still be sore for a few more.

Bruising & swelling[*]

This is normal. The bruising and swelling doesn't always happen immediately - it often happens after a few days but in most cases has mostly disappeared after two weeks.

Bleeding[*]

Frequently blood may seep under the skin, so that penis and scrotum appear bruised. If there is no dangerous swelling, this problem usually disappears without treatment within a week or two.

Hematoma [*]

Pooling of blood within the tissue of the scrotum occurs in up to 29 percent of all vasectomy patients. It usually starts within the first week after the procedure, and can cause a painful swelling.

Lasting Pain

Chronic Pain Conditions Following Vasectomy

Post-vasectomy pain syndrome

Post-vasectomy pain syndrome (PVPS) is a chronic and sometimes debilitating condition that can develop immediately or several years after vasectomy.[*]

The incidence of PVPS can range approximately from 10-15% (that’s at least 1 out of every 10 vasectomies).[*][*][*][*]

Considering the high incidence of such a chronic condition, recent recommendations instruct doctors to warn patients there is a risk of long term pain following vasectomy procedures.[*]

The treatment for PVPS (and the other of chronic/persistent pain conditions following a vasectomy) can include conservative treatments (ex. avoidance of sexual activity and anti-inflammatory medications) or surgical methods (ex. removal of the epididymis and vasectomy reversal).

Other Chronic Pain Conditions Following Vasectomy

Persistent pain after the vasectomy procedure has been evaluated in Urological literature as early as the late 1970’s. Here are several studies examining characteristics of chronic genital pain after vasectomy:

Vasectomy Reversal for the Post-Vasectomy Pain Syndrome: A Clinical and Historical Evaluation

The Journal of Urology DEC 2000

patient’s genital pain complaints included epididymal pain, pain on ejaculation and pain during intercourse.

Vasectomy Reversal for Treatment of the Post-Vasectomy Pain Syndrome

FEB Clinical Urology 1997

patients complained of testicular pain as a dull ache that increased with sexual arousal, intercourse or ejaculation. A retrospective study of post-vasectomy patients found 33% had chronic testicular discomfort and 15% considered the pain troublesome. The pain was described by some as a dull ache and others as a sharp severe pain. The sharp pain was testicular and could increase in frequency after intercourse.

Chronic Testicular Pain following Vasectomy

British Journal of Urology FEB 1992

5% of the patients complained of pain associated with intercourse.

The incidence of chronic scrotal pain after vasectomy: a prospective audit

BJU International DEC 2007

4% of 488 men had pain with intercourse. Other patients with post-vasectomy pain have required epididymectomy for relief of pain.

Epididymectomy for Post-vasectomy Pain: Histological Review

British Journal of Urology OCT 1991

9 out of 10 patients reported constant pain in either the testes or epididymides.  Four of ten had pain with activity, and three had pain during intercourse.

Uncertainty of Cancer Association

Prostate Cancer Concern

The link with prostate cancer and vasectomy procedures is inconclusive.

With several studies confirming an increased risk, it is medically advised that when a man considers a vasectomy, the uncertain association between cancer risk and the procedure should be a routine part of informed consent.[*][*][*][*]

In 1993, a team of Harvard epidemiologists presented data from two large studies in the Journal of the American Medical Association (JAMA). One of the two studies was retrospective, while the other was prospective and followed new patients. Both studies found vasectomy to be associated with a moderately elevated relative risk of prostate cancer that increased with time after the procedure. After more than 20 years, a vasectomized man appeared to be twice as likely to develop prostate cancer as a nonvasectomized man of the same age.[*]

A definitive conclusion has not yet been made regarding cancer risk and vasectomy, as many studies provide no association with cancer and vasectomy.  It is noted however, that the vasectomy procedure with other potential risk factors (such as race, family history, and dietary habits) may link vasectomy as an associated factor (but not causally linked) to the development of prostate cancer as a primary carcinogen.[*]

The studies that have been completed over the last 20 years are inconclusive, yet the medical community agrees that further research is essential.[*][*][*][*]

Infection

While infection after a vasectomy is fairly common, a small number of men do run into trouble after the operation (one study illustrated a 32.9% overall infection rate after vasectomy).[*][*][*]

The most common infection following vasectomy is of the incision site. Infections of the urinary tract and epididymis are also typical. Rarer types of infections can include Fournier's gangrene and endocarditis (an inflammation of your heart's inner lining).[*]

Any infection, particularly with the growing occurrence of bacteria that have become resistant to antibiotics, should be treated seriously.

Here is Karen’s story regarding infection after a routine vasectomy procedure on her husband: How a vasectomy operation killed my husband.

Where have all the cowboys gone?

Sperm backup, re-absorption and immune response

When a vasectomy is performed sperm are still produced, however, there is no longer an exit strategy. This results in several peculiar responses from the body:

Congestive Epididymitis

If the re-absorption of backed up sperm fails or is inadequate, the epididymides become enlarged, inflamed and can be quite painful. Epididymitis is one of the more common post-vasectomy complications, occurring in approximately 1 out of every 15 vasectomies. Heat and anti-inflammatory medications (alone or combined with antibiotics) are used to treat this condition. This particular side effect can lead to chronic post-vasectomy pain and can affect a man’s ability to participate in physical activities on a long-term basis.[*][*][*][*]

Anti-Sperm Antibodies

Typically, immune cells will not come in contact with sperm, however, in the event of vasectomy certain barriers are breached an immune response will be mounted.  

Membranes in the epididymis increase in size to break down and absorb matured sperm which triggers the immune system to produce more macrophages and the large majority of men (up to 75%) will develop anti-sperm antibodies.[*][*]

Concern has encouraged researchers into learning more about anti-sperm antibodies and the effects on the body because immune reactions against parts of one's own body can cause disease.[*]

Current knowledge has not yet yielded large concern at this time, nevertheless rheumatoid arthritis, tumor growth, atherosclerosis (clogging of arteries), and multiple sclerosis are just some of the illnesses suspected or known to be caused by immune reactions of this type.[*][*][*]

Granulomas

When sperm leaks out into the scrotum via the cut/damaged vas defrans (the tube that is severed to keep the sperm from entered the semen), another immune response occurs. The sperm is surrounded by a protective mass (granuloma) which is commonly felt as swelling and radiating pain in the groin which can last up to year.[*]

Granulomas occur in approximately 40% of vasectomies, nearly 1 out of every 5 men that has a vasectomy will experience pain that last more than 3 months (described as interfering with daily activities).[*][*][*]

****

Before choosing a vasectomy, a couple should seriously consider the many alternative methods of contraception – particularly when there is risk is chronic pain.

I hope this information helps with creating more awareness of risk that may not be discussed openly/willingly from your medical professional. 

The Epidural: Less Satisfying and More Painful Birth?

Pregnancy and birth are filled with many unpredictable features, whether this be your first go at the rodeo or 5^th.

Pain experienced during labor is also unpredictable. Pain may be manageable without medication, or it may become severe and exhausting.

If you find yourself calling the United States your home, then you are among the majority if you opt for epidural pain relief during labor.

Ladies in the U.S. have fewer options for labor pain management than our counterparts in other industrialized nations (such as the UK and Canada). It is uncertain if the excessive use of epidural analgesia is a true preference in the US or if it is simply chosen because of the lack of other presented options.[*]

Interesting, none-the-less….

What is certain is that epidural use is nearly always an elective procedure. Although it can be a useful tool in supporting a laboring mother, the use of epidural medication expands the chance for complications, this does not occur in drastic numbers. Each family has their own comfort level with side effects and risk – what one family may consider safe, another may become uncomfortable. (you can learn more about risks associated with epidural use here and here) 

Everyday, devoted and loving soon-to-be mothers opt for epidural anesthesia pain relief during the birth of their babies.

I was among them, choosing an epidural with my first daughter because I thought it would help with pain and allow me to have a more enjoyable experience. In actuality, I experienced agonizing break-through pain and a cascade of interventions that I wasn’t anticipating (urinary catheterization, artificial rupture of membranes, internal fetal monitoring, use of synthetic oxytocin). 

Was my disillusionment with epidural anesthesia in the minority? 

Higher Pain Recall Among Those Opting for Epidural Analgesia

A remarkable finding from a longitudinal study (2009 BJOG) regarding women’s memory of labor pain found that mothers who opted for epidural analgesia reported higher pain scores at all time points versus those who went without.[*]

Another study (2006 JPOG) substantiates the above findings and also goes to on to provide data that women who received epidural analgesia not only had higher recollection of intense pain at two months and one year but also had greater difficulty forgetting pain 10 months later.[*]

If a mother chooses an epidural in most part to experience a labor that is less painful then one without anesthesia the data above can be sobering.

Research also suggests that pain experienced during labor is not entirely a negative experience, with more then 1 out of 4 women (28%) assessing pain as more of a positive than a negative – suggesting that coping with pain is a rewarding experience for some women.[*]

Lower Satisfaction Among Those Opting for Epidural Analgesia

Although women and care providers may assume that effective pharmaceutical pain relief during labor will ensure a more positive birth experience, there is mounting evidence that the opposite is true.

Several studies have shown that women who use no labor medication are the most satisfied with their labor and birth (times being assessed at time of birth, six weeks and one year after birth).[*][*][*][*][*][*]

Also worth noting, women who cope with labor using non-medical alternatives such as water birth, massage, positioning, focusing and breathing done with the support of another person report more satisfied than with standard pain relief given during childbirth.[*]

Natural techniques utilize a woman’s own strengths and places her in control of her own body. They also have been assessed to improve obstetric outcomes compared to pharmaceutical relief.[*][*] 

Interestingly, the influence of pain relief on satisfaction is not as powerful as the attitudes and behaviors of the mother and caregivers involved. Consider a 2002 study published in the American Journal of Obstetrics & Gynecology which concludes four factors that appear to override pain experienced in labor:[*][*]

1. Personal expectations

2. Amount of support from caregiver

3. Quality of caregiver-patient relationship

4. Mother’s involvement in decision making

This reaffirms the main key to satisfaction and managing labor pain effectively, is to ready yourself in advance – arranging continuous support, accurately understanding pain control options (and the interventions involved) and having an active role in the decision making process.[*][*]

****

As much as some might like to discount natural childbirth as a progressive trend among a small number of women, research affirms that women who opt for epidural anesthesia experience more pain, have a more difficult time forgetting the pain, and experience less satisfaction overall.  

Women do not decline an epidural simply to “win a medal” – instead information on different types of pain relief are assessed and balanced against other goals such as walking, pushing effectively, or minimizing maternal/neonatal side effects and/or risks.

How much of an effect an epidural medication can have on a newborn or mother is not easily predetermined and can vary based on dosage/mix of pharmaceutical drug combination, the length of labor, and each individual.[*]

Opting for an epidural anesthesia is one method (among many) that can aid in relief of pain and discomfort during the labor process. This type of pain relief requires a mother to give some control to the hospital staff. It does involve risk and additional intervention.

The decision, rightfully, rests for each woman to make. In due course, researching the procedure and talking others who have may be able to offer different perspectives could help a mother decide on what is right for them.

As the data suggests, most women who choose unmedicated birth (and prepare for it) find the pain intense but manageable and they are happier with their experience afterwards.

Ultimately, what can be said, each woman should use the insight into herself to be the best guideposts in directing her toward a positive decision regarding pain relief during labor.

"You gain strength, courage and confidence by every experience

 in which you really stop and look fear in the face."

- Eleanor Roosevelt

Witness to Normal Birth

It was about the best thing I ever experienced.

The minute she came out, I was born again. It was like we’d just been born together.



paper dolls photography



If you are privileged enough to have witnessed a woman giving birth naturally in a place she has chosen, what will you have seen?

You will first be in awe of her strength.

 

And you will think – for how could you not – what a phenomenal creature a woman is. But you will only have seen this astonishing sight if you have understood that if you disturb her in her work, she will be thrown off course. One must sit quietly and patiently, almost invisible, breathing with her, not disturbing her internal rhythm. And you will see that the pain of her labor seldom overwhelms her.

A deep significance to the mother, the momentous quality of pain, as she is surrounded by the deep sense of inwardness, forced to recognize her independence, her loneliness, selfhood, becoming conscious of her own existence. Paradoxically, this actual self-consciousness exposes a woman to her wholeness, her strengths and her endurance.

Nature would not have organized labor to be intolerable. It is the limits of our human understanding that wish to control all that is surveyed, that has conquered women by making them labor in the most tortuous environment constructed.

Let us bring them into harsh rooms with bright lights. Let us make them lie on their backs on hard narrow beds. Let us tether them to machines so they cannot move. Let us make them stay silent. Let us restriction their eating and drinking. Let us expose their most private parts and threaten them with cold steel. Let us make them push their babies upwards, against the pull of gravity. Let us monitor and measure and chart every move they make. Let us swab, wipe, prod, poke, irate, confuse and frighten them as much as we can.

In these conditions, labor swiftly becomes unbearable and pain relief becomes a woman’s only hope. Get me an epidural, cut it out of me, anything, make it stop. Please help me!

This is not the natural cry of a woman in labor bringing a child into the world, although if you have only ever witnessed labor and birth in a medicalized setting you might be inclined to think so. Her only hope for salvation lies in the anesthetist who numbs the pain or the obstetrician to remove it.

And a woman spoke, saying, Tell us of Pain.

And he said: Your pain is the breaking of the

shell that encloses your understanding.

Even as the stone of the fruit must break, that

it’s heart may stand in the sun

so must you know pain.

- Gibran

Altered passage and excerpts can be found in:

Normal Childbirth: Evidence and Debate. Chapter: The Role of Pain in Normal Birth and the Empowerment of Women (Nicky Leap and Tricia Anderson). Pages 25-39. 2004. http://readinglists.lib.monash.edu/items/5BB0FE73-9C52-D121-1760-8D2D7F4AACC9.html

Natural Childbirth: Pain With Great Purpose

After about ten months (or more!) of growing, planning, dreaming, and preparing for such an awesome gift, the birth of a baby will most likely be one of the most rewarding and challenging moments in a woman’s life.  No matter how or where the baby is born.

something this size is meant to come out naturally?!

With my first child, I did the expected, predictable thing. I went to a hospital and got an epidural. There’s no reason to go through the pain of childbirth if you don’t have to, right?

While we may not know for sure all the purposes of pain in labor, we would be reckless to think there are none.

With my second, I had a non-medicated, midwife assisted homebirth. I found out first hand what I had missed with my first. The pain experienced during labor does have a purpose, many in fact.

(No matter where, what, when, why or how –childbirth is a remarkable event and every woman should be supported in her decision. There are those out there wanting to belittle, condemn, scrutinize, and humiliate but these actions get us no where in the safety of mothers and babies. Instead, I ask you to read the list with an open mind and consider there is another option available to birth that doesn’t automatically necessitate drugs.)

The Pain Prepares You

When a women starts to feel contractions, the dull ache is a signal that it’s not just another day. When I felt I was in labor, it gave me time to gather up the things I needed and to make sure the support I needed was there. I also made sure to not to overexert myself that morning, to lazy around, take many showers and relax.

now that's just lazy

More importantly preparing myself mentally, physically and emotionally helped prepare me in a different way compared to my first medicated birth. There was a level of selflessness there that I didn’t have with my first daughter. I am in no means stating that all women who take medication are selfish – I am only speaking of my personal experience.

I knew no matter how painful labor was going to get, I was opting out of drugs because I wanted my baby to have the safest, most gentle birth possible. I wasn’t choosing pain because I am a masochist, I was choosing it because I wanted what I thought was best and most safe for my daughter.

For me, this altruism made room for me to grow into a better mother and wife.

This was what love meant after all: sacrifice and selflessness.

It did not mean hearts and flowers and a happy ending,

but the knowledge that another's well-being

 is more important than one's own.

The Pain Protects You

While I was in labor, the pain from contractions made me move, a lot. I was on my feet for most of the day. I walked outside, inside, upstairs, downstairs. I took a shower and then walked some more. When I did lay down to rest, my left side was more painful to lay on, so I laid on my right. All of my actions that day eased the pain a bit and helped me get from one contraction to the other.

This movement protected my body as well as my daughter’s. Since my movement was not restricted at all the entire process, I was able to help facilitate the baby’s decent. Using gravity in the process, movement also eases the pressure on the baby and on the birth canal.

It was extremely helpful to remember during my natural birth that my baby is not a passive but rather a very active participant in the process. I thought of pain as sort of a language between us.

The Pain Provides Natural Relief

Coping with pain during labor allows the body to increase oxytocin release, which in turn causes more effective, stronger contractions. This ultimately leads to the release of endorphins, a natural narcotic. Endorphins are endogenous opioid peptides that function as neurotransmitters (say that 5 times fast). They are normally released during exercise, excitement, love, orgasm and you guess it – pain.  

With my first child, the epidural wore off about half way through labor. The pain was excruciating. I was laying down, tied up to monitors, plastic IV’s, and a catheter. I had to lay there and deal with the pain until I was able to talk the nurse into calling for the anesthesiologist – for more drugs. If I combined the pain of getting the epidural, the pain of it wearing off, and the pain of a slower recovery, my first birth (that was medicated) was more painful then my second natural birth.

ok, that's just needlessly painful

I understand that it may be difficult to understand, but in my case – at home, naturally, the pain was gradual and manageable. I relaxed and breathed deeply while I swayed back and forth. Not only was this beneficial to me, but the deep breathing allows the baby to get lots of oxygen.  

The Pain Helps You Respond

When I used drugs with my first birth it disrupted what I should have been doing to have an efficient labor. I know this only because I experienced what labor was like without medication. There is no way in hell I would have laid on my back for 6 hours straight if I was having a natural birth. Laying down is not effective at getting a baby out, whether using drugs or not.

Who the hell thought this would work for getting a baby out?

 For me, when I was unable to feel contractions or feel the pressure of my baby, I was unable to respond to it. I laid there and waited for a doctor to tell me to push. My body wasn’t stimulated to produce optimal oxytocin and endorphin levels. I found that out when the epidural wore off. I went from zero to 1 million. I didn’t know how to react, how to respond – so I asked more drugs instead.

Once I removed the pain during the journey, I removed the signals my body needed to keep labor progressing and to protecting itself and my baby.

When I had a natural birth, it was like I knew exactly what to do. I distinctly remember leaning over the couch and going through a pretty intense contraction. Immediately following that, I stood up and changed positions – I knew that I had to respond in a different way.

Coping with the pain in labor helped me have an easier birth, I had an alert baby, and I felt healthier.

Pain is not just an unfortunate side effect of labor but instead it is an important piece of the normal process of labor and birth. I think it would be most valuable for women and babies if more people would talk about the benefits of pain during labor instead of attempting to escape it automatically.

Epidurals do carry medical risks as well as the interventions needed when deciding on pharmaceutical pain management. Personally, I find the bias encouragement women receive in pharmaceutical pain relief for their own good with little reference to the possible side effects for the baby very distressing. Luckily, many women when discovering that these drugs do cross the placenta are motivated to try other forms of pain relief, since harming their baby (even if it is remote) is  undesirable.

I found labor very bearable, especially when I knew it meant better health for my daughter. I have no doubt that other women would feel the same way if they knew the benefits of pain in labor, to both themselves and their babies.

Rejoice not in the fact that you are suffering,

but in the confidence that the pain can be transformed.

The value lies not in the pain itself,

but in what you can make of it.