Vasectomy and The Male Pill
From Encyclopedia of Sex and Sexuality
Two important approaches to male contraception, or birth control, center on blockage of the passage of sperm from the testicles to the ejaculatory area, or medical treatment to prevent production of sperm. The surgical blockage of sperm flow from the testicles to the ejaculatory area is easily performed in the minor surgical procedure called vasectomy. With this approach, the vas deferens, the strong muscular tube that carries sperm from the testicles to the ejaculatory area, is divided and tied off with sutures or metal clips. This is a simple and highly effective surgical procedure, that has only minimal side-effects. However, many men are concerned about the potential effects on their testicles and sexual function after vasectomy. These fears are generally ungrounded, because vasectomy does not affect the functioning of the testicles or hormonal levels that affect sexual desire and function. Some men are concerned about the reversibility of vasectomy should they later desire to father children.
Because of these fears, alternatives have been attempted. These include the “no-scalpel vasectomy,” a surgical procedure that also divides the vas deferens and ties off the ends, but does this through a smaller incision than a standard vasectomy. In addition, a number of techniques to place obstructing substances, such as plastics or an “on-off valve” into the vas deferens have been attempted. These attempts are more reversible but have higher failure rates because sperm can squeeze around the blockage.
Because there is some sperm still stored beyond where the blockage is formed, other methods of birth control must still be employed by a man who has had a vasectomy until up to fifteen ejaculations have occurred subsequent to the surgery. A simple test can be administered to insure that no sperm are present in the ejaculate.
Because it is a minor operation (with some new methods of microsurgery, the “operation” really amounts to little more than a puncture in the scrotum) there are rarely complications, though some pain is normal, and swelling and bruising are possibilities, as is risk of infection. Most men lose no time from work after having the procedure, though some do take a few days to recover. Strenuous exercise must be avoided for a time.
Having a vasectomy does not affect a man’s “maleness” in any way. He continues to produce all of the male hormones. The amount of a man’s ejaculate decreases by only about 5 percent, which is not noticeable. Sperm (they are microscopic in size) are still created, but they are not ejaculated and instead are dissolved and absorbed by the body, a harmless process, which takes place within the body all the time with other dead or unused cells.
There are no known health problems resulting from vasectomy. However, it was reported in 1978 that laboratory monkeys that had undergone the operation were at increased risk of arteriosclerosis, especially when fed a high cholesterol diet. But more than twelve studies carried out on men have failed to find any excess cardiovascular disease, hospitalization, or illness in men who have had vasectomies. Similarly, many studies have examined the incidence of prostate cancer in men with vasectomies. A 1993 study indicated there may be an increased risk of such cancer after the operation, but the study has not been duplicated or substantiated and no other studies or reports have found an association between the disease and vasectomies.
Although most vasectomy procedures can be reversed with careful microsurgery to reattach the two ends of the vas deferens, vasectomies are not 100 percent reversible. Therefore, this should be considered a permanent procedure (see also sterilization).
An alternative, non-surgical approach to male contraception is aimed at decreasing the production of sperm by the testicles or causing sperm to become nonfunctional through medication. The most common approach in the past has been with hormones, since there is a delicate hormonal control of sperm production in the testicle. Unfortunately, to completely block sperm production by hormonal means has meant removing all effects of male hormones in the body. This “medical castration” results in changes in libido (sex drive) in the man as well as other possible changes in secondary sexual characteristics, such as beard growth. New, alternative approaches to a male pill, with lower doses of hormones, different hormones, or hormone-like drugs with less pronounced effects on the libido are currently being tested and evaluated.
Given the many millions of sperm produced in a man every day and the need to achieve zero sperm production to absolutely assure contraception, it is difficult to perfect a drug that will work effectively as a male contraceptive pill. Long-term effects of suppression of sperm production and its subsequent recoverability are unknown. Certainly, the ideal male pill would act promptly, not affect libido or other hormonal action, and be completely reversible.
The Chinese drug gossypol has been applied in an attempt to affect sperm function without necessarily stopping sperm production. Gossypol, a derivative of cottonseed oil, blocks the motility of sperm and therefore renders the sperm nonfunctional. This drug has been used extensively in China with good results. Unfortunately gossypol appears to affect kidney function and the processing of fluids within the body, and its long-term use has not been proven safe. Therefore, gossypol is unlikely to be widely accepted as a male contraceptive, or “male pill.” Derivatives similar to gossypol hold some promise of providing an ideal male pill.
One problem that limits all attempts to affect male fertility is the fact that sperm production and maturation in the testicle takes approximately seventy-seven days. Therefore, any drug that affects sperm production or function may take up to three months to achieve its full effects or to have those effects wear off. Development of a successful male contraceptive pill is one of the more challenging areas of medical research.
