Are you ready for a vasectomy?

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.

Get It On(line)

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Four Play

How Long Is Long Enough?

According to a study by the University of New Brunswick in Canada, foreplay lasts an average of 12 minutes, and women would like it to go on for an average of ab out 18 . But a by-the-minute approach is the wrong way to think about it . Dee Mc Donald, founder of The Centre for Sexual Wellbeing in London, says she’d really like “people to forget the concept of ‘fore’ and simply play more throughout their sexual activity”.

1. It’s the shift
Real life isn’t sexy. Yet all too often we expect our partners to make a seamless transition from harried mom and/or overworked career to the tantalising courtesan of our dreams. Foreplay allows both of you to make the transition between “real” life and a more magic space. This is especially important for women. “In my research, I’ve found that there are literally hundreds of things that can shut down a woman’s arousal process, from worrying about work and kids to whether or not their legs are shaven,” says sexologist Dr Robin Milhausen. “Obviously, that’s a really problematic situation for men. So it’s very helpful for them to know what they can do to help their partner to stay actively engaged, excited and passionate.”

2. Foreplay closes the gap
Women take longer to become aroused. Without some stimulation before the main event, she’ll just be getting warmed up as you’re rolling over for a nap. “Since the number of women who reach climax just by vaginal penetration is limited,” says sexual therapist Miguel Cuetos, “men need to forget about coitus for a while and concentrate instead on sexual games beforehand, so that she can have one or more orgasms – even without penetration.” The quality of her orgasm will also be Four reasons why foreplay is so important Four Play better if you take your time. “You don’t take your expensive sports car from zero to 60 in the winter, do you?” asks Japanese-German sex educator Midori, author of Wild Side Sex (R186 www.kalahari.net). “If you want the best performance, you warm it up first.”

3. It syncs her up
Great sex is essentially a battle between two parts of the nervous system, the sympathetic and the parasympathetic. Her sympathetic nervous system is what kicks into high gear when she’s confronted by a bear or Brad Pitt in his boxers. Her pupils dilate, her heart rate speeds up, she breaks out into a light sweat and heavy breathing begins. But her parasympathetic system is what calms her down enough to enable her to have an orgasm – and it’s really important for women. In fact, a Swedish study discovered that it was totally impossible for a woman to have an orgasm if the part of her brain that processes anxiety was activated. In short, great sex is essentially a combination of stimulation and relaxation – a difficult balance to achieve. That’s where foreplay comes in.

4. Communicate
Foreplay is the handsdown best way to get to know your partner’s body – what she likes and doesn’t like, what makes her crazy, what leaves her cold. “No matter what you might read in magazines, orgasm isn’t the sole objective,” says British sex journalist Megan Roberts. “Conentrate instead on getting to know her, and her body – and tell her equally what she can do to turn you on.”

1. What’s good for her is good for you
The more foreplay you engage in, the more she’s going to enjoy the sex, and the more she enjoys the sex, the more sex she’s going to want to have. So you win right off the bat. And don’t forget that the more turned on she is, the more likely she is to agree to more creative positions or fantasy play. “Spend extra time focusing on each other’s body and your intercourse will be more action-packed,” says Dr Carol Queen, author of Exhibitionism For the Shy (R187 www.kalahari. net). The skilled knowledge of her body that comes with good exploratory foreplay will surely come in handy during your next quickie, allowing you to rev her engines more quickly.

2. Better sex for you!
You know that the longer you hold off from direct genital contact, the better it feels when it happens. And staying aroused for a long time before ejaculation is the ticket to a mind-blowing
orgasm.

3. Sex is fun again!
There’s quite a lot of anxiety that goes along with sex in the modern world. (Am I big enough? Am I going to stay hard? Am I doing it right?) But there’s no such thing as “doing it wrong”. As Dr Michelle Grahame, of British adult toyshop www.nookii.com, says: “Sex isn’t about bits and pieces – doing this or that to her G-spot for x number of minutes. It’s about intimacy, imagination and two people having a bit of fun!” By making exploration and discovery the goal – as opposed to how to get one another off in the least amount of time possible – you remove some of the anxiety that’s crept into our sex lives – and bring some fun back into it.

4. Who said it had to be all about her?
It’s worth mentioning that although we sometimes tend to think of foreplay as exclusive attention to her, many women find the idea of pleasuring you an exciting way to begin the lovemaking process.

Sharing is not caring

How to tell her not to share your sex life with her friends.

My wife discusses our sex life with her friends. How do I tell her I’m not comfortable with it?

Women often have the tendency to talk about their sex lives with their close friends (ever watched Sex and the City?) Sadly for you, it doesn’t just happen in the movies. That doesn’t mean it’s not important to think about your partner and the spoken – or unspoken – rules of your relationship. If you’re not comforted knowing it’s classic female behaviour, approach your wife in a friendly, relaxed manner and explain your feelings. She’s bound to ask why, so have some ammunition. Think about good reasons why she shouldn’t be blabbing. Some possiblities: you’ll feel uncomfortable when you see the friends again; you’re a “private” person and would like to keep your sex life private; you’re embarrassed and worry about who else they’re going to tell; or you feel your sex life is sacred and should be kept between the two of you. And the clincher: ask her how she’d feel if you were oversharing with your buddies. Keep the conversation focused on how you feel and don’t get angry.

Be her do-right man

A guide to common bedroom mistakes made by men. With, of course, gentle corrections.

You know how public pools post lists of unacceptable behaviour? Don’t run, don’t dive, don’t vomit a fillet steak and a bottle of Cabernet Franc into our brand-new filtration system. Be assured that this is the last time I will ever liken my vagina to a public pool, but I’ve always thought how great it would be to post something similar in my own bedroom. Look, we love that you love having sex with us, and we love having sex with you, too. But sometimes you do things that we don’t like. Weird things. Things that you think are going to make us groan with gratitude and pleasure but really make us want to roll over and turn on the TV. Luckily, these mistakes generally result not from lack of skill but from wrong information. You can easily unlearn them. Remember: I probably know what I like better than you do. And if I had a bedroom sign, this is how it might read.

DO NOT ASK, "WHAT DO YOU LIKE?"
the first time we have sex. It's our third date. Okay, so maybe it's only the second, or maybe we just met in an elevator. At any rate, we're making out. Pants are coming off, eyes are smouldering. You ask this question and, bam... the magic is gone. First, I am embarrassed.

I may have been ready to have sex, but not so up for talking about it! Second, I feel pressured to provide a provocative answer, something involving toys or systematic humiliation, but the only thing I can think of to say is, "Well, Steve, I suppose I like manual and oral stimulation followed by intercourse resulting in my eventual orgasm." Finally, I am annoyed. Are you trying to sound sexy, wild, open to anything? Because if you are, won't I eventually discover that?

DO...
ask questions later. Questions help an ongoing sexual relationship move forward. They slow a new one down.

DO NOT STICK YOUR TONGUE IN MY EAR
The innocent, unfortunate ear (a) is a semi-discreet spot, (b) is a hole and (c) has folds. For these reasons, it has been ill-defined as a major erogenous zone. This is one of the great misperceptions in the history of Western civilisation.

DO...
tread lightly. I'm not saying never go for the ear. Just not every time. When you do, the ear is to be kissed gently, maybe licked on the edges, or nibbled with restraint. Then you can leave it alone. It's an ear.

DO NOT TRY TO STUFF YOUR SEMI-HARD PENIS INSIDE MY VAGINA
I understand: you're hoping it will get harder once it's in. Or you're thinking that if you act like everything's fine, then everything will be fine. Or maybe you're treating your penis like a stubborn teenager - you're going to show him who's boss and send him to his room. The only thing more humiliating than stuffing a flaccid penis inside someone is being stuffed by a flaccid penis. In this one wretched act, we can feel all of your fear, desperation and insecurity, concentrated in the precise place where you want us to feel something else.

DO...
anything but this. Kiss. Watch The OC. Order a pizza. Unless it's a recurring problem requiring medical or psychiatric attention, it's not a big deal. Really.

DO NOT REACH FOR MY CLITORIS
if you are in a position that is unsuitable for such a connection. Like when I'm clearly enjoying whatever we're doing. Or, say, if you're in the lounge watching TV and I'm in the kitchen making brisket. Such persistence is not admirable; it's annoying. It's good that you know clitoral stimulation is important. Now you need to know that if it's not done right - the right angle and pressure, the right motion - then it doesn't feel good, and it may even hurt.

DO...
ask. It might help to take her hand and say, "Show me what you like here". Then you can follow the motion of her hand, or she can guide yours until you've fi gured it out. In certain positions, a woman just doesn't want stimulation there, or prefers to do it herself.

DO NOT SHAVE YOUR BALLS
Having sex with a guy who shaves his balls is like riding a horse with a saddle made of broken glass. If you are going to shave, you're going to have to do it regularly. Say, every half hour.

DO...
embrace your hairiness. Unless you come up with a dignifi ed solution - and they are expensive - try to accept your body hair. You're a guy. Your greatgreat- grandfather was a gorilla.

DO NOT HAVE A NERVOUS BREAKDOWN
about ejaculating too fast, losing your erection or not being able to get one. An occasionally temperamental penis is no cause for alarm - but a guy who freaks out about it is. (If you make a big deal about it, we'll start to think maybe it really is a big deal.) Conversely, it's also not a good idea to act as if nothing happened, because, well, that is just bull, and that never flies.

DO...
acknowledge it, then laugh it off. The guy who says, "Wow, I usually only last for fi ve seconds, so that was a record" or "Gee, I guess those amazing anti-erection pills I got online are working" - that's the kind of guy who makes us want to try again. Later.

Take her for a ride

The five best techniques for action in motion.

1. Stick her into gear Research by Holiday Cars shows that one in five customers hires a car just to try out the suspension. If you don’t want to be caught out by an eagle-eyed traffic cop, go somewhere secluded, and get the windows steamed before you really get down to it. “Push the passenger seat back and have her lie down flat on it,” says sex therapist Dr Michael Seiler. “Straddle her, using the seat for support. She can go on top if she is much smaller than you, but be careful, if she tumbles off the seat, somebody could get hurt.” Especially at 140km.

2. Take her to new heights Having sex at 30 000 feet is illegal. But if you can’t resist joining the mile high club, your best time to try is either straight after take-off, or 15 minutes into the film – when the least passengers will be milling around. Get seats at the back and then have her head for the bathroom. Wait two minutes then follow her. “Once you are in, place her hands on the wall as if you are going to frisk her. Pull her hips back and enter her,” says R Don Steele,author of Body Language Secrets: A Guide During Courtship and Dating. To get away, you should feign illness, while she does sick-bag duty. Genius.

3. Elevate your sex drive “People often make lift fantasies come true in hotels,” says Patricia Love, author of Hot Monogamy. One of you needs to keep your thumb on the “doors close” button. Hit stop when you are between floors. You’ll have about three minutes before people start prying. For a truly private session find a goods lift – they won’t have a camera.

SEX FACTS 68 Percentage of people who have had sex in a car. One in 10 say they had even got busy while driving. Six percent said they had damaged their vehicles while getting busy – but only one in 100 of these were bold enough to claim on their insurance. Source: www.ananova.com

4. Enter the tunnel Trains can be risky, but the fear of getting caught should heighten your senses and make the frisky business all that more exciting. “It will focus you on the sexual experience,” says sexologist Carol McQueen. Get tickets for a night train, and enjoy your breakfast in bed.

5. Float her boat Grab your lilo and head for the sea. Aim for the sunset – not only is it romantic, but there will be fewer prying eyes on the shore. “You can play under the surface, which adds tension,” says clinical sexologist Gloria Brame. Have her lie on her front across the middle of the lilo and take her from behind. Bring some silicone-based lube that won’t wash off in your exploits.

Coping with STDs

The syphilised man by Ron Geraci.
How to broach the subject of your partners' sexual history.

My second-favourite boxers were at my knees. “Look at that,” I said to Dr Brudersky. He turned my snake with a latexed finger, then retrieved a magnifying glass that looked like a Sherlock Holmes prop. “Mmm... that,” he said, eyeing the marble-sized, sandpapered red patch that my penis had sprouted four days before. “That’s nothing. A little trauma.”

“Trauma from what?” “You tell me,” he said. “I’ve never seen that before,” I pleaded. I questioned him about the opposites of best-case scenarios. He mentioned herpes, then scoffed the way doctors scoff when they send patients home with apple-sized brain tumours.

“Come back in two weeks if it’s still there. I’m fairly sure it’s nothing.” I leant towards him. “Swear on the baby Christ,” I demanded.

I’ve been terrified of STDs since my first run-in with them in 1977. Mr Jeffers, the perm-and-headband-wearing biology teacher, taught the first sexeducation class for boys in our school. Lacking a filmstrip that showed weeping genital ulcers, Jeffers gave his own, graphic explanation of VD: peeing burns. Sores on your thingy. Scarred for life. Women can get it and give it to their babies.

“I’ve got VD!” I wailed.

I tugged on his lime green velour tracksuit. “How does a girl get it?” I asked tentatively. His weak smile turned devilish. “By having sex too many times.”

Walking home, I made neurotic computations of my mother’s tally. Me. My brother. Two sisters. God knew how many other times. A block from home I realised it burnt when I pissed. I bit my forearm in terror, ran the last block and slammed myself upstairs. Seeing my unusual devastation before dinner, my mother questioned me until I finally broke.

“I’ve got VD!” I wailed.

She paused and leant back. She wanted to know how I got it. My face turned to fury. What nerve! I cocked my finger like a .357. “I got it from you!”

She blinked a few times. Then she asked for details of the crime. I pointed to the photos on our piano, then to my dad reading obliviously in the kitchen. “That’s four right there,” I spat. “And he said you get it from having sex too many times.” My mother put her palms into her eye sockets. “Not with the same person!” she screamed, rattling knickknacks.

Escaping the whole villainous lot - from chlamydia to Aids - has been 10 percent smarts and 90 percent dumb luck. I know that. But at 32, I can’t blow the perfect game now. Who could have given me herpes? I smouldered as I went over the list. Delia? Those three moronic romps with Hayley? Good God... Teri? Maybe it was a long-fused bomb from Tracy, that waitress from the pizza takeaway 16 years ago. After my night with her, I remember my 75-year-old dad, in his slippers, pushing open the bathroom door at 5am to find me scrubbing my penis with the cat’s flea shampoo. He cursed inaudibly and shuffled back into his room, likely figuring the road ahead would require more heel leather than he had left.

The night of my doctor’s visit, Teri came over. She was tearing at a pizza. “We’ve never talked about... a few important things,” I said. She bit into a slice. “Like?” Like the humorous little issues of what we might have done with whom,and if we might still need pills or creams for it, I suggested. “I thought we said we were both healthy.”

I explained that our seven-second talk while straddling the ottoman on date four wasn’t exactly full disclosure. She agreed. She asked how many women I’ve had sex with. I did trigonometry in the air. I mumbled a number. It wasn’t quite the legal drinking age. “That’s not... bad,” she replied. “You?” I said. “A couple more.” Her mouth wavered. “Maybe... double yours. Plus a few.” My beer glass started sliding through my fingers. My expression was not controllable. A violent argument ensued. “What, you want me to get tested?” she exploded. “As if that’s even your place to ask. Ever thought that maybe I want you to get tested!”

“I’ll get tested,” I said calmly. “And I think I actually do have the right to... Teri, that’s not what I mean. I just wish we’d talked abou-”

“Walk me to the door,” she ordered.“Teri, I am not saying you’re... promiscuous, for God’s sake,” I said softly.

“That’s what it felt like,” she said. “And I have no ammunition to retaliate against that.” We went downstairs without a word and I watched her car speed off down the road. Something bad just happened, thought. I still don’t know what. I don’t care about how many men she’s slept with. At least, consciously, I don’t care.

She took my four phone calls but was terse. You get to a point where you can’t apologise anymore. Unheard regret and confusion start to fester in you and you can’t apologise even once more. You can sit dazed like you’ve caught shrapnel in the head, but the sorry talk and flowers are eventually done. Then, after that, maybe you hope a magazine subscription will budge something.

Brudersky’s office called on Tuesday to see if I still needed the follow-up appointment. I walked to the john. No red mark. I had no idea how long it had been gone.