Don't make a snip decision unless you have all the facts."How about a little snip, snip?" my wife asked slyly, making a scissoring motion with the fingers of her right hand. I was naked, exposed, ready to step into the shower.
It was Saturday morning. The subject was contraception. The 'snip, snip' was her way of telling me to get fixed. I can't imagine a more emasculating reference.
Surely she knew - she had to know - how sensitive a subject this was. Like most guys, I'd spent years, from teendom until age 30, establishing my virility. Weights, sports, cars, dates.
Then came the ultimate proof: two of the cutest, smartest children on God's green earth. And now, cutting off the ability to reproduce at age 36 seemed such a waste. Not just for me, but for God's green earth, which can always use more cute, smart kids.
Factor in that I'd been trained since my earliest years never to put anything sharp near my testicles. My mind was made up.
No. The answer would be no. But then she upped the ante. She talked about sex, which she doesn't talk about, and hinted - kind of teased me - about the prospect of more, better sex. I think she used the word 'spontaneity'. I remembered I have a combi. Why should birth control be solely her responsibility?
But on the heels of that thought came other, darker ones. What if something happened to one of our kids, or even my wife? What if someday I wanted more children? What, I thought, though not seriously, about my trophy wife when I'm 50?
"Umm, I'll have to think about it," I said, climbing safely into the shower and jerking on the cold water. "It's a big deal."
"Does it have to be?" she said. Then this: "Let me know. I'll be waiting." Confused, I did what we Men's Health editors always do: I talked to our research department. They dug through tons of studies and consulted doctors who deal with this decision every day. Not just whether to have it done, but how, when, and why.
The resources and information they offered follow. My wife? She's waiting, and so am I. But neither one of us can wait forever.
The snip decision
A vasectomy may be a minor procedure, but it's a major decision. True, microsurgical reversal has a 40 to 73 percent chance of leading to a naturally conceived pregnancy (versus test-tube conception), but consider this: a vasectomy takes eight to 30 minutes, can cost as much as R5 000 (although you can get one for free if you choose), and may be covered (at least in part) by medical aid. A reversal takes about three-and-a-half-hours, costs as much as R30 000, and is minimally covered by insurance if it's covered at all.
"Men need to go into vasectomy thinking it's permanent," says surgeon Dr Marc Goldstein.
"I've been neutered" and other myths Vasectomy. Hear the word and thoughts naturally stray to that day Fido was fixed. Butts suddenly went unsniffed and couches unhumped; your wife started to call him 'It'. You never quite forgave yourself for neutering him, so how can you do it to yourself?
Firstly, it's a very different procedure. Your best friend was castrated; you're just cutting off your sperm supply, and that has no effect whatsoever on how horny you get, says Dr Joel Feigin.
Other urban legends...
You'll run dry Actually, only three percent of a man's ejaculate comes from his testicles, but that's where 100 percent of his sperm originates. Not only will you still be erupting at full capacity, but there will also be no change in the semen's colour, taste, texture or smell, says Feigin.
You'll have scars The two incisions made during a standard vasectomy are no longer than 1.5 centimetres and are sutured with one or two stitches. Within a few weeks of the procedure, all visible signs fade into the folds of the scrotum.
The preferred no-scalpel technique is even less invasive, requiring only a pinpoint puncture of the scrotal skin. The puncture virtually disappears from sight after surgery.
You'll get prostate cancer A few years ago, researchers noticed that men with vasectomies had higher rates of prostate cancer. Is there a link? Absolutely not, says urologist Dr Stephen Jones. "Men who get vasectomies go to urologists," he says.
"Therefore they're also getting rectal exams and blood tests that detect prostate cancer." In fact, studies show that men who have vasectomies are more likely to have their prostate cancer diagnosed in its early stages, when it's still treatable.
Don't go under the knife
Technically, you have two vasectomy options: scalpel or no-scalpel. Both are safe and medically proven, but if they were our eggs, we'd put them all in the no-scalpel basket. No-Scalpel Vasectomy (NSV) is up to 50 percent quicker, results in 10 times fewer complications, and, because there are no incisions or sutures, involves less bleeding and post-operative pain.
The caveat? NSV requires considerable skill. Find a doctor who performs a minimum of 25 procedures a year, says Dr Goldstein, who has performed 2 500 NSV surgeries since 1985.
How a No-Scalpel Vasectomy is performed
During NSV, the scrotum is anaesthetised with two injections. The surgeon isolates one of the vas deferens (the tubes that deliver sperm to the prostate gland) and makes a puncture two to five millimetres deep with dissecting forceps. The vas deferens is severed, cauterised and returned to the scrotum.
The opposite vas deferens is then extracted through the same hole, and the process is repeated. When it's all over, the puncture contracts to two to three millimetres in size, meaning no sutures are necessary. A dab of antibiotic ointment is applied, the puncture is dressed, and the patient is sent on his way.
Total elapsed time: 20 minutes, tops.
The pre-op checklist
Schedule the procedure for a Friday. You'll be in, out and back at work on Monday
Avoid aspirin
In the week before and after V day, avoid aspirin and anti-inflammatory analgesics like Advil (ibuprofen); they thin blood and can increase the risk of post-operative bleeding. Use a non-aspirin pain reliever, such as Tylenol.
Eat light
The anaesthetic (or the feeling of a needle piercing your privates) can induce nausea in rare cases.
Shave yourself
You'll need a R5-size bare spot in the middle of the scrotum, directly beneath the penis. If you don't want to get mowed by a nurse, do it yourself.
Prepare to indulge during recovery
Set up a recliner and a tray table in front of the TV with the essentials: list of shows, remote, magazines and bell to summon pity food. Add a small cooler of beer and you'll wonder why you didn't get snipped sooner.
The post-op checklist
To minimise strain, replace your boxers with a jock strap.
Keep your feet elevated for the first 24 hours aftersurgery.
Ice the area with a bag of frozen peas (it'll conform to irregular shapes better than an ice pack).
You can't participate in sex or sports for a week (watching is okay though).
To kill the itch when your hair resprouts - and believe us, it will itch - use a 50-50 mix of one percent hydrocortisone cream and Lamisil, both available over the counter of your friendly chemist.
Keep the condoms
It's been a week, and your soldier's ready for deployment. Better strap on some protection. Why? There's still some ammo left in the barrel. It takes approximately 15 post-vasectomy ejaculations for a man to be azoospermic (fancy way of saying 'without sperm'), says urologist Dr Richard Berger.
Doctors perform a first semen analysis after six weeks, and a second four to six weeks later. After two consecutive samples come back sperm-free, you can trash your Trojans.
What could go wrong?
The most common complication is haematoma, excessive post-op bleeding that causes the scrotum to swell, "sometimes to the size of a grapefruit," says Goldstein. Reoperation is sometimes needed to drain the blood.
This is why you want a no-scalpel vasectomy: haematoma is nearly 10 times less likely after NSV than after a standard scalpel vasectomy (one in 1 000 versus one in 100).
Why gentlemen get vasectomies
If you really want to impress a woman, get a vasectomy. Bilateral tubal ligations (tube-tying in women) still outnumber vasectomies by nearly two to one, despite the fact that tubal ligation can take three times longer than NSV and is 20 times more likely to lead to complications.
The reasons? One, guys traditionally haven't been responsible for sterilisation, and, two, they're scared. Get over it. Statistics show that a woman's risk of dying from tubal ligation is small, but real. No one dies from a vasectomy.
Where does all the sperm go?
Every day, your body produces 72 000 000 sperm. On average, if you ejaculate every three days, that's about six teaspoons a week, a cup a month, almost two litres a year. You may have been fixed, but that doesn't cut your production.
"All these millions of sperm make up only three percent of a man's ejaculate. They could fit on the head of a pin, but that's enough sperm to populate the whole of South Africa," notes Goldstein. A vasectomy prevents these sperm from mixing with the ejaculate. With no outlet, the sperm sit in the epididymis. After a few days they die and are flushed from your system.
There's no risk of accumulating sperm - unless you decide to have a reversal of your vasectomy. After you get snipped, traces of sperm inevitably leak into the bloodstream. Your system treats them like viral invaders and starts concocting antisperm antibodies. The antibodies aren't dangerous, but if you have a reversal down the road, they may keep you infertile.
