Vasectomy and the male pill
Vasectomy – will an alternative to this surgical male contraception appear?
For years, work on hormonal male contraception has been going on without success. The most promising is the work on combining progestogens with androgens (testosterone). The effectiveness of such preparations is not as high as that of hormonal contraception for women. Moreover, side effects occur much more often and are more serious.
Until recently, apart from the condom, men had no way to relieve their partners in this respect. Only the no-scalpel vasectomy, as a minimally invasive and painless method, enabled them to take this chivalrous duty on their own shoulders.
Vasectomy is, moreover, a reversible method. A man who has undergone a vasectomy can have children in the future. It suffices to have the separated vasa reconnected, i.e. a reversal (vasectomy reversal) – a microsurgical operation that nowadays has a very high success rate – or to undergo in vitro fertilisation, in which, after a vasectomy, sperm are retrieved directly from the testicles.
Work is also under way on other pharmacological forms of male contraception – but none of them has come close even to hormone-based approaches, let alone to vasectomy.
Evaluating vasectomy itself is complicated by the fact that many centres performing the procedure currently use completely different variants of the method. The vas may be cut, or a fragment excised; it may be closed by tying (clamping) with external ligatures, or clamped with a titanium clip. What is more, some centres bring one end outside the sheath of the spermatic cord. In some it is the testicular end that is brought out, in others the end leading to the prostate and penis. The opening in the sheath is also closed in different ways, sometimes with thread, sometimes with a titanium clip. Another variant is thermo- or electrocoagulation of the vas. Sometimes, without cutting the vas at all, it is heated from the outside over a few centimetres, causing it to shrink and become blocked. Mix all these variables together and you get dozens of no-scalpel vasectomy variants.
The American Urological Association is striving to standardise the way no-scalpel vasectomy is performed worldwide.