To Snip Or Not To Snip

What you need to know about vasectomies before taking the cut.

IN modern society, we make decisions based on our knowledge. Detailed understanding of certain subject matter will allow us to weigh the pros and cons before making any judgment.

The principle of informed consent for patients’ care is fundamentally based on the same philosophy. As healthcare providers, our main role is to help patients to figure out the benefits and risks, before embarking on a treatment decision.

In reality, the benefits and risks may not be as clear-cut as we would like them to be. The father of modern medicine, William Osler, once described elegantly: “Medicine is a science of uncertainty and the art of probability”

In the Internet era of information overload, is overwhelming data improving the clarity of uncertainty or clouding the lucidity of probability? Lets deal with a confused reader’s questions about the vasectomy procedure after he discovered a piece of scientific journalism from Harvard Medical School, no less!

Dear Dr. G,
Thanks for answering my question.
I am 36 Years old and my wife is also same age as me. We have been married for 12 years.
We have three beautiful kids. Our youngest, is now 9 months old, and to be perfectly honest, wasn’t exactly planned.

Since the birth of baby Joe, my wife and I have been rather apprehensive about having another “accident”. Personally, I don’t think I have the financial ability or energy to father another child.

My wife who was previously on the pill had refused to go on the contraception again as she had put on a lot of weight since the last pregnancy.

I had been had been contemplating doing a vasectomy for several years. Of course, the issue has becomes more pressing in recent months.

I have been put off by a study I read. I understand it was a research work done in Harvard that showed men with vasectomy are more likely to contract prostate cancer. Apparently, the younger you are, the higher risk of the cancer.

I mean studies from Harvard? Surely there is some truth in it.

Can you please let me know what exactly the vasectomy is? What exactly are the associations with cancer? Thanks in advance.

Regards
Confused

Vasectomy is a simple procedure carried out with the intention of restricting the flow of sperm in terms of reaching seminal secretion. Although it is a form of contraception that may be reversible, for most men it is considered sterilization, as the process is mostly considered permanent. Such intervention is accepted by 15% of men in the USA as the form of family planning.

The practice of the vasectomy is simply the excision and ligation of the vas deferens, which is the tube that delivers sperms to the outside world. Such a procedure is done either using local or general anesthesia. In fact, the interruption of this “delivery tube” should have no impact on the production or release of male hormone. Hence, it definitely has no impact on sexual libido.

The pelvic vessels only provide the blood and nerve supplies to the penis; therefore the erectile rigidity and sensation during intimacy are also unaffected by vasectomy.

So, what is the deal with the Harvard study? This is a US research project which followed 49,405 men over 24 years, a quarter of whom have had a vasectomy. So, the study made a comparison between men who developed prostate cancers and those who did not in the follow up period. This study was published in a peer reviewed Journal of Clinical Oncology.

During the period, it was noted that 12.4% of those who had had a vasectomy developed prostate cancer, compared with 12.1% of those who hadn’t. Although the absolute risk (Absolute difference in the incidence rate) is 0.3%, statistically this translates to 10% increase in risk of prostate cancer.

The same study also demonstrated an association of 19% increased risk of more aggressive cancer that had spread to other organs or causes death in the vasectomy group.

The Press in the West of course was very “excited” with the findings. However, the Telegraph and the Guardian reports of the men who had the vasectomies at younger age were at greatest risk, were not really supported by the research.

Overall, this is a large size and long follow-up study, which had adjustments for many factors of the participants. Having said that, such cohort study cannot really demonstrate causation, as there are other confounders remaining.

In reality, the men who had vasectomies were actually monitored a lot closer with more frequent prostate cancer blood tests PSA, than the non-operated group. That may account for the small 0.3% difference in the incidence of cancer.

Overall, I think the conclusions of the study are interesting and worthy of further research. But men who have had the surgery or those who are contemplating the snip, should not be overly concerned by these findings.

Isaac Newton once said: “A man may imagine things that are false, but he can only understand things that are true. For things that are false, the apprehension of them is not understood”. So, in reality, I think the only fact you need to understand is, the birth of another child will bring more apprehension. So, to snip or not to snip, that is the big question!