7 vasectomy myths and the truth about them

Myth 1: Vasectomy affects sexual function and pleasure

Sexual pleasure—for yourself and your partner—has nothing to do with the ability to father children. Research shows that a vasectomy does not in any way diminish libido, virility, sexual pleasure, the ability to have an erection, the ability to orgasm or to give pleasure. Here’s why:

• There’s no change in the level of testosterone in the body, as the procedure only involves the vas deferens (the vas deferens is a muscular tube that carries sperm from the testes to the urethra). Testosterone is produced in the testes.
• There’s only a minuscule reduction of about 0.3ml in the ejaculate of men who have a vasectomy, as 95% of ejaculate is made by the prostate and the vesiculae. This finding was based on a study on 204 men who had had a vasectomy.
• There’s research to show that the sex is equally satisfying for females and possibly more satisfying for males after a vasectomy: According to a survey of 294 couples—where 90 men took the International Index for Erectile Function survey and 74 females completed the Female Sexual Function Index questionnaire—there was no perceptible change in the female partner’s sexual satisfaction after a vasectomy. Male partners reported slightly better results on erectile function, orgasm, sexual desire and intercourse satisfaction.

Studies and analyses so far have shown that there is no reduction in sexual function or satisfaction after a vasectomy. Still, researchers understand the concern around it and more studies are underway to make sure of this—researchers at the Chengdu University of Traditional Chinese Medicine has started a new meta-analysis on vasectomy and male sexual dysfunction that will include data and trials up to November 2021.

A vasectomy is usually done under local anaesthesia and takes about 30 minutes. It is a minimally invasive, low-risk surgery. Most patients experience mild swelling, testicular pain or discomfort in the testes and/or at the site where the urologist makes a small incision to cut and tie up the ends of the vas deferens. This swelling and pain usually go away on their own in one to three weeks.

Five patients in a hundred may experience post-vasectomy pain syndrome, or pain in the testes for several months—patients reported more pain with scalpel use than non-scalpel surgery. It is a good idea to see your doctor if you get a vasectomy and your pain hasn’t subsided even after a fortnight to three weeks.

There is a very small chance that some patients may see a little bit of blood in their semen the first time they ejaculate after a vasectomy, but this is nothing to worry about. (If the bleeding persists, they should, of course, see a doctor.)

Patients typically make a full recovery within days, though they are recommended to avoid lifting heavy objects and strenuous exercise for a week to 10 days. Patients are also advised against ejaculating for a week after the surgery—this means no sex, no masturbation for at least seven days. But that’s pretty much all the precautions for most men who get a vasectomy.

Around 30 years ago, some American studies put a question mark over whether a vasectomy could lead to prostate cancer later in life. Those studies have since been debunked. According to an article published in the Bulletin of the World Health Organization in 1994, the association between vasectomy and prostate cancer was “weak” and certainly not enough to change the global guidelines on vasectomy. The author said the weak association may even be the result of poor methodology of those earlier studies.

Vasectomy is also not considered a risk factor for testicular cancer. A meta-analysis of existing research by the American Urological Association found “no significant difference between groups in terms of the odds of being diagnosed with testicular cancer for vasectomized men compared with non-vasectomized men”.

The American Urological Association does not consider vasectomy a risk factor for primary progressive aphasia and other types of dementia. The reason, according to the AUA 2015 vasectomy guidelines, is that there simply aren’t enough studies to prove a connection. And the one study that did, was small and of “uncertain significance”. Additionally, this study said that anti-sperm antibodies were responsible for the link between vasectomy and dementia. However, a later study found no link between these antibodies and dementia or language ability.

Sperm can still be present and active in the section of the vas deferens that is left attached to the urethra. This can cause unintended pregnancies in the first year after a vasectomy. To avoid this, doctors advise using additional means of contraceptive for roughly three months or 20 ejaculations—it is a good idea to see a doctor before you depend on a vasectomy as the only contraceptive method.

Vasectomy reversal is slightly more complex than a vasectomy—the reversal does not work some of the time and the chances of reversing a vasectomy go down significantly 10 years after the procedure. That is why doctors counsel you and ask if you have any children before you get a vasectomy.

STDs or sexually transmitted diseases like HIV/AIDS and syphilis can be transmitted through semen. Sperm makes up 2-5% of semen. The rest of the semen is composed of:

• 60% fluid from seminal vesicles. This fluid contains fructose, amino acids, citric acid, phosphorus, potassium and prostaglandins.
• 30% fluid from the prostate. This fluid contains citric acid, acid phosphatase, calcium, sodium, zinc, potassium, protein-splitting enzymes and an enzyme called fibrolysin which reduces blood and tissue fibres.
• The remainder is thick, clear, lubricating mucus from the bulbourethral and urethral glands.

Even in the absence of sperm, semen can transmit STDs during unprotected sex, including unprotected oral sex and unprotected anal sex.

A vasectomy is the most effective and long-lasting solution for male contraception. It is a low-risk procedure, and most patients can get back to their normal day-to-day routine within a week. It is advisable to avoid sex for a few weeks after a vasectomy, and use protection to avoid unwanted pregnancy for the next few months (or 20 ejaculations).

Importantly, a vasectomy does not affect the level of sexual desire, performance or satisfaction. It also does not affect muscle mass (linked to testosterone). While a vasectomy can—after a few months—prevent pregnancy, it cannot stop the transmission of STDs. Meaning, you should still use a condom and practise all the precautions of safe sex after you've had a vasectomy.

Some of the popular myths around vasectomy are not just unfounded, they can actually be harmful to the health and well-being of your family. If you are considering a vasectomy, do talk to your partner and figure out if you may want children in the future—a vasectomy isn't always reversible and the chances of reversing it successfully go down as time passes.