Vasectomy: Some Questions and Answers by Keith
THE RELATIVE PERMANENCE of surgical sterilization causes people to pause
before taking such a serious step. Yet, driven by fear--fear of sickness or
death from the Pill or IUD and their abortion-causing effects, fear of
unplanned pregnancies resulting from the less effective barrier methods, and
sometimes fear of exercising sexual self-control--many couples turn to
surgical sterilization out of desperation.
Many of these couples later regard this step as drastic and unwise especially
after they have become informed about the highly effective modern method of
natural family planning knows as the Sympto-Thermal Method.
What is vasectomy?
A vasectomy is a surgical operation performed to make a man sexually sterile.
In a vasectomy, a doctor cuts out a portion of both ducts (vas deferens)
through which sperm pass from the testes; then he ties or coagulates the ends
and sutures the cut made in the scrotum. Usually performed under local
anesthesia, the operation is relatively painless, although some swelling and
tenderness are common during the brief recovery period.
Is vasectomy 100% effective?
No. The only 100% effective sterilization surgeries are male castration
(removal of both testicles) and female castration (removal of both ovaries);
these surgeries are simply not performed for birth control purposes.
Vasectomy has a failure rate of .1% (one-tenth of one percent).1
Recanalization, the rejoining of a vas deferens by internal healing
processes, occurs in one case per thousand, and sometimes the urologist will
not catch the rare presence of a third vas deferens. Both situations may
result in a surprise pregnancy.2
What are the health risks of vasectomy?
Although the final verdict on the health risks of vasectomy is not in,
suspicions are rising that the long-term effects on a mans immunological
system can pose serious health problems. Criticism is mounting within the
medical community about the uncritical way in which vasectomy has been
declared medically safe. Between 10% and 15% of adult men in the U.S. have
been vasectomized3and yet, as Dr. H. J. Roberts has written, "I know of no
other operation performed on humans that induces responses to such a degree
by the immune system."4
What happens to the sperm?
After a vasectomy, sperm production continues as before, around 50,000
spermatozoa per minute.5 Lacking a normal anatomical passage, these cells are
either consumed by destroyer cells (macrophages) or degenerate and produce
antigens that cause antibodies to be produced.6
At least eight of these sperm antigens have been identified. These antigens
frequently infiltrate into the bloodstream and induce other cells throughout
the body to manufacture antibodies against the sperm. These are called
What is autoimmunity?
Antibodies are the way we immunize ourselves against specific diseases in our
environment. Antigens are the triggering mechanism the body needs in order to
produce the right antibodies for its defense. An example of this effect is
the allergic reaction that occurs when the body is highly sensitive to a
certain food cell.
When the body gears up its defenses to destroy cells of its own making, as
after a vasectomy, then the body becomes "auto-immune" --allergic to itself.
Has this been linked with vasectomy?
Several studies confirmed this linkage in the l970s, finding antibodies to
sperm antigens in 55% to 75% of patients within two years after vasectomies.7
In a 1982 study, investigators pointed out. "...the incidence of sperm
antibody following vasectomy may have been underdetected."8 It is so common
to see this reaction among vasectomized men that an absence of such
antibodies has become an indicator of hormonal malfunction.9 With more
advanced methods of detection, it has been possible to detect the antibody
response within two weeks after vasectomy.10
What are some auto-immune diseases?
Auto-immunity has been suspected to cause diseases such as multiple
sclerosis, diabetes mellitus, rheumatoid arthritis, some types of hepatitis,
Addisons disease (malfunction of the adrenal glands), and lupus
A landmark study by Nancy J. Alexander and Thomas B. Clarkson concluded that
"the immunologic response to sperm antigen that often accompanies vasectomy
can exacerbate atherosclerosis" (hardening of the arteries).12 Subsequent
studies have lent support to their finding.13
What about the risk of cancer?
In the early 1980s, Dr. Richard Ablin, researcher at the Hwektoen Institute
in Chicago, hypothesizes that prostate cancer could be caused by unejaculated
sperm. A decade later, epidemiologists reported an "unexpected association "
between vasectomy and prostate cancer. One study found the risk of this
cancer increased between 3.5 to 5.3 times;14 a separate study found an
overall risk 1.7 times greater beginning 12 years after vasectomy, rising to
2.2 times (more than double the risk) between 13 and 18 years later.15 Two
large studies of vasectomized men were conducted through the Harvard Medical
School and published in 1993. They found the overall risk of prostate cancer
increased between 56 and 60%, increasing to 89% for those who had vasectomies
20 or more years earlier.16
Prostate cancer is the second leading cause of cancer deaths among American
men, claiming some 30,000 lives per year. Although these studies did not
prove any conclusive link between vasectomy and prostate cancer, the American
Urological Association urged that patients be informed of the risk on the
basis of these papers.17
Increased risks of lung cancer, non-Hodgkins lymphoma and multiple myeloma
were noted among men 20 years after vasectomy.18 The Coronary Artery Surgery
Study, analyzing 1106 men, found a two-and-a-half times higher risk of kidney
stones among vasectomized patients 30-35 years old.19 An association with
testicular cancer has also been noted.20 A healthy immune system is our
day-to-day defense against cancer. The authors of the Harvard studies
hypothesized "the immune response to sperm antigens following vasectomy may
enhance tumor growth by blocking of antibodies of tumor suppresser cells by
Are vasectomies reversible?
High-cost microsurgery techniques reverse sterilization in men and women. The
functional success rates vary widely. A published paper reported rates around
50%;22 anecdotal reports tell of rates ranging up to 80%. Still, men and
women "must consider any sterilization technique as permanent."23
Are there psychological side effects?
A standard personality disorder test revealed that over 40% of a vasectomy
study group experienced personality disturbances between their first testing
and that of a year later after the operation.24
A study of vasectomy patients and their wives by Dr. Frederick Ziegler found
"striking adverse changes and reduced marital satisfaction in husband and
wife notwithstanding general satisfaction with the procedure itself."25
When a person takes such an irrevocable course of action, it is
psychologically difficult to admit that a mistake has been made. This
explains why patients who experience difficulties with sterilization still
respond in surveys that they are "satisfied" with the procedure. "The need to
convince ourselves is served by convincing others," noted one researcher.26
Thus, while 53% of vasectomized participants in an Indian study suffered
decreased sexual desire, 92% of the group expressed satisfaction with the
What are the social consequences?
Although a million Americans each year choose sterilization for birth control
purposes,28 there is little research on the social consequences of
sterilization. It has been suggested that men who believe themselves to be
truly sterile may feel more inclined toward marital infidelity. Vasectomy may
also aggravate the tendencies among middle-aged men that lead them to discard
their wives in favor of younger women.29
Minimum age and spousal consent requirements for sterilization have been
reduced in many states, which can cause stress in marriages, especially when
a couple later on reconsiders this permanent decision made earlier in their
Regrets over this decision, made under stressful circumstances, may adversely
affect marriages. Some of the most heartbreaking letters received by the
Couple to Couple League come from couples who have deep sorrow and bitterness
about a sterilization operation.
Another distressing social consequence comes from the very nature of sexual
sterilization: the acceptance of the idea that an essential part of the body
can be disconnected like a machine. This has grave implications. Cats and
dogs are spayed for the convenience of their masters--who are the "masters"
in the human social order?
Can "voluntary" sterilization become "forced"?
Yes. Perhaps the greatest social danger from "voluntary" sterilization is
that it is only a half-step away from forced sterilization. If people reject
the reality that sterilization is a serious evil, accepting it as a "morally
neutral act," the way is paved for coerced sterilization.30 In any functional
social order, citizens may be morally compelled to do certain things, but
they may not morally be forced to perform evil actions nor forced to consent
to them. For example, traffic laws force us to limit our speed but there is
nothing inherently evil in driving slower. Such legitimate laws are morally
justified forms of coercion.
However, sterilization attacks the physical integrity of the human person.
While this may be justified as a punishment for crime, the evil of
sterilization should not be forced on anyone as a matter of social policy.
Those considered "unfit" by Nazis standards lost their right to reproduce.
Indira Gandhi launched a massive coerced sterilization campaign that led to
her electoral defeat. In the United States, Margaret Sanger, foundress of
Planned Parenthood, advocated sterilization of the poor,31 and there have
been other attempts to employ forced sterilization for population control.32
How does religion view sterilization?
Before 1930, no Christian Church accepted sterilization or any form of
contraception as morally acceptable. The Catholic Church and some Protestant
Churches still teach that deliberate sterilization is an immoral form of
birth control. "Equally to be excluded [as morally permissible], as the
teaching authority of the Church has frequently declared, is direct
sterilization, whether perpetual or temporary, whether of the man or of the
woman." (Humanae Vitae, 14).33
Is there a safe and healthy alternative?
Yes. Even for the couple who have a most serious reason to avoid pregnancy,
the Sympto-Thermal Method of Natural Family Planning (NFP) offers a realistic
and moral alternative. No methods of conception regulation are 100% effective
(except total abstinence or castration), but studies of Sympto-Thermal
Methods have show remarkably high effectiveness rates;34 one study of a
temperature-only form of NFP showed an unplanned pregnancy rate below that
for vasectomy and tubal ligation sterilization.35
How can I learn about Natural Family Planning?
Contact the Couple to Couple League either in your own area or at its
national office in Cincinnati, Ohio.
(c) 1995 The Couple to Couple League International, Inc. The Couple to Couple
League P O Box 111184 Cincinnati OH 45211 (513) 471-2000
1. Robert A. Hatcher, et al., Contraceptive Technology (New York: Irvington,
1990), p.414. 1. Ibid. p.412. 3. T. Randall, Journal of the American Medical
Association ((1991) 268:176-179. 4. H. J. Roberts, Is Vasectomy Worth the
Risk?(West Palm Beach, Fla; Sunshine Sentinel Press, 1993)14. 5. G. Frenkel,
et al., Israel Journal of Medical Sciences (1973) 8:34 6. N. J. Alexander and
T. G. Clarkson, "Effect of vasectomy on diet-induced atherosclerosis, "
Vasectomy: Immunologic and Pathophysiologic Effects in Animals and Man, Irwin
H. Lepow and Ruth Crozier, eds. (New York: Academic Press 1979), 122.7 K.S.K.
Tung, "Human sperm antigens and antisperm antibodies," Clinical Experiences
in Immunology (1975) 20:93-104. R. Ansbacher, et al., "Sperm antibodies in
vasectomized men," Fertility and Sterility (1972) 23:640; T. Samuel, et al,
"Autoimmunity to sperm antigens in vasectomized men," Clinical and
Experimental Immunology (1975) 21:65-74; J.D. Matthews, et al., "Weak
antibody reactions to antigens other than sperm after vasectomy," British
Medical Journal (1976) 2:1359; S. Shulman, et al., "Immunologic consequences
of vasectomy," Contraception (April, 1972) 5(4) 269-278. See also N. J.
Alexander , D. L. Fulgham, E. R. Plunkett and S. S. Witkin, "Antisperm
antibodies and circulating immune complexes of vasectomized men with and
without coronary events," American Journal of Reproductive Immunology and
Microbiology (1986) 12:38-44. 8. S. S. Witkin, et al, "Sperm-related
antigens, antibodies, and circulating immune complexes in sera of recently
vasectomized men," Journal of Clinical Investigation (1982), 70:33-40. 9. H.
Fisch, et al., "Detection of testicular endocrine abnormalities and their
correlation with serum antisperm antibodies in men following vasectomy,"
Journal of Urology (1989) 141:1129-1132. 10. S. Naaby-Hansen, "The humoral
autoimmune response to vasectomy described by immunoblotting from
two-dimensional gels and demonstration of a human spermatozoa antigen
immunochemically cross reactive with the D2 adhesion molecule," Journal of
Reproductive Immunology (1990) 17:187-205. 11. J. Fried, Vasectomy (New York:
Saturday Review Publ., 1972) 46. 12. N.J. Alexander, and T. B. Clarkson,
"Vasectomy increases the severity of diet-induced atherosclerosis in
Macacafasciularis," Science (1978) 201:538-541. 13. N. Bansal, N. K. Ganguly
Majundar, R. N. Chakravarti, "Long term effects of vasectomy on experimental
atherosclerosis in rhesus monkeys, " Australian Journal of Experimental
Biology and Medical Sciences (1986) 64:527-533; H. G. Fahrenback, N. J.
Alexander, J. W. Senner, et al, "Effects of vasectomy on the retinal
vasculature of men," Journal of Andrology (1980) 1:299-303; H. S. Jacob,
"Complement induced granulocyte aggregation; Important in myocardial
infarction and shock lung," Journal of the American Medical Association
14. L. Rosenberg, J. R. Palmer, A. G. Zauber, et al., "Vasectomy and the risk
of prostate cancer," American Journal of Epidemiology (1990) 132:1051-1055.
15. C. Mettlin, N. Natarajan, and P. Huben, "Vasectomy and prostate cancer
risk," American Journal of Epidemiology (1990) 132:1056-1061. 16. E.
Giovannucci, a. Ascherio, E. B. Rimm, et al, "A prospective cohort study of
vasectomy and prostate cancer in U.S. men," Journal of the American Medical
Association (1993) 269:873-877; E. Giovanucci, T. D. Tosteson, F. E. Speizer,
et al., " A retrospective cohort study of vasectomy and prostate cancer in U.
S. men,"Journal of the American Medical Association (1993) 269: 878-882. 17.
Position Statement of the American Urological Association, Feb. 17, 1993. 18.
E. Giovannucci, T. D. Tosteson, F. E. Speizer, et al., "A long-term study of
mortality in men who have undergone vasectomy," New England Journal of
Medicine (1992) 326:1392-1398. 19. R. A. Kronmal, J. N. Kriegar, J. W.
Kennedy, et al., "Vasectomy and R. J. Presett, I. W. J. Wallace, " Does
Vasectomy accelerate testicular tumor? Importance of testicular examination
before and after vasectomy," British Medical Journal (1990) 300:370; J. A .
Thornhill, M. Butler, J. M. Fitzpatrick, "Could vasectomy accelerate
testicular cancer? The importance of prevasectomy examination," British
Journal of Urology (2987) 59:367. 21. Giovannucci, Tosteson, and Speizer,
JAMA, 877. 22. For men the rate is around 50%, for women slightly better,
although up to 70% of women requesting reversals are not accepted for the
surgery because of irreversible damages. A. M. Siegler, et al.,
"Reversibility of female sterilization," Fertility and Sterility (1985)
43:499-510. 23. Hatcher, 416-417. 24. H. Edy, "Psychological aspects of
vasectomy," Medical Counterpoint (January 1972) 25. F. J. Ziegler, D. A.
Rodgers, S. A. Kriegsman, "Effect of vasectomy on psychological functioning,"
Psychosomatic Medicine (1966) 20:8. 26. H. Wolfers, "Psychological aspects of
vasectomy, " British Medical Journal (1970) 4:297. 27. K. Dandekar,
"After-effects of vasectomy," Artha Vijnana (Poona, India: Gokhale Institute
of Politics and Economics, 1963) 5:212. 28. Association of Voluntary Surgical
Contraception News (July 1989) 27:1 29. The psychological and social forces
responsible for this distressing phenomenon are described superbly in George
Gilders Men and Marriage (Gretna, L. A.: Pelican Books, 1992). 30. "Let it
be considered also that a dangerous weapon would thus be placed in the hands
of those public authorities who take no heed of moral exigencies. Who could
blame a government for applying to the solution of the problems of the
community those means acknowledged to be licit for married couples in the
solution of a family problem?" Pope Paul VI , Encyclical letter Humanae Vitae
dated July 15, 1968, 17. 3l. Margaret Sanger, Pivot of Civilization (New
York: Brentanos 1922), 124-145. Sanger expresses an especially strong
paranoia that irresponsibly copulating "subhumans" will overpopulate the
earth and contaminate the gene-pool. 32. Sterilization as a tool of the state
has a long history in America. In the mid-1890s castration was used on the
"feeble-minded" in Kansas. In 1899 a 19 year old was castrated at the Indiana
Reformatory because of his "addiction" to masturbation. In 1907 Indiana
commenced sterilizing criminal and unfit elements in the state. Fifteen
states enacted similar laws between 1907 and World War I. The eugenics
movement touted the social benefits of involuntary sterilization into the
1930s. In 1974 two Alabama sisters, age 12 and 14, were sterilized without
their consent at a Montgomery birth control clinic.
33. Pope Paul VI, Encyclical letter Humanae Vitae, July 25, 1968, 14. 34. R.
E. J. Ryder, "Natural Family Planning effective birth control supported by
the Catholic Church," British Medical Journal (September 18, 1993)
307:723-726. This article compared studies from around the world indicating
that modern inexpensive NFP methods, used by well motivated couples, are as
effective as the Pill in regulating births. 35. B. Vincent, et al., Methode
Thermique a et Contraception: Approaches medicale et psychologique (Paris:
Masson, 1967) 52-73.
(c) 1995 The Couple to Couple League International, Inc.
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