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MALE STERILIZATION

Vasectomy is a simple surgical procedure that consists of cutting and tying each vas deferens (the tube that carries sperm). The operation is usually done using local anesthesia in a doctor's office or clinic and requires only about fifteen or twenty minutes. The man can then go home, although it is usually advisable to avoid strenuous physical activity for a day or two afterward.

Vasectomy does not stop sperm production; it blocks the passage of sperm from the testes to the upper part of the vas deferens. Sperm then accumulate in the epididymis (a mass of tubes at the back of each testis), where they are engulfed and destroyed by cells called phagocytes. Some sperm appear to leak out into the scrotum, where they disintegrate. Because some sperm are already above the point where the vasectomy was done, it usually takes six to eight weeks (about a dozen ejaculations) after this operation before the ejaculate is sterile (contains no sperm). For this reason, the man and his sex partner should use another method of birth control until at least two consecutive semen exams show that no sperm are present.

Vasectomy does not affect hormone production and does not interfere in any way with erection or ejaculation. The amount of the ejaculate is almost unchanged, since secretions from the testis and epididymis account for less than 5 percent of the volume of seminal fluid. There are no long-range health risks created by vasectomy.

Vasectomy is the simplest and safest form of surgical contraception: the failure rate is a very low 0.15 percent. Failures occur either because of unprotected intercourse before all sperm have disappeared from the ejaculate, mistakes in performing the operation, or, very rarely, because the cut ends of the vas have grown back together. The rate of medical complications such as bleeding or infection is less than 5 percent, although minor swelling, pain, and temporary skin discoloration due to bruising occur in about half of men after this procedure. Postoperative ice packs and a well-fitted athletic supporter can reduce discomfort.

Less than one man in twenty reports decreased sexual pleasure after a vasectomy, while close to half claim increased pleasure and about a quarter report an increased frequency of intercourse. In fact, many couples find that sex is more spontaneous and fun after a vasectomy since they don't need to worry about becoming pregnant or using other contraceptive methods. Men who have a history of sexual problems are not always good candidates for vasectomy, since they may be more prone to developing psychological impotence or other difficulties after such surgery. For some couples, there may be a drop in marital harmony after a vasectomy, because the man expected special recognition or gratitude from his wife in return for having the surgery or because the wife resents not being able to have additional children. Occasionally, a man who has been well adjusted to a vasectomy may become impotent (usually temporarily) if he divorces and then remarries, particularly if he and his new wife would like to have children. More typical, however, is this comment from a thirty-year-old man six months after his vasectomy: "It was simple and quick and did the trick. Now sex is really making love, without worrying about 'accidents.' "

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Men's Health Erectyle Dysfunction