Vasectomy

Vasectomy is a surgical procedure for male sterilization and/or permanent birth control. During the procedure, the vasa
deferentia of a man are severed, and then tied/sealed in a manner such to prevent sperm from entering into the seminal stream
(ejaculate). Vasectomies are usually performed in a physician's office or medical clinic.
There are several methods by which a surgeon might complete a vasectomy procedure, all of which occlude (seal) at
least one side of each vas deferens. To help reduce anxiety and increase patient comfort, men who have an aversion to needles
might opt for the "no-needle" application of anesthesia while the "no-scalpel" or "open-ended" techniques help to speed-up
recovery times and increase the chance of healthy recovery.
Due to the simplicity of the surgery, a vasectomy usually takes less than 30 minutes to complete. After a short recovery
at the doctor's office (usually less than an hour), the patient is sent home to rest. Because the procedure is minimally invasive,
many vasectomy patients find that they can resume their typical sexual behavior within a week, and do so with minimal
discomfort.
Because the procedure is considered a permanent method of birth control (not easily reversed), men are usually
counseled/advised to consider how the long-term outcome of a vasectomy might affect them both emotionally and physically.
Effectiveness as birth control
The Royal College of Obstetricians and Gynaecologists states there is a generally agreed upon rate of failure of about 1
in 2000 vasectomies which is considerably better than tubal ligations for which there is one failure in every 200 to 300 cases.
Early failure rates, i.e. pregnancy within a few months after vasectomy typically result from having unprotected intercourse too
soon after the procedure. Late failure, i.e. pregnancy after recanalization of the vasa deferentia, has been documented. A 2005
systematic review of 28 studies described a total of 183 failures or recanalizations from approximately 43,642 vasectomy
patients (0.4%), and 20 studies in the same review described 60 pregnancies after 92,184 vasectomies (0.07%).
Most physicians and surgeons who perform vasectomies recommend one (sometimes two) post-procedural semen
specimens to verify a successful vasectomy; however many men fail to return for verification tests citing inconvenience,
embarrassment, forgetfulness, or certainty of sterility. In January 2008 the FDA cleared a home test called SpermCheck
Vasectomy that allows patients to perform postvasectomy confirmation tests themselves; however compliance for
postvasectomy semen analysis in general remains low.
Complications
Short-term complications include temporary bruising, infection and bleeding, known as hematoma. A study in 2012
demonstrated an infection rate of 2.5% post vasectomy. The stitches on the small incisions required are prone to irritation, but
this can be minimized by covering them with gauze or small adhesive bandages. The primary long-term complications are
chronic pain conditions or syndromes that can affect any of the scrotal, pelvic and/or lower-abdominal regions, known as postvasectomy pain syndrome. Animal and human data indicate that vasectomy does not increase atherosclerosis and that increases
in circulating immune complexes after vasectomy are transient. Furthermore, the weight of the evidence regarding prostate and
testicular cancer suggests that men with vasectomy are not at increased risk of these cancers.
After a vasectomy, the natural duct for sperm, the vas deferens, is closed off. The testicles continue to produce sperm at
a rate of about 50,000 cells per minute. These sperm cells build up pressure in the delicate epididymis portion of the testicles,
which eventually ruptures from the pressure. This can occur spontaneously, or often when there is stress in the area, such as
when a man is ejaculating. These ruptures can lead to what many men have described as an ice pick-in-the-testicle-like
sensation. Or the effect can be that a mans testicles just ache, either all the time or in a cyclical pattern. Research results range
from as low as 2% to as high as 33% of vasectomy patients experiencing some form of long-term post-vasectomy pain.
Prevalence
Vasectomy is the most effective permanent form of birth control available to men. In nearly every way that vasectomy
can be compared to tubal ligation, it has a more positive outlook. Vasectomy is more cost effective, less invasive, has techniques
that are emerging that may facilitate easier reversal, and has a much lower risk of post operative complications. Given the
aforementioned, in the United States, vasectomy is utilized at less than half the rate the alternative female "tubal ligation".
According to the research, vasectomy is least utilized among black and Latino populations, groups of which have highest rates
of female sterilization.
New Zealand, in contrast to the US, has higher levels of vasectomy than tubal ligation uptake. 18% of all men, and 25% of all
married men have had a vasectomy. The age cohort with the highest level of vasectomy was 40-49 where 57% of men had taken
it up.Canada, the UK, Bhutan and the Netherlands all have similar levels of uptake.

History
The first recorded vasectomy was performed on a dog in 1823. A short time after that, R. Harrison of London
performed the first human vasectomy; however the surgery was not done for sterilization purposes, but to bring about atrophy of
the prostate. Vasectomy began to be regarded as a method of birth control during the Second World War. The first vasectomy
program on a national scale was launched in 1954 in India.
Availability and legality
Vasectomy costs are (or may be) covered in different countries, as a method of both birth control or population control,
with some offering it as a part of a national health insurance. Vasectomy was generally considered illegal in France until 2001,
due to provisions in the Napoleonic Code forbidding "self-mutilation". No French law specifically mentioned vasectomy until a
2001 law on contraception and abortion permitted the procedure.
Intrauterine device
The current intrauterine device (IUD) is a small device, often 'T'-shaped, containing either copper or levonorgestrel,
which is inserted into the uterus. They are one form of long-acting reversible contraception which are the most effective types of
reversible birth control. Failure rates with the copper IUD is about 0.8% while the levonorgestrel IUD has a failure rates of
0.2% in the first year of use. Among types of birth control, they along with birth control implants result in the greatest
satisfaction among users.
Evidence supports effectiveness and safety in adolescents and those who have and have not previously had children.
IUDs do not affect breastfeeding and can be inserted immediately after delivery. They may also be used immediately after an
abortion. Once removed, even after long term use, fertility returns to normal immediately. While copper IUDs may increase
menstrual bleeding and result in more painful cramps hormonal IUDs may reduce menstrual bleeding or stop menstruation
altogether. Other potential complications include expulsion (25%) and rarely perforation of the uterus (less than 0.7%).
Cramping can be treated with NSAIDs.
As of 2007, IUDs are the most widely used form of reversible contraception, with more than 180 million users
worldwide. A previous model of the intrauterine device (the Dalkon shield) was associated with an increased risk of pelvic
inflammatory disease, however the risk is not affected with current models in those without sexually transmitted
infectionsaround the time of insertion.
The types of intrauterine devices available and the names they go by differ by location.
In the United States, there are two types available:

1. Nonhormonal copper IUD ParaGard

2.Hormonal IUD Mirena or Skyla

The WHO ATC labels both copper and hormonal devices as IUDs. In the United Kingdom, there are over 10 different
types of copper IUDs available. In the UK, the term IUD refers only to these copper devices. Hormonal intrauterine
contraception is considered to be a different type of birth control and is labeled with the term intrauterine system (IUS).

Copper
Copper IUDs primarily work by disrupting sperm mobility and damaging sperm so that they are prevented from joining
with an egg. Copper acts as a spermicide within the uterus, increasing levels of copper ions, prostaglandins, and white blood
cells within the uterine and tubal fluids. The increased copper ions in the cervical mucus inhibit the sperm's motility and
viability, preventing sperm from traveling through the cervical mucus or destroying it as it passes through. Copper IUDs have a
first year failure rate ranging from 0.1 to 2.2%.
Most non-hormonal IUDs have a plastic T-shaped frame that is wound around with pure electrolytic copper wire and/or
has copper collars (sleeves). The arms of the frame hold the IUD in place near the top of the uterus. The Paragard TCu 380a
measures 32 mm (1.26") horizontally (top of the T), and 36 mm (1.42") vertically (leg of the T).
Copper IUDs containing noble metals are becoming increasingly popular because they are more resistant to corrosion.
In the "Gold T IUD", which is made in Spain and Malaysia, there is a gold core, which further prevents the copper from
fragmenting or corroding. GoldringMedusa is a differently-shaped German version of the Gold T. Another form of AuCu IUD is
called Goldlily which is made by the Hungarian company, Radelkis. Goldlily consists of a layer of copper wires wrapped
around an original layer of gold wires, and it provides electrochemical protection in addition to ionic protection.

Silver IUDs also exist. Radelkis also makes Silverlily, which is similar to Goldlily, and GoldringMedusa is available in
an AgCu version as well. Nova-T 380 contains a strengthening silver core, but does not incorporate silver ions themselves to
provide electrochemical protection.
Other shapes of IUD include the so-called U-shaped IUDs, such as the Load and Multiload, and the frameless IUD that
holds several hollow cylindrical minuscule copper beads. It is held in place by a suture (knot) to the fundus of the uterus. It is
mainly available in China, Europe, and Germany, although some clinics in Canada can provide it.
Advantages of the copper IUD include its ability to provide emergency contraception up to five days after unprotected
sex. It is the most effective form of emergency contraception available. It contains no hormones, so it can be used while
breastfeeding, and fertility returns quickly after removal. Copper IUDs are also available in a wider range of sizes and shapes
than hormonal IUDs. Disadvantages include the possibility of heavier menstrual periods and more painful cramps.
In addition to copper, noble metal and progestogen IUDs, patients in China can get copper IUDs with indomethacin.
This non-hormonal compound reduces the severity of menstrual bleeding, and these coils are popular.

Hormonal
The hormonal I.U.D. (brand name Mirena) does not increase bleeding as copper-containing IUDs do. Rather, they
reduce menstrual bleeding or prevent menstruation altogether, and can be used as a treatment for menorrhagia (heavy periods).
Use of Mirena results in much lower systemic progestogen levels than other very-low-dose progestogen-only hormonal
contraceptives.
As of 2007, the LNG-20 IUS marketed as Mirena by Bayer is the only IntraUterine System available. First
introduced in 1990, it releases levonorgestrel (a progestin) and may be used for five years per its label but 7 years per
researchers/clinicians (?who). With use of Mirena, the hormones are localized to the uterine area unlike oral contraceptives and
other systemic contraception (e.g. depot medroxyprogesterone, etonogestrel implant).
Adverse effects
Regardless of containing progestogen or copper, potential side effects of intrauterine devices include expulsion, uterus
perforation,pelvic inflammatory disease (especially in the first 21 days after insertion), as well as irregular menstrual pattern. A
small probability of pregnancy remains after IUD insertion, and when it occurs there's a greater risk of ectopic pregnancy.
Advantages and Disadvantages of Intrauterine Devices (IUDs)
Consideratio IUDs
n
Advantages
More than 99% effective in preventing pregnancy1
Most cost-effective method of birth control over time
Easy to use
Does not require interruption of foreplay or intercourse
Does not require cooperation of sexual partner
Safe to use while breast-feeding
Can be removed whenever you have problems or want to stop using it. Fertility returns with the
firstovulation cycle following IUD removal.
Hormonal IUD can relieve heavy menstrual bleeding and cramping in most women
Copper IUD can be used for emergency contraception within 5 days of unprotected intercourse
Can be inserted after a normal vaginal delivery, a cesarean section, or a first-trimester abortion
Disadvantage
Costs several hundred dollars for insertion. (This cost may be covered by your health insurance.
s
Some community clinics may offer insertion and removal at a reduced rate or free to low-income
clients.) If the IUD is expelled, it costs just as much to get a new one. Having an IUD removed is
also costly. However, if an IUD is used for 5 years or longer, it is the most cost-effective form of
birth control.
Only a health professional can remove the IUD. Never attempt to remove the IUD yourself or allow
a partner to try to remove it.
Does not provide protection against sexually transmitted diseases (STDs) or HIV. (A condom is
needed for STD protection.)
When inserted, can spread a genital infection into the uterus, leading to pelvic inflammatory disease
(PID) in the first months after insertion. This is why you are screened for STDs before getting an
IUD.