Archive for the ‘vasectomy’ Category

Vasectomy And Prostate Cancer-What’s the Risk

July 10, 2014

I often receive calls about the relationship between prostate cancer and vasectomy. There have been many studies that have looked into this relationship and this blog will shed some light on the issue and help men make an informed decision on having a vasectomy, one of the best methods of permanent contraception.

Men who had a vasectomy had a significantly greater risk of developing aggressive, potentially fatal prostate cancer, according to data from a 50,000-patient cohort study.
A recent study in the Journal of Clinical Oncology stated that the overall association between vasectomy and prostate cancer was modest.

The lead authors was quoted as saying, “I think we need to tell men that vasectomy has some risk with prostate cancer, may be linked, but we don’t know. It’s something they need to be aware of and monitored, but really, to me, this is not something that is such a strong association that we need to be changing the way we practice, either prostate cancer screening or vasectomy.”
Studies dating back to the early 1990s have yielded conflicting results about the association between vasectomy and prostate cancer. Some studies have shown as much as a twofold increase in the risk of prostate cancer after vasectomy, whereas others showed no association, the authors noted.

During follow-up through 2010, 6,023 participants had newly diagnosed prostate cancer, including 811 lethal cases. The data showed that 12,321 of the men had vasectomies. The primary outcomes were the relative risk (RR) of total, advanced, high-grade, and lethal prostate cancer, adjusted for a variety of possible confounders.

Vasectomy did not have a significant association with low-grade or localized prostate cancer.

The study adds information to the discussion and controversy surrounding vasectomy and prostate cancer but leaves many questions unanswered. Use of transurethral resection of the prostate, statins used to treat elevated cholesterol levels, selenium, and a number of other factors can influence prostate cancer risk.

The study added little information that goes beyond what previous studies had shown, said Gregory Zagaja, MD, of the University of Chicago. The study suffered from the same limitations of studies that came before it.

Multiple experts state that no consensus exists about potential biological explanations for reported associations between vasectomy and prostate cancer or whether the association is biologically plausible.

Bottom Line: There is a modest risk of prostate cancer in men who undergo a vasectomy. All men, whether or not they have had a vasectomy, need to have a regular PSA and digital rectal exam. For more information on this topic and the relationship between prostate cancer and vasectomy, speak to your doctor.

Vasectomy and Other Medical Issues-Prostate and Testicular Cancer

November 14, 2013

There isn’t a day that goes by that men ask me about the consequences of having a vasectomy.
These reports were prompted by concerns that vasectomy, which involves surgery to cut the tubes that carry sperm, could lead to inflammation in the pelvic region. Prolonged inflammation in certain circumstances can increase cancer risk.

There has been some uncertainty surrounding this question, but recent studies have demonstrated that having a vasectomy has NO effect on the risk of prostate or testicular cancer.
Older data – from studies tracking disease rates across broad population groups – suggested a modest connection, while other studies found no such link.

More recent studies from researchers at institutions such as Boston University and the University of Washington showed no convincing association between vasectomy and prostate cancer. The Boston University group and researchers in Denmark found no link between vasectomy and testicular cancer.

Bottom Line: Today, we can say with confidence that vasectomy does not increase or decrease the likelihood of developing prostate or testicular cancer.

Vasectomy-The Prime Cut, Most Men Are Satisfied With The Decision and the Procedure

June 22, 2013

I have performed nearly 6000 vasectomies in my career and I have found very few men are disappointed with the procedure or the results. The majority of men don’t have any reservations after the procedure.
Often men will ask if the procedure is reversible and the answer is that the vasectomy can be reversed. However, men should make the decision to have a vasectomy only if their family is complete or they don’t plan to ever have children. The cost of the vasectomy is less than $1000 but the cost of the reversal can be north of $20,000. The vasectomy is done with a local anesthetic only takes 10-15 minutes and a reversal requires a general anesthesia and can take 2-3 hours to complete.

A study conducted at the University of Iowa reported half of the men said they considered a vasectomy for a year or less before having the procedure; 85 percent had a high level of certainty they made the right decision. The most common reason for the sterilization was that a man didn’t want additional children and felt a vasectomy was the best birth-control option. Over 90 percent were married, and had two or more children.

Almost a third of the men had some anxiety about the procedure, primarily concern about possible pain and “fear of the unknown.”
Bottom Line: Vasectomy remains one of the best forms of permanent sterilization. Most men are satisfied with the procedure and the results and would do it again and recommend it to others.

No Sperm, No Baby, No Problem

March 29, 2013

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Women have received a bad rap.  The assumption that most problems associated with the difficulty to conceive and have a baby is the fault of the female partner.  However, let the truth be told, 1\3 are a result of female problems, 1\3 are a male issue, and 1\3 are linked to both male and female problems. 

That’s the bad news.  The good news is that two-thirds of couples treated are ultimately able to conceive.

Part of the issue today is that many women are waiting much later in life to have children.  As women get older they’re going to see more problems trying to conceive. Men are capable of fathering children later in life, certainly into their 40s and 50s. They don’t have the same fertility issues that women have at that age.  That is, the biologic clock of men ticks longer than for women.

Common causes of men’s infertility can be hormonal problems, injuries, illness, medications, or a previous vasectomy. Lifestyle issues like smoking and alcohol use may affect sperm production, but are secondary factors.

A common cause of infertility in men is varicocele, an enlargement of the veins in the scrotum that heats the testicles, affecting the number and shape of sperm.  A varicocle is a common problem and up to 30 percent of all men have a varicocele.

Varicocele can develop in adolescence, and may be discovered by a pediatrician. Because of the long-term effects that can lead to infertility, a pediatric surgeon or urologist may recommend a procedure to correct the problem, depending on the severity. The purpose of the surgery is to seal off the affected vein and route blood flow into normal veins.

Another cause of male infertility is vasectomy.  Men are having a vasectomy, which is a reasonably permanent form of sterilization at an earlier age, and then have a change of heart when they get divorced and then marry a younger partner and want to have children and start a second family.  A vasectomy reversal is now quite successful and can be done as an outpatient in an ambulatory treatment center.

More recently, the public has been bombarded with advertisements for medications aimed at correcting low testosterone or low T. These popular medications for hormone replacement for low testosterone may affect a man’s future fertility.  Men should talk with their doctors about medications if they are trying or may be planning to achieve a pregnancy in the future.

Bottom line: Infertility is just as much a man’s problem as it is for the woman.  Help is available and the place to start is a semen examination to be sure that the man has all the ammunition he needs to father a child. 

When You Have A Tack In Your Sack-Chronic Testicular Pain

June 15, 2012
When It Hurts Down There

Chronic Testicular Pain

Chronic testicular pain is a common malady causing havoc in men with this problem. The pain can be so debilitating that men lose productivity in the work place, have sexual problems and even depression that requires treatment. Men often have anxiety about cancer. Chronic testicular pain is also called orchialgia, orchidynia, chronic pelvic pain syndrome, or chronic scrotal pain syndrome. These are all terms used to describe intermittent or constant testicular pain.

Chronic testicular pain occurs at any age but the majority of the patients are in their mid to late thirties. The pain can involve one or both testicles. The pain can remain localized in the scrotum or radiate to the groin, perineum, back or legs. On clinical examination the testis may be tender but in the majority of men is otherwise unremarkable.

Causes of orchialgia include infection, tumor, testicular torsion, varicocele, hydrocele, spermatocele, trauma and previous surgical procedures such as a vasectomy.

Any organ that shares the same nerve pathway with the scrotal contents can present with pain in this region. Pain arising in the kidney, hip, prostate gland or back pain caused by a herniated disc can present as testicular pain. Injury to nerves following a hernia repair can cause chronic testicular pain. Chronic testicular pain has been recognized as a feature of diabetic. Some men attribute the start of their chronic testicular pain to some form of blunt injury to the testicles. Unfortunately in a large proportion of patients the cause of their pain remains unknown.

Post vasectomy chronic pain syndrome
It is not common but there is a possibility that following a vasectomy an obstruction or congestion of the vas or in the epididymis may be the cause of the pain.
If the man has an injection of local anesthetic, such as xylocaine, prior to cutting the vas, this may reduce both immediate and long term post vasectomy pain.

The formation of spermatic granuloma following a vasectomy has been well documented but its protective or causative role as been controversial.

Testing
Scrotal ultrasonography is usually part of the evaluation of patients with scrotal pain. However, in the absence of significant clinical findings during physical examination and in the presence of negative urinalysis, the only real benefit of scrotal ultrasound is reassurance to the patient worried about cancer

Treatment
Surgery is to be avoided if possible. Even if infection has not been identified a small number of patients may respond to a combination of antibiotics and non-steroidal anti-inflammatory drugs. Tricyclic antidepressants, such as imipramine, sometimes relieve the pain. Those with intractable symptoms may benefit from a multidisciplinary team approach involving a urologist and a pain clinic specialist including a psychologist. Transcutaneous electrical stimulation or TENS analgesia often have favorable results. This works on the principle that transcutaneous electrical stimulation causes release of endorphins in the nerves of the spinal cord that supply the scrotum.

A spermatic cord block with a local anesthetic such as xylocaine can be done in the doctor’s office. The procedure, if successful, can be repeated in regular intervals.

For patients who fail to respond to conservative management and wish to avoid the surgical options that are available in treating chronic orchialgia, a trial with an alpha blocker might be an option.

For patients in whom all medical treatments have failed and testicular pain continues to impair their quality of life, surgical intervention may be indicated as a last resort. A number of surgical strategies have been described.

Microsurgical denervation of the spermatic cord may provide relief of chronic testicular pain. Another technique is to divide the ilioinguinal nerve and its branches.

Removal of the epididmymis or epididymectomy should be performed only if the patient had been counselled regarding the likelihood of poor results.

Vasectomy reversal
Putting the vas back together or a vas reversal has helped a number of men with chronic testicular pain.

Unfortunately a small number of patients who fail to respond to medical or more invasive treatment will ultimately undergo removal of the entire testicle for pain relief. This procedure must be the last resort.

Bottom Line:
Chronic testicular pain remains a challenge to doctor as well as the patient.
Help is usually available with medication, nerve stimulation with TENS, and only surgery as a last resort.

Pain in the Pouch- Scrotal Pain May Be Coming From Somewhere Else

June 9, 2012

By far, most causes of pain in the pouch is from the testicles and the epididymis, the gland behind the testicle where sperm are nurtured and mature. But there are other causes of scrotal pain that must be considered and which have different treatments.

Testicular tumors do not usually cause pain, but it is possible. Since testicular cancer is common in young men (between the ages of 18 and 32) and is often cured if treated early, prompt medical attention to any lump is important. If you feel something down there that is new or is hard, see your doctor right away.

Inguinal hernia—An inguinal hernia is part of the intestines which protrudes through the inguinal canal (passageway connected to the scrotum). Inguinal hernia is suspected if swelling or pain above the scrotum worsens with coughing, sneezing, movement, or lifting. This condition is fairly common, especially in young boys, and it occasionally causes pain in the scrotal area. Premature infant boys have the highest risk for inguinal hernia. This condition usually results from an abdominal wall weakness present at birth, but symptoms may not appear until adulthood.
Hernias do not resolve without treatment and may cause serious complications if not treated. Hernia repair surgery is usually required to treat this condition. Often this surgery can be done through a laparoscope which consists of a several pencil sized openings in the lower abdomen. Most men can go home the same day of the surgery and resume all activities, including heavy lifting in 3-4 weeks after surgery.

Pudendal nerve damage (neuropathy), also called “bicycle seat neuropathy,” may cause numbness or pain. Pudendal nerve damage can result from the pressure of prolonged or excessive bicycle riding (e.g., competitive cycling), especially improper seat position or riding techniques are used. Special bicycle seats have been designed to decrease pressure on the area between the scrotum and the rectum, potentially preventing or resolving this problem. Pudendal neuralgia is the painful type of this nerve damage. Sometimes called “cyclist’s syndrome,” pudendal neuralgia is painful inflammation of the pudendal nerve. The pudendal nerve carries sensations to the genitals, urethra, anus, and perineum (area between the scrotum and anus), so the pain can be felt in any of these areas. Pain can be piercing and is more likely to be noticed while sitting. If untreated, nerve damage can lead to erectile dysfunction or problems with bowel movements or urination, such as involuntary loss of feces or urine (e.g., urinary incontinence).

Pudendal Nerve Damage

Narrow bike seat can cause pudendal nerve injury

Surgery—Temporary testicular pain and swelling can be expected after surgical procedures in the pelvic area, such as hernia repair and vasectomy. Post-surgery pain that lasts longer than expected should be reported to a physician. Chronic or recurring pain may be the result of a surgical complication or an unrelated problem, and may need treatment.
Kidney stones—Stones usually cause abdominal pain, but the pain radiates into the testicular area in some cases. Intense, sudden, and severe pain in the scrotum that cannot be explained by a problem in the scrotum may be caused by kidney stones.

Swelling with mild discomfort—Conditions that cause swelling in the scrotal area also may occasionally result in mild discomfort. These conditions include varicocele, hydrocele, and spermatocele. Many cases are benign (mild and non-threatening), but swelling and discomfort in the scrotal area should be addressed by a doctor. If a hydrocele (an abnormal fluid-filled sac around the testicles) becomes infected, it can lead to epididymitis, which can cause severe pain.
Unrelieved erection—An erection that does not end in ejaculation sometimes can cause a dull ache in the testicles. This minor ache, commonly called “blue balls,” is harmless and usually goes away within a few hours or when ejaculation occurs.

Bottom Line: Scrotal pain is common condition that usually involves the structures in the scrotum. However, there are other conditions that can cause scrotal pain. If your doctor evaluates these other causes of scrotal pain, effective treatment can relieve the discomfort.

The Sterilization Decision-Vasectomy vs. Tubal Ligation

May 25, 2012

You have had all the children you would like and you like to ensure that you won’t have another pregnancy then you need to make the sterilization decision.

So who is going to become sterilized? This him-or-her question should be decided with great care. For couples weighing whether they’re ready to permanently prevent pregnancy, here are some important questions to ask.

At this time men have just one option when they want to permanently turn off the possibility of sperm getting to an egg– and women can choose from several. For men, the option is a vasectomy. A doctor cuts and seals off the two tubes that allow sperm to travel from the testicles to the outside world.

The vasectomy can be done without a scalpel and without a needle to inject the local anesthetic so it is nearly painless. The procedure takes about 10-12 minutes but the man is not sterile right away. He needs to ejaculate approximately 15 times to purge sperm from the vas above the area where the occlusion of vas takes place. (See Figure)

After 15 ejaculations, a specimen must be examined under a microscopic to be absolutely certain that there is no sperm in the ejaculate and then the man is sterile.
Women can have a tubal ligation, also called a “tubal” or “getting your tubes tied.” Her fallopian tubes are sealed off, keeping her eggs from meeting any sperm. Or a doctor can do an in-office procedure in which he inserts tiny devices into the tubes through the uterus, blocking them permanently.
Women become sterilized nearly three times as often as men. About 16% of reproductive-age women had opted for tubal sterilization in 2002, compared to 6% of the male member of the relationship who submits to a vasectomy.

What Could Go Wrong?
Women were 20 times more likely to have a serious problem related to a tubal than men face from a vasectomy. In addition, men tend to recover more quickly from a vasectomy than women do from a tubal ligation. A tubal ligation requires anesthesia and deep incisions into her abdomen both of which are concerns.
The most common problems related to vasectomy include bruising, infection, and inflammation in the epididymis, a sperm-holding structure near the testicle. But each of these seems to occur in less than 5% of cases.

How Much Does It Cost?
In terms of cost, a vasectomy is definitely more cost-effective. In general, a tubal costs about three times as much as vasectomy.
If you have health insurance, check on whether it will cover the procedure and what costs may still be your responsibility. Talk with your health care provider to see what your costs are for other birth control options, since other forms of birth control may be more cost-effective.
Bottom Line: There are effective methods of sterilization. A discussion with your doctor will help you decide which one is right for you, vasectomy or tubal ligation.

Vasectomy-The Big Snip Does Not Affect Your Sex Drive

October 21, 2011

It’s a natural concern, for both husband and wife. Couples often want to know, but sometimes don’t know how to ask the question. Will things be the same – especially for the man – following a vasectomy?

Does a vasectomy effect a male sex life? The straightforward answer to this question is a “No.” A vasectomy does not reduce a man’s sexual drive or his ability to have or enjoy sex. The procedure eliminates only the man’s ability to father a child… he can still experience an erection and ejaculation as before.

This is an excellent topic for a candid discussion between husband and wife, and perhaps with the doctor of their choice. Some couples are concerned about a reduced libido or sex drive, but they may be shy about asking the question.

What they may come to discover is, once sterility is complete, they no longer need to worry about accidental pregnancy – and that lovemaking can be more spontaneous, more sensuous and more enjoyable than before.

A vasectomy does not effect the blood vessels or nerves that are part of having an erection or ejaculation. Nothing physiologically changes in that respect.

Two important cautions!

It’s important to note that a man will not be sterile immediately following a vasectomy. Talk to your doctor, who will test your semen for sperm before you can have unprotected sex. It may take up to 20 ejaculations or more and several weeks before your reproductive system is free of active sperm.

Another caution is that a vasectomy is not a protection against sexually transmitted disease (STD). If you are at risk of transmitting or acquiring an STD, you and your partner will still need the protection of a condom or other means of protection.

So what’s the difference?

Typically, the only significant difference after a vasectomy is that the sperm normally produced is missing from the semen. The glands that produce semen are not changed by a vasectomy. Sperm is such a tiny portion of the total ejaculation fluid (about 2 percent) that the change can’t be noticed. Even the color and consistency of the ejaculate are not changed.

There’s no effect on “masculinity,” either. The man’s body continues to produce hormones as before, and there is no change in any of the male characteristics such as beard or voice. Testosterone continues to be produced and released into the bloodstream. Testicles continue to manufacture sperm, but they don’t leave the body. Unused sperm are simply absorbed by the body as normally occurs with or without a vasectomy.

In Summary:

Talk candidly with your spouse and your doctor.
A vasectomy will not decrease your sex drive.
The procedure only eliminates your ability to father a child.
Sterility is not immediate; your doctor will need to test you and advise.
Vasectomy is no protection against sexually transmitted disease (STD).
You can still have an erection and ejaculate.
The body continues to produce hormones.
Male characteristics (voice, beard) are not affected.

Read more: http://www.vasectomy.com/ArticleDetail.asp?siteid=V&ArticleId=5#ixzz1bRaLDYcv

The Contraception Conundrum-Vasectomy vs. Tubal Ligation

May 28, 2011

Every couple whose family is complete comes to a fork in the road and asks which partner is going to get either a vasectomy or a tubal ligation.  This blog will answer a few questions that may help you make a more informed decision.

First of all both procedures should be considered a permanent form of contraception or sterilization.  A vasectomy isn’t nearly as costly and invasive as the surgery to reverse it. And the odds that you’d be able to father a child again aren’t good enough to count it as a fall-back option down the road, Shih says.

What Could Go Wrong?

A report in a medical journal pointed out that women were 20 times more likely to have a serious problem related to a tubal ligation than men who select to have a vasectomy. In addition, men tend to recover more quickly from a vasectomy.  Most men can return to all activities, including sexual intimacy, 3-4 days after the procedure.   A tubal ligation requires a general anesthesia and incisions into her abdomen.  Both of these can result in significant complications.  However, if a woman is going to have her tubes tied during a planned C-section delivery, the added risk of the tubal is less of a concern.

A vasectomy can be done in the doctor’s office using a local anesthetic and usually takes less than 15 minutes.  The most common problems related to vasectomy include bruising, infection, and inflammation in the epididymis, a sperm-holding structure near the testicle. But each of these seems to occur in less than 5% of cases.  Now that the procedure is performed without an incision but through a tiny puncture wound and does not even require a needle to provide the local anesthesia,

If you’re looking for instant results, a tubal holds the edge: It works immediately. After a vasectomy, a man can still get a woman pregnant until lingering sperm are flushed from his plumbing which usually requires 15 ejaculations.  So it’s crucial for couples to use a backup method of contraception until your doctor says you’re in the clear. And men need to provide a semen sample after a vasectomy that is examined under a microscope to be absolutely certain that no sperm are present.

The Essure and Adiana devices, which are inserted into the Fallopian tubes, also require a checkup to ensure that they’re installed properly and the woman can’t get pregnant.  If you choose these options, be sure you’re going to do the follow-up work. During the first three months after insertion of the device, another form of birth control must be used.

If you’re thinking about your bank account, In terms of cost, a vasectomy is definitely more cost-effective. In general, a tubal costs about three times as much as vasectomy.

Bottom Line:  Most couples are happy when children are planned.  When the time comes to cut off  “reproduction production”, consider either a vasectomy or a tubal ligation.

The Prime Cut-A Vasectomy For When You Are Done Having Kids

May 28, 2011

Though their circumstances vary widely, millions of men have asked themselves two questions: Do I have all the kids I want and can afford? If so, should I get a vasectomy?

Men have one successful option when they want to permanently turn off their baby-creating machine – a vasectomy. A doctor, usually a urologist, cuts and seals off the two tubes that allow sperm to travel from the testicles to vagina and ultimately to combine with an egg and produce a baby.

At the present time only 6% of couples wishing to have a sterilization procedure select a vasectomy.

Reasons that men choose to have the procedure include wanting to avoid difficult pregnancies if their partner has had previous problems during pregnancy, or if the partner had problems using hormonal contraception. Many men are now feeling that a vasectomy is their chance to contribute. 

There are nearly 400,000 vasectomies performed each year in the United States.  The procedure can now be accomplished without an incision and even without a needle to inject the local anesthetic.  The procedure takes 15 minutes and most men can resume all activities, including sexual intimacy, in 2-3 days after the procedure.

For more information, please go to my webiste, www.neilbaum.com or http://www.neilbaum.com/the-vasectomy-procedure.html for an article and a video on the subject.  


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