I wrote another article for the web aimed at being real about
vasectomy side effects instead of offering men platitudes about no
risks...

Why is Vasectomy "Oversold" and Described as Having No Sexual Side-
Effects?

When I began to read information about vasectomy after the birth of
our third child, I found a lot of information on the Internet. I read
the descriptions on "official" websites first, and found the
procedure described in detail, but thought the wording of the
information was like an advertisement for a new car or like what you
might see in the back of a magazine for a product of dubious value.
This "hype" or "overselling" of the procedure felt disingenuous to
me, and I continued my research, feeling as though I wanted to know
more about the risks, and less about the "facts" that stated there
were essentially few or no side effects of consequence acutely or
long after the procedure. I was not used to this type of advertising
for a medical procedure and I felt as though the ads were designed to
overcome male fears of surgery on their genitals in a paternalistic
way, as if men could not really choose, but needed to be reassured
excessively about their "unrealistic fears" regarding the procedure
affecting their manhood or masculinity.

Qualifiers such as, "transient" or "minor" always followed the side
effect descriptions, and there seemed to be an inordinate focus on
alleviating fear and anxiety over "vasectomy myths". These myths
supposedly included any change in sexual function and any long-term
risks, health consequences or safety issues. I found lists of these
myths online and wondered if they were all myths.

I found articles entitled "How to Convince a Man to Get a Vasectomy",
which seemed a bit strange. If vasectomy is so simple and has no side
effects, why is all this convincing necessary?
http://www.ehow.com/how_2081530_convince-man-vasectomy.html?
ref=fuel&utm_source=yahoo&utm_medium=ssp&utm_campaign=yssp_art

I saw quotes like: "Although complications such as swelling,
bruising, inflammation, and infection may occur, they are relatively
uncommon and almost never serious." I also found out that infection
or bleeding issues after vasectomy occur in 2 to 5% of patients. Some
of these men require surgery for hematoma (blood collections) or for
abscesses (collections of pus due to infection). The affected men
probably didn't find it to be "never serious".

Even when I did further research, adverse events were always
minimized as if to placate the reader, as if he were a child. For
example: "A major study of vasectomy side effects occurring within 8
to 10 years after the procedure was published in the British Medical
Journal in 1992. Investigators questioned 10,590 vasectomized men,
and an equal number of non-vasectomized men, to determine if they had
developed any of 99 different disorders. After a total of 182,000
person-years of follow-up, only one condition, epididymitis/orchitis
(defined as painful, swollen, and tender epididymus or testis)--was
found to be more common after vasectomy. This local inflammation most
often occurs during the first year after surgery. Treated with heat,
the condition usually clears within a week."

It turns out that congestive (not infectious) epididymitis occurs in
about 6% of men who have a "closed" vasectomy and in about 2% of men
who have an "open" vasectomy.

"This study was done to determine if there was a difference in
results when both vas ends were closed or when the prostatic end was
closed and the testicular end left open. The author performed 6220
vasectomies between June 1, 1972 and June 1, 1992. The first series
consisted of 3081 vasectomies in which both ends of the vas deferens
were closed. The second series consisted of 3139 vasectomies in which
the testicular end of the vas deferens was left open while the
prostatic end only was closed. No portion of the vas was excised.
Congestive epididymitis was diagnosed in 6% of cases utilizing closed-
end vasectomy and 2% of cases where the open-end vasectomy was
performed. Open-end vasectomy is recommended because the incidence of
congestive epididymitis is reduced." (Moss, WM)

What the study doesn't say is what happens after you develop
congestive epididymitis. The closed versus open descriptor refers to
whether the testicular end of the vas deferens (tube that carries
sperm from the testes to the ejaculatory duct) is left closed or
open. For some men, the pain symptoms do not respond to warm baths
and anti-inflammatory medicine and can become chronic. Some of them
require vasectomy reversal or removal of the epididymus and even
these treatments aren't always effective in relieving the pain.

I also read this online: "Vasectomy does not affect your hormones,
orgasm or ejaculation so there is no reason for it to have a negative
impact on your sex life."

Does Vasectomy affect a man sexually? Seems a fair question. Here is
what you will read: "Not at all. Vasectomy has no effect on the
production or release of testosterone, the male hormone responsible
for a man's sex drive, beard, deep voice, and other masculine
traits." Well, again, this may not be entirely true. Vasectomy causes
testicular fibrosis (scarring) and this can cause changes in
testosterone levels and cause symptoms of hypogonadism (andropause).
(See my other article: "Vasectomy Causes Testicular Damage".)

You might find this: "The operation also has no effect on sexuality.
Erections, climaxes, and the amount of ejaculate remain the same.
Occasionally, a man may experience sexual difficulties after
vasectomy, but these almost always have an emotional basis and can
usually be alleviated with counseling. More often, men who have
undergone the procedure, and their partners, find that sex is more
spontaneous and enjoyable once they are freed from concerns about
contraception and accidental pregnancy."

Again, this is not true for all men and the idea that if you do have
some noticeable change, it "almost always has an emotional basis and
can be alleviated with counseling" is a strange statement with little
research basis. I am a psychiatrist and have never seen a patient
seeking counseling for emotionally induced sexual dysfunction after
vasectomy. It is more instructive to look at what happens when
vasectomy is performed. There is a study in the medical literature
showing that 50% of the nerves that travel with the vas deferens (in
the spermatic cord) are cut during vasectomy.

"Quantitatively, the mean number of nerves per cross-section was
about 1/2 of the number in spermatic cords; the total area of nerves
resected on average during vasectomy amounted to nearly 50% of all
nerves found near the vas in spermatic cords. This nerve resection
could result in poor functional results after reversal of
sterilization because the powerful contractions of the proximal vas
deferens would be lacking." Pabst, et al 1979.

In another study, the changes in the complex innervations of the vas
deferens (tubes) were destroyed by vasectomy. "Vas deferens specimens
taken from 43 men during vasovasostomy were examined by histochemical
techniques and electron microscopy for evidence of noradrenergic and
acetylcholinergic nerve structures. The subjects had been
vasectomized 1-15 years ago (mean 6.5 years). Controls were 22 men
being operated for vasectomy. Light microscopy revealed fine
noradrenergic nerve plexi throughout the muscle coat, in the
proximal, urethral portions of the vas, and circling blood vessels in
the adventitia, as well as in both proximal and distal control
specimens. The distal, testicular specimens of previously
vasectomized men contained only occasional adrenergic fibers. In
proximal or urethral portions, fine cholinergic nerves occurred in
the muscle coat; large ones in the adventitia near blood vessels, and
numerous cholinergic fibers were located under the epithelium. In
distal, testicular portions, cholinergic nerves were similar to
controls and to urethral specimens from vasectomized men in the
muscle layer only, but absent in lamina propria. Ultramicroscopic
structure of these various nerve fibers is described in detail. It is
to be noted that the distal portion of the vas is the testicular
portion, as concerns innervation, and this is lost after vasectomy.
It was remarkable to see evidence of reinnervation of cholinergic
axons distally, however. It has been established that noradrenergic
control is important for the motor and secretory activities of the
vas. Physiological significance of adrenergic innervation is unknown.
These results add evidence for the advice to men seeking vasectomy to
consider it a permanent form of fertility control" (in other words,
you can't go back to the way you were).

It seems plausible that if you cut these nerves, a change in function
could occur. There are also studies that show a decrease in prostatic
secretions after vasectomy, but no mention of this is made in pre-
vasectomy counseling. Only that "no change" will occur in
ejaculation. I have read many posts online (frequently made
anonymously online in men's health forums) that describe changes in
ejaculation and orgasmic sensation after vasectomy. Here are a few:

"When I had my vasectomy, I actually noticed a spike in sex drive
three or four weeks after the procedure, but within three months I
was experiencing much of what other posters here are describing: weak
erections and ejaculations, going from near-daily morning erections
to none, even an increase in the softness of my skin."

"Since my vasectomy (2 years ago) I have felt a total lack of
satisfaction after sex and do not have any feeling during orgasm.
Can't say my sex drive has reduced though. It feels like I haven't
had sex since my operation. Whatever they may say about there only
being about 2 percent of sperm in an ejaculation the body seems to
have a kind of fuel gauge built into the testicles. These are not
getting emptied and therefore I get no sense of release from sex.
There seems to be a lot of similar cases to mine and I can assure you
it is a physical, not mental problem any couch could fix."

"My husband had a vasectomy about a month ago and while, thankfully,
he is not experiencing the chronic pain that is mentioned in this
forum, he is having trouble of different sort. He says that his
arousal is normal, sex is normal, and the amount of ejaculate is
normal; however, when he climaxes, it is much less intense. He is a
psychologist and keeps himself extremely healthy both physically and
mentally. He said that during sex, there is no build up anymore. He
just has a spontaneous orgasm with no warning. It just happens
suddenly and build up that typically accompanies an orgasm is no
longer there. It is incredibly frustrating because our sex life has
always been incredible."

"And here I thought I was all alone, I have pretty much the same
problem as most of you..... The sex is great, here comes the orgasm,
here it comes...wait for it....here we go!!! OK so it's over what the
hell happened? I had my vasectomy 3 years ago and sex has not been
the same since so don't tell me I need more time to recover...Great
hey I'm only 30 now, what a sex life to look forward to in the
future."

"I just located this site while I was searching to find out if other
men had the same problem I had and it appears they do. I have a very
noticeable decrease in orgasm pleasure (sometimes I am unaware that I
had one). It has been about a month since my procedure and it was
uneventful but now where I used to have a very high sex drive and
could never get enough sex the diminished pleasure of orgasm makes
sex feel like too much work for to little return. I am only 38 and
the prospect of this being "as good as it's going to get" is very
depressing."

You can find hundreds of these posts online. Of course, you could
find hundreds of posts from men saying vasectomy caused no changes
for them at all. This just proves the end result is individual. You
really won't know how it will turn out for you. My point in writing
these articles is to advise people of risks that are not mentioned in
the consent process, or on vasectomy information pamphlets, etc.

I think the sites that feature the standard,
· No change in the semen
· No change in sex drive
· No change in climax sensation
· No change in the testes or scrotum
· No change in erections
are to be distrusted.

For some men, there is a change in the semen quantity, color, or
consistency. There can be a change in libido, especially if the man
develops chronic genital pain after vasectomy. There is a change in
orgasmic sensation for some men. There can be changes in the testes
and scrotum, like painful sperm granulomas, scarring that makes one
testicle higher or lower than it was before, or other changes. There
can be a change in erectile potency that can be psychogenic, pain
related, or physiologic and related to drops in testosterone levels.
Do a bit of reading and don't just talk to your brother-in-law or
friends before you choose. Over 80% of men do not have significant
symptoms, or are not bothered by the symptoms they do have, but
plenty do have problems. For more information, you can go to my
website: www.VasectomyPain.org. There are many linked sites available
from there to fully explore the official position of the American
Urological Association and also links to forums full of men with good
and bad outcomes.

I think it is unconscionable to state that vasectomy changes nothing
when so many men complain of changes. Think of the effect of this.
You have been told that you will experience no change in sexual
function. You have a vasectomy and it creates a new problem that
affects your sexual function. (pain, decrease in ejaculate, decrease
in orgasmic sensation, potency problems) No one believes you because
it can't happen. (Everyone does fine after vasectomy.) You seek
treatment, and your complaint is considered "emotional" because it is
so well known that men have "emotional" problems after vasectomy.
Perhaps you should see a counselor…

Where did this information come from? What research supports that men
are so fragile that if you stop sperm from getting in their ejaculate
that it should cause them all sorts of new psychological problems
with no past history? What about all of the studies showing damage to
nerves in the spermatic cord or the studies showing testicular
fibrosis after vasectomy? Could this damage play a role? The medical
field has always relegated unexplained illness to psychological
causes. In this case you have insult added to injury and you can
garner no empathy as you have a "non-complaint", an impossible
outcome.

It must be in your head…