Archive for the ‘contraception’ Category

The Month of March Means Time For the Prime Cut – Vasectomy

March 8, 2017

Vasectomy remains one of the easiest and cost effective methods of permanent contraception. Many men opt for the outpatient procedure during the month of March so they can chill out and stay glued to the TV for March Madness the month-long college basketball tournament.

In the past few years, there’s an annual spike of vasectomies of approximately 10% in men getting the prime cut shortly before the nationally-televised tournament begins.

The idea is that, with weeks of games to catch up on, they’ll have plenty to keep them occupied and distracted while they recuperate on the sofa for a few days.

I perform the no-scalpel, no-needle vasectomy in my office. The procedure is usually accomplished in 15 minutes. A single, small, less than 1\4 inch opening, is created on the scrotum using a local anesthetic that does not require a needle to render the skin free of any pain or discomfort. The procedure consists of dividing the vas or the tubes located in the scrotum that transports sperm from the testicles to the ejaculation fluid that exits the penis at the time of orgasm. The vas ends are sealed with tiny clips or sutures. By dividing the vas, no sperm can reach the seminal fluid (semen), which is ejaculated from the penis during sex. Since there is no sperm in the semen, a woman’s egg can’t be fertilized – and the procedure has nearly 100% success rate. Most men will not feel any pain during the procedure. In most cases the small opening requires no sutures and the opening will close within 1-2 days after the procedure.

After a vasectomy, a man’s hormones remain normal, and there is no noticeable difference in his ejaculate volume, since sperm make up only a tiny part of the semen.

Many men ask what happens to the sperm produced by the testicles. Because the sperm cannot come out after the vas deferens is cut, like other dead body cells, the sperm disintegrate and are reabsorbed by the body.

After the procedure, men are instructed to go home and lay flat in bed and apply an ice pack or a pack of frozen peas on top of the scrotum for 30 minutes of each hour. However, many will feel some minimal discomfort for a couple of days after the procedure. Most men can return to all activities including sexual intimacy within 5-7 days after the procedure

After a vasectomy, a man’s hormones remain normal, and there is no noticeable difference in a man’s ejaculate volume, since sperm make up only a tiny part (less than 5%) of the semen.

The procedure does not affect the hormones produced in the testicle (testosterone) and therefore, there is no impact on a man’s virility or libido. The only change is in his fertility!

Bottom Line: Vasectomy is an effective and nearly painless means of contraception. So if you want to watch NCAA basketball games in peace and quiet, talk to your doctor about a vasectomy. It’s a cut above the rest!

At Last a Reversible Vasectomy At the Touch of a Button

January 15, 2016

Clemens Bimek is a German inventor of a device to control the sperm flow through a flipping switch.

The device is implanted through surgery and attached to the vas deferens. The device is equipped with a valve which is closed and opened as desired through the skin on the scrotum.

If the valve is in the off position sperm cells are prevented from reaching the seminal fluid. This allows ejaculation no sperm is present in the seminal fluid.

The procedure basically works as a vasectomy. But in comparison with a vasectomy which is only reversible through microscopic surgery the new device makes it reversible with a flip of the switch.

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I believe that clinical trials in humans are underway. Until now the only men who tested the device is the inventor.

At the present the inventor is satisfied with his device so he plans to implant it to 25 men during a clinical trial this year and if everything goes well the device will hopefully get on the market by 2018.

As new information becomes available on this device, I will post a blog on what I find out.

FAQs on Vasectomy

June 27, 2015

Many men want the opportunity to plan the number of children they have – and many women want to finally be able to share the responsibility of contraception with their partner.
So as we mark Men’s Health Month, an awareness campaign on why the snip is not really the snip and why a little more conversation can mean a lot more action. It’s time to get informed.
1. Will vasectomy make me impotent?
A lot of men worry that a vasectomy will lead to a reduction in sexual performance or desire – not surprising really when in some cultures they use the same word for vasectomy and castration! But it can actually improve your sex life because of the peace-of-mind it brings. Having a vasectomy is liberating – imagine never having to worry about unwanted pregnancies again. Instead of frantically rummaging through the bathroom cabinet for a condom, hoping that the mood won’t pass, you can do it whenever you like!
2. What will happen when I ejaculate?
Having a vasectomy does not affect your hormones, ejaculation or orgasm. There’s no noticeable change in what your semen looks like, what it smells like, even what it tastes like. You will still have erections and produce the same amount of semen. The only difference is that the semen won’t contain sperm, as instead of travelling out of your penis, they will be naturally reabsorbed by the body.
3. Does it involve a lengthy operation?
Vasectomies only take 10-15 minutes. The same time as your morning shower or a coffee break from work and unlike the former means you and your partner never have to worry about contraception or unintended pregnancy again.
4. Should I be scared of going under the knife?
It may be known as the snip but at Marie Stopes UK we use a no-scalpel technique. A fast-acting anaesthetic is given before the procedure to numb the area and the sperm-carrying tubes (vas deferens) are sealed using heat. There are no hormones and nothing to insert, no stitches are needed. The procedure is also thought to be less painful and less likely to cause complications than a conventional vasectomy. A form of sedation is also available at some of our centres and can be requested at the time of booking.
5. Will it take ages to recover?
The recovery involves little more than a few days of guilt-free rest and relaxation. You can start having sex as soon it feels comfortable to do so and should be fit to return to work and after a couple of days unless you have a very physically demanding job. If you are uncomfortable, a regular painkiller such as Tylenol or Ibuprofen should do the trick and since you have got your feet up thanks to doctor’s orders, why not book one in to coincide with some good TV? Olympics 2016 anyone?
6. What is the failure rate?
Vasectomy is more than 99% effective. Out of 2,000 men who are sterilized, only one will get a woman pregnant during the rest of his lifetime. However it takes a number of weeks to clear the tubes of sperm after the treatment, so you will need to use another method of contraception until you have been given the all clear. I ask you to ejaculate 15 times and then bring in a specimen for me to exam under the microscope.

7. How risky is it?
Vasectomy is a very common and safe procedure. It is always worth arming yourself with all the facts, but ultimately vasectomy is the safest permanent contraception method on earth. The potential complications are much rarer than for a woman getting her tubes tied and most men experience no problems whatsoever.
8. Can I reverse my vasectomy if I change my mind?
The decision to opt for a vasectomy remains a highly personal one in which the potential risks and benefits must be considered, including the possibility that you may change your mind. Vasectomy reversal is possible but success is not guaranteed and depends largely on how long ago it was done so it is much better to consider it a permanent procedure.

Bottom Line: A vasectomy is the most effective method of permanent contraception. The no-scalpel, no-needle technique is associated with less pain and discomfort, less blood loss, and a quicker return to normal activities than the conventional scalpel plus incision technique.

No-Scalpel, No-Needle Vasectomy-The Prime Cut

December 8, 2014

Most practices are impacted at the end of the year by the rush of patients who have met their deductibles. In Urology, aside from patients wanting to get stones busted (Lithotripsy), scrotal issues addressed, and an occasional prostate; by far and away, the number of vasectomies that are done in December is at least 4-5 times the number that our offices perform during any of the other months. The following is intended for any questions that you may have regarding vasectomy and is based on more than 5,000 vasectomies I have performed over 30 years of urologic practice.

Vasectomy Facts

1. Average time for the procedure is 6-8 minutes.

2. Patients are not given any narcotics as Aleve or Advil are sufficient for any discomfort. Less than 1 in 100 patients require a narcotic prescription.

3. Patients are offered the option of Valium 20 mg. to take prior to the procedure with instructions to have a driver.

4. 95% of the men who come in for a vasectomy consult go on to have the procedure.

5. The biggest fear is of someone they do not know holding sharp instruments and working on their scrotum while they are awake. Because of proper education, including an article given to all patients prior to have the procedure, men need not worry about the vasectomy impacting their sexual function.

6. The sperm make up only 5% of the ejaculatory volume so no noticeable change in the semen volume.

7. Rarely men will be seen following the procedure for some discomfort and typically, it is related to some inflammation or small hematoma and Tylenol or Advil are more than adequate.

8. Because of the way the procedure is performed, it is very rare to see a scrotal hematoma, which can occur and creates a small swelling of the scrotum. This occurs most often in men who do not heed the advice of going home, lying down and keeping ice on the incision.

10. Occasionally, a question is asked regarding sperm banking and this can be done in a facility in one of the infertility clinics in the area.

11. Vasectomy reversal is a formal surgical procedure that can take anywhere from 1-1/2 to 2 hours to perform. Through a scrotal incision, the testicle and spermatic cords are brought into the surgical field. The ends of the vas identified, freshened up and scar tissue removed and an operating microscope is used to perform a surgical closure using typically anywhere from 7-0 to 9-0 permanent suture. Success rates for vasectomy reversal is approximately 75% within the first 10 years and drops to about 30% after 10 years.

Anatomy

The vas deferens is a small tube approximately 3 mm (1\8 inch) in diameter that carries sperm from the testicle up into the body where it unites with the seminal vesicles and stores the sperm until ejaculation when the semen is deposited in the vagina in order to fertilize an egg and start the process of conception.

No Scalpel Procedure

Following anesthetizing the skin in the mid-section of the scrotum with a device that deposits the anesthetic without the use of a needle. Then a single puncture is made about 1\4 of inch in length in the middle of the scrotum. Each vas is occluded with very small titanium clip. No sutures or stitches are required. The patient lies on the table for a few minutes and then goes home and lays flat in bed for a few hours using ice over the scrotum for 45 minutes out of every hour until going to sleep.

Office visits

A vasectomy consultation is always performed before the procedure for a number of reasons:

1. To explain the procedure to the patient.

2. To allay fears, address misconceptions, and put the patient at ease.

3. To ensure anatomically that there are no problems with performing the vasectomy which include an extremely large patient with small scrotum, prior evidence of infection, and to screen for extremely anxious patients who probably would not tolerate the procedure being performed in the office under local anesthesia.

4. Pre-procedure instructions are given including the need to shave all the hair on the scrotum preferably the night before.

5. Men are given a prescription for Valium, which they should take 30-45 minutes before the procedure. If the man takes the Valium pill, then he will need a ride home as he should not drive a car after using Valium.

6. Post-procedure instructions are given including the need to go home and stay off his feet and keep ice on for two days. Sexual intercourse can begin typically 3-4 days post- procedure. Additionally the men are instructed to return for a follow-up visit. It takes approximately 15 ejaculations to clear all sperm from the portion of the vas above the legation of the vas.

6. Typically, a man makes a follow-up appointment at 6-8 weeks although the record is one week, but he wasn’t married! They are also informed of the 1 in 1500 chance of reconnection of the vas.

Summary

The majority of men have the procedure performed on Thursday or Friday, spend the weekend resting with ice, return to work on Monday and are back to regular activity including intercourse by Wednesday or Thursday of the following week.

Bottom Line: Having done more than 5,000 vasectomies, I can think of very few men who would not be willing to undergo the procedure again or recommend it to a friend. Certainly, in comparison to tubal ligation, which requires general anesthetic, it is a much simpler, less costly and less painful form of sterilization.
Don’t hesitate to give me a call if you have any questions about vasectomy or go to my website to view a video on vasectomy: http://neilbaum.com/videos/vasectomy

What Happens After A Vasectomy?

October 10, 2014

A vasectomy, using the no-scalpel, no needle technique takes just a few moments to accomplish in the doctor’s office. However, there are some precautions that are necessary after the procedure.

Most often, men are concerned about the pain involved in a vasectomy procedure as well as having a healthy, functional sex life afterwards. The no needle technique using a local anesthetic and the no-scalpel procedure which allows the procedure to be accomplished through a quarter inch opening without requiring an incision, causes minimal or no pain during or after the procedure.

Post Vasectomy Advice

  • The vasectomy procedure lasts anywhere from 10-12 minutes.
  • Patients do not require any general anesthesia and often take a Valium tablet before the procedure to remove the anxiety often associated with the procedure.
  • A bag of frozen peas or ice should be placed on top of the underwear over the scrotum to help reduce any swelling. Instead of frozen peas, you can place a few ice cubes in a zip lock bag and place this over the scrotum for a few hours after the procedure.
  • You may feel an ache in your testicles which is treated with extra strength Tylenol or Aleve.
  • You will need to have a ride home if you take the Valium.
  • It is recommended that vasectomy patients abstain from sex for 3 days.
  • You should have no activity the day of the procedure and minimal activity for 2-3 days after the procedure. You can resume all activity including heavy lifting and bike riding seven days after the procedure.
  • You will need to use some form of contraception until your semen is examined under the microscope to be certain that all sperm are absent from the ejaculate. I suggest that you have 15 ejaculations using contraception and then bring in a specimen for me to examine. If no sperm is seen, I will ask for a second specimen a few days later and if the second specimen is without sperm, you will be considered sterile and can stop using contraception.

Bottom Line: While pain tolerance varies from person to person, the pain following a vasectomy is generally a mild discomfort as long as instructions are followed. Avoid heavy lifting and strenuous exercise, take pain medication when necessary and place ice on the scrotum to speed up recovery time.   Finally, a vasectomy is not a protection against sexually transmitted diseases (STD).

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.

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.