Vasectomy: a definitive male contraception?

Crédit photo Creative Commons K. D. Schroeder

Unlike women, men have few contraceptives. Vasectomy is one of these means, but it has the particularity, compared to other possible means of contraception, of consisting of sterilization which may be irreversible.

A simple surgical procedure

Legal in France for adults since 2001, where it remains much less widespread than in the United States, Canada or Great Britain for example, vasectomy is a surgical procedure generally under local anesthesia, which lasts about twenty minutes. It consists, depending to various possible techniques (ligation, excision, cauterization…), in blocking the vas deferens. These usually carry spermatozoa produced by the testicles to the prostate and seminal vesicles. The occlusion of these channels then prevents the spermatozoa from being delivered.

After the operation, it takes three to four months for the spermatozoa that were lodged in the vas deferens before the operation to be evacuated following repeated ejaculations. To ensure total absence of spermatozoa, a sperm analysis must be performed in the laboratory (spermogram).

What impacts on sexuality?

If vasectomy affects fertility, it does not affect sexuality organo-physiologically. Thus, it does not consist of castration (the testicles are not affected by the operation), erection function is not affected, and the operated man continues to ejaculate. Only, his ejaculation is devoid of spermatozoa. But it continues to consist of other sperm secretions, which usually make up the nourishing medium of spermatozoa (Cowper’s gland secretions, prostate secretions, seminal vesicle fluid).

A psychological impact is possible, depending to men. Some men may feel affected in their virility, falsely associating vasectomy with a form of castration. Others, however, will feel better in their sexuality, no longer living with the anguish of unwanted fertilization.

Irreversible sterilization?

Vasectomy can be considered irreversible, as the procedure on the vas deferens cannot be cancelled. However, a surgical procedure that consists of “stitching” or repermeabilizing the channels is possible. This is called vasovasostomy. The effectiveness of this operation depends on many factors, such as age, the vasectomy technique used, the number of years between the vaso-vasostomy and the vasectomy. According to the summary document on the evaluation of sterilization techniques published in 2005 by the French High Authority for Health (HAS), the pregnancy rate after a vasovasostomy is between 40 and 50% only. It is therefore preferable to be sure of your choice. Semen storage prior to the procedure may also be considered for possible subsequent in vitro fertilization.