Interest in vasectomy has been increasing recently in the Czech Republic. How do you explain this?
Dr. Josef Stolz: In my view it’s linked to couples’ awareness of the possibilities of contraception. In Western countries vasectomy is far more widespread than here, it’s a common method. However, in comparison with the situation roughly ten years ago, when vasectomy was practically never spoken about in this country, it’s now obviously far more in the public awareness these days. Although a large section of the male population here still holds the opinion that contraception is the woman’s responsibility and refuses to consider the option of vasectomy, there are men here who are aware that hormonal contraception has a large number of side effects and frequently limit the woman. In my opinion both partners should share the responsibility, and so if a couple decides to address the issue of contraception it’s good to know that vasectomy is one possible choice. What’s fundamental is that vasectomy represents a far cheaper option than surgical sterilisation of women.
What are the criteria for performance of a vasectomy?
Dr. Josef Stolz: Thanks to the amendment to the law which outlined the conditions for sterilisation for both men and women, as of January this year the consent of a sterilisation commission, which was practically a formality, is no longer required. A man who decides to undergo a vasectomy must meet the criterion of responsibility, he should be given sufficient instruction concerning the surgical procedure and the connected matters at least 14 days before the operation and sign an informed consent form, in which the procedure, its risks and benefits are described in detail.
What awaits men who decide in favour of vasectomy?
Dr. Josef Stolz: First of all a comprehensive interview. The client’s condition of health and the reasons why the client has decided to undergo the procedure are assessed, another integral component is a physical examination and an examination of the exterior genitalia. In practical terms, if the man has no fundamental contraindications such as bleeding, if he does not take any drugs which dilute the blood, then there is no reason to examine him further and the surgical procedure can be conducted. For a number of days after the operation it is recommended to avoid physical exertion, but this need not place any limitation on ordinary activities or employment. Six to seven weeks after the operation it is recommended to perform a semen analysis. Only after the performance of the semen analysis, which demonstrates the absence of sperm in the ejaculation, can the operation be considered to have been successful.
How exactly is the operation performed?
Dr. Josef Stolz: It’s a short surgical procedure of approximately 30 minutes on the scrotum under local anaesthetic. In the operation the natural flow of sperm upon ejaculation is simply prevented by cutting off the vas deferens, which is the tube that transports sperm out of the testicles.
What then happens to the sperm?
Dr. Josef Stolz: That’s a very good question, because men are often put off the idea of a vasectomy by the idea that their testicles will swell up due to an accumulation of sperm. These fears are completely unfounded. The size of the testicles remains the same after a vasectomy, even though sperm are still generated – the only difference is that they are not discharged in the course of the ejaculation but gradually undergo biodegradation, thus they break down and are absorbed. In this the hormonal function of the testicles, together with the attendant sensitivity etc. remains unaffected.
Does a vasectomy have any influence on a man’s sex life?
Dr. Josef Stolz: There’s no need to fear any “side effects” in this respect. The ability to ejaculate, libido, erection – all of this remains. Only the amount of the ejaculation (which does not contain sperm) is smaller, by approximately 40 percent.
Every operation has its pros and cons, and this is no doubt also true for vasectomy. Can you describe the potential risks?
Dr. Josef Stolz: The risks can be immediate and delayed. Immediate means that this is a certain surgical, even if minimally invasive procedure, and so there is a risk of bleeding in the wound or infection. Although these complications occur to a minimal extent, in only two percent of cases, it is necessary to know about this. A long-term so-called “side effect” may be a certain amount of discomfort in the area of the cut vas deferens – the patient may find sensitive area known as a granuloma, nevertheless these complications are also not common, it concerns ten percent or less of clients after a vasectomy.
“Never say never” – what if a man who has undergone a vasectomy later decides he would like to have another child?
Dr. Josef Stolz: As I’ve already said, in this operation the man does not lose his sperm, only their transport is cut off. Practically speaking, the man therefore has two options. The first is known as anastomosis, in which both ends of the cut vas deferens are connected and thus the physiological, normal discharge of sperm in ejaculation is renewed. This is a more time consuming procedure and cannot be performed in outpatient conditions, and the success rate is 50 – 60 percent. It’s certainly a more complicated operation than a vasectomy. If this operation is not successful, another option is what is called microsurgical expiration of sperm or taking of a sperm sample under a microscope and their insertion in vitro into the egg of the partner. Artificial insemination is subsequently performed.
Dr. Josef Stolz MBA works as the head of the urological outpatient department at Canadian Medical Care and at Motol hospital. He is a specialist in andrology and uro-oncology and is the author of several professional articles. He also presents lectures.