Clearing the cancer doubts before the snip

Dear Dr. G,

I am in my late thirties and have a fear of becoming a father again.

My wife and I are blessed with two beautiful children, who are both in their teens.

I have nightmares about her getting pregnant again as the twins were born prematurely, and both my wife and I had such a horrible experience.

I am not a big fan of the condoms as I find this reduces the sensitivity of intimacy.

Besides, I am also allergic to latex.

We are currently relying on my wife taking the oral contraceptive pills. I am just a bit worried about its effectiveness since she became pregnant despite the pills.

I think God must be hearing my prayers, as the pregnancy did not go through the first trimester.

My wife has been suggesting that I go for a vasectomy after reading your column.

I understand your views about the ease of vasectomy and how men should take the lead in family planning and contraception.

I beg to defer as I don’t think you are too forthcoming with the link between prostate cancer and vasectomy.

Therefore, I am hoping to put Dr. G on the spot the clear the air.

Can you explain the recent article linking men who underwent vasectomy to prostate cancer? What is the mechanism of such adversity?

Is this procedure too early for the understanding of the true impact of such intervention?

Incidentally, what exactly is vasectomy and how is it different from ligation in women?

Non-supporter

Vasectomy is a surgical procedure for male contraception and sterilization. The operation essentially severs the continuity of the vas deferens, preventing sperms from entering the seminal fluid prior to ejaculation. This simple intervention is usually done in the clinic with a small incision under local anaesthesia. Such a mode of contraception is safe and more cost-effective, as compared to fallopian ligation in women, usually conducted under general anaesthesia with more complications. Many men are also pleasantly surprised after the vasectomy, as their libido, erectile rigidity and quality of ejaculation remain unaltered after the snip.

The acceptance of vasectomy in many countries has gained momentum amongst men actively participating in contraception. Ten per cent and 18% of men in the USA and New Zealand, respectively have had a vasectomy as a form of sterilization. However, some men are resisting the intervention due to a lack of awareness and fear of complications.

The potential adversity of vasectomy can be divided into short- and long-term complications. Common short-term complications such as bleeding, infections, pain and hematoma are usually self-limiting and affect less than 5% of men after the procedure. Long-term complications such as chronic testicular pain are also reported, affecting less than 1% of sufferers up to three months post-operatively. In recent years, the issues of the causative effect of vasectomy resulting in prostate cancer have compounded uncertainties in men contemplating the snip.

The first large-scale study in 2014 linking vasectomy to prostate cancer was highlighted in 2014. Although the exact etiology and mechanism are unknown, the study demonstrated a 10% increase in the risk of prostate cancer amongst men who had a vasectomy. As the study had generated some concerns, most healthcare professionals considered the evidence “weak” as it does not take into account more obvious cancer risks such as smoking and a sedentary lifestyle.

A more recent study published in the Journal of Clinical Oncology demonstrated no link between vasectomies with cancer. In a much larger study with a longer interval of follow-up, the researchers at the American Cancer Society analysed more than 363,000 men since 1982. This includes 42,000 known to have had vasectomies. In this study, about 7,400 participants died of prostate cancer over 30 years, and there is no difference in the cancer development between those who did and did not have the snip.

Benjamin Franklin once said: “He that is good for making excuses is seldom good for anything else”. Considering the certainty (and uncertainty) of scientific data linking vasectomy, it is natural for men to have doubts about vasectomy, with fear of getting prostate cancer in the future. Men who truly worry about prostate cancer should focus on reducing their exposure to cigarettes and a high-fat diet, as the link to prostate cancer is more well-established. Furthermore, in the latest research with the large number of participants, with more than 30 years of follow-up, there are no more excuses not to have the snip. When men are still having concerns about the risk of cancer after vasectomy is putting Dr. G on the spot to clear the doubts. His view is: “He that is good for making excuses for vasectomy is seldom good for anything else, when another unwanted pregnancy is a reality.”