NSV - The Book - 003
The Possible Complications
Right Away:
Syncope: That’s the medical term for fainting. One particular subtype, vaso-vagal syncope, happens to certain prone individuals when they experience a noxious stimulus, like the sight of blood, the smell of cautery, the idea of vasectomy, to cite but a few examples. It’s like a sudden panic attack, then the nervous system over-reacts to it’s own adrenaline and pumps out a bunch of vasodilators; chemicals that relax blood vessels, particularly in the abdomen and extremities. As blood pools to these areas the blood pressure drops and the person feels faint, dizzy and clammy or may even pass out briefly.
In the First 10 Days:
Hematoma: This results from bleeding into the scrotum. It can get large and painful, and turn the scrotum black and blue. Incidence with conventional vasectomy is around 3%. The NSV literature puts it at 0.3%, but I’ve only seen 3 “big ones” in 15,000 (0.03%).
Infection: Minor infections occur in about 1 to 2% of patients. Serious infections, requiring intravenous antibiotics or drainage of an abscess occur in about 0.2% of cases. Even these rare and serious infections usually resolve completely in a few weeks.
Vasitis or Epididymitis: Inflammation and swelling of the tissue surrounding the vas or extending down around the epididymis (the part just below the vas that joins it to the testicle) occurs about 10% of the time. It’s usually mild and transient, no bigger than a grape, but rarely this can get to the size of “a third testicle”. Needless to say, this can be painful, but this too will settle with religious use of industrial strength non-steroidal anti-inflammatory drugs (NSAIDs), but it can sometimes take a few weeks to settle down. Given that swelling is what the male genitalia like to do best, all this is not surprising. In fact, inflammation and erection both produce swelling through almost identical biochemical pathways. That is why I encourage the liberal use of ibuprofen or other NSAIDs for a full week post-op, even if you're not having pain. Tylenol is usually not as effective for this.
Later:
Sperm Granuloma: This as a small inflammatory lump which can occur near the cut end of the vas or in the epididymis weeks or even months after surgery. It can be painful, but it’s not serious and usually resolves with a short course of an NSAID like ibuprofen.
Chronic Post-vasectomy Pain: This is rare. Most pain settles within 1 to 2 weeks with NSAIDs, if you take them. If this doesn’t work then a longer, stronger NSAID is required. In about 1 per 1000 pain will persist beyond this and a number of other approaches may be tried, including anti-depressant meds or other “pain modulating” drugs. An exact cause of the ongoing pain is usually not apparent, but this condition appears to be similar to other chronic pain syndromes in that pain pathways in the spinal cord and brain appear to be active in the absence of any apparent ongoing stimulus. Surgery to reverse the vasectomy is a last resort and is said to be 85% successful. For some strange bureaucratic reason BC Medical will not cover the cost of reversal even in this medically indicated situation. (Talk to your MLA!) Converting a “close-ended” vasectomy to an “open-ended” vasectomy has been recommended by some but this has not been shown to be effective.
NOTE!
If you are still experiencing pain or discomfort after a month, don’t ignore it. Come and see me.
Regret: About 2% of men come to regret having had their vasectomy. Typically it is a man who finds himself in a new marriage, typically with a younger partner who would like a child. These days some men seem to be getting vasectomies younger. I just hope they (and you) don’t come to regret it down the road. So, “BE SURE!”
The Risk of Prostate Cancer: NO! Vasectomy does not increase the risk of prostate cancer. Back in 1992 some large studies suggested an increased incidence of prostate cancer in men who had been vasectomized. By 1994, after careful review of the old data and through subsequent studies expert panels of urologists and oncologists concluded that was not the case. They explained that the earlier conclusions were flawed by “selection bias”. Statisticians explain it like this:
Men who have undergone vasectomy have seen a doctor and are, demographically speaking, better educated and health conscious relative to the average, unvasectomized “Joe” who would never see a doctor for a vasectomy, let alone a prostate check. When new studies controlled for this bias they found that vasectomy does not increase the risk of any cancers or any other diseases. Some studies even suggested that vasectomized men actually live longer, but again, this is probably just selection bias as well, given that vasectomites are a healthier demographic population. Surveillance is ongoing.
Other risks: Very rarely something weird happens after vasectomy. In my 15,000 vasectomies to date I’ve seen three bladder infections, one acute prostatitis, one appendicitis and one cholecystitis (gallbladder attack). The medical literature even reports a few cases of subacute bacterial endocarditis after vasectomy.
(Rich’s First Law of the Universe….”Sh*t happens!)
You will find some internet websites warning of vasectomy dangers, particularly related to anti-sperm antibodies and chronic pain. Men do indeed form these anti-bodies after vasectomy but the levels go down over time and levels do not correlate with any symptoms problems or medical conditions. The overwhelming medical consensus is that they are of no significance. Still, you need to decide on these issues for yourself.
And finally, the standard medical disclaimer:
We can never be certain that researchers won’t find some new risk at some point in future, so every man must bear the responsibility for his own decision.