Dear Dr G,

My wife and I are blessed with two beautiful children, 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 a terrible experience.

As my wife approaches her forties in 2025, I am also worried about the risks of a high-risk pregnancy at this age.

I am not a fan of condoms as I find they reduce the sensitivity of intimacy, and I am also allergic to latex. We currently rely on my wife taking oral contraceptive pills. I am concerned about her constantly taking medication, as she suffers from side effects including weight gain.

My wife has suggested I consider a vasectomy after reading your column. I understand your views on the simplicity of vasectomy and how men should take the lead in family planning and contraception.

However, I disagree because I believe you have not been forthright about the link between vasectomy and prostate cancer. Therefore, I hope to put Dr G on the spot to clarify this issue.

Can you explain the link between men who have undergone vasectomy and prostate cancer? What is the mechanism of such a risk? Incidentally, what exactly is a vasectomy and how is it different from ligation in women?

Yours truly,

Reluctant Raymond

A vasectomy is a surgical procedure for male contraception and sterilisation. The operation involves severing the vas deferens, preventing sperm from mixing with seminal fluid before ejaculation. The acceptance of a vasectomy in many countries has increased among men actively participating in contraception. In the USA and New Zealand, 10% and 18% of men, respectively, have undergone vasectomy as a form of sterilisation.

However, some men resist the procedure due to a lack of awareness and fear of complications; a vasectomy is generally a simple procedure, usually performed in the clinic under local anaesthesia. Small incisions are made on both sides of the scrotal skin to remove a segment of the vas deferens.

This method of contraception carries negligible risks and is generally more cost-effective. In comparison, sterilisation in women such as fallopian tube ligation is usually conducted under general anaesthesia and is associated with more complications.

Many men are pleasantly surprised that their libido, erectile function and ejaculation quality remain unchanged after a vasectomy.

The potential adverse effects of a vasectomy can be divided into short- and long-term complications. Common short-term complications, such as bleeding, infections, pain and haematoma, are usually self-limiting and affect less than 5% of men after the procedure. Long-term complications like chronic testicular pain have also been reported, affecting less than 1% of patients up to three months post-operatively.

In recent years, concerns about the possible link between vasectomy and prostate cancer have added to the uncertainties faced by men considering the procedure. This fear originates from a study that linked vasectomy to cancer. The first large-scale study in 2014 highlighted this potential link. Although the exact cause and mechanism remain unknown, the study showed a 10% increase in the risk of prostate cancer among men who had a vasectomy.

Despite the concerns raised by the study, most healthcare professionals consider the evidence weak, as it does not account for more significant cancer risk factors such as smoking and a sedentary lifestyle.

A more recent study published in the Journal of Clinical Oncology found no link between vasectomy and cancer. This larger study, with a longer follow-up period, involved researchers from the American Cancer Society who analysed more than 363,000 men since 1982, including 42,000 who had undergone vasectomy. Approximately 7,400 participants died of prostate cancer over 30 years, with no difference in cancer development between those who had the procedure and those who did not. With such robust evidence challenging the earlier publication, the association between vasectomy and prostate cancer has generally been dismissed.

Given the certainty of scientific data linking vasectomy to prostate cancer, it is natural for men to have doubts about the procedure due to fears of future cancer risk. However, men concerned about prostate cancer should focus on reducing exposure to cigarettes and high-fat diets, as these are more well-established risk factors.

Furthermore, with the latest research involving a large number of participants and more than 30 years of follow-up, there are no more excuses not to consider the procedure.

When men continue to have concerns about cancer risks after vasectomy, they put Dr G on the spot to debunk the myths. He believes that “he that is good for making excuses for vasectomy is seldom good for anything else, especially when facing an unwanted pregnancy.”

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