Why vasectomy must find its place in the family planning debate

Wednesday July 24 2019

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By Daily Nation

For many years, the contraceptive conversation has been one-sided, with male involvement beginning and ending at the condom. The vasectomy option has remained unpopular, despite the procedure being in existence since 1823.

Vasectomy has been surrounded by misconceptions, which have been a huge barrier to the uptake of this 15-minute office procedure that has a high success rate and minimal complications.

While in America approximately 500,000 men undergo vasectomies every year, Kenya’s uptake is dramatically low.

The biggest and probably the most damaging untruth is that vasectomy destroys your manhood. What is even more damaging, is the definition of the term manhood in our society.

While to some men, this means interference with sexual performance, to others, it may as well mean total castration, where the entire testes and penile shaft are removed. With such negative connotation, no wonder some men have not given it a thought!

FACE THE KNIFE

While we continue dragging our feet, surgeons have made the procedure easy, painless, bloodless and really quick. It cannot even compare to circumcision, a procedure whose biggest gain yet, has been the reduction of HIV transmission, but is more often celebrated as a promotion to manhood. Many men are willing to calmly face the knife by the riverbank in the freezing cold wee hours of the morning without flinching.

However, mention vasectomy and the riverbank will empty in a flash.

Vasectomy entails making a small window in the scrotum, hooking and pulling out the vas deferens (the tube that carries semen out of the testis), cutting it and clamping or burning off the cut ends and dropping them back where they came from. This ensures the sperms can no longer travel out of the testis to fertilise an ovum because their pathway has been disrupted.

Vasectomy is deemed a permanent method of contraception, suitable for men who are satisfied that they have sired enough offspring and are not interested in playing ping pong with Mother Nature when it comes to fertility.

In most developed countries, men have a vasectomy because they have absolutely no desire to be responsible for the conception of any more little beings bearing their DNA.

In our set-up, most will do it because nothing else seems to work for their wives and they make the decision to bear the responsibility of putting a stop to their procreation.

This is why the commonest question when the vasectomy conversation comes up is if the procedure is reversible.

This is a fair question considering, statistically speaking, one in five men will regret their decision and opt to have a reversal within 10 years. Many times, this decision is reconsidered when a relationship breaks down or in the sad event that the couple loses their child(ren) and are looking to fill the gap by having another.

So, before signing across the dotted line, it helps to know that the success rate of the procedure is 99.9995%. The cause of the extremely rare failure is recanalisation of the vas deferens that was initially cut. Moreover, men must understand that one does not cease to have sperm immediately after the procedure. There is a three-month waiting period, to allow one to be sure that the sperm that had lined up in the vas deferens above the cut have all come out or died. If a man does not use protection during this window period, he will raise his own failure rate.

It is also important to know that despite the procedure being painless, one needs to avoid lifting anything strenuous for a few days and it is also useful to avoid sex for the same period to allow healing and reduce complications such as bleeding into the scrotum and resultant infection. Is reversal of the procedure possible? Yes, it is.

However, it requires great skill in the fine scientific art of microsurgery because this is a procedure that intends to bring together the cut ends and stitch them up.

REVERSAL SURGERY

The sutures used are finer than a strand of hair and the equipment required is delicate and extremely expensive. While snipping the tubes off was a five-minute affair, reconnecting them will take not less than three hours in the hands of the finest surgeon.

Success of reversal microsurgery is highly dependent on the skill of the surgeon, the duration after the vasectomy itself and the location of the initial cut along the vas deferens.

Further, despite a successful surgery, there is still need to ensure the female partner is fertile and that the man does generate adequate, viable sperm. Some men develop antibodies against their own sperm following a vasectomy and in such instances, successful conception becomes even more unlikely.

It is worth noting that reversal microsurgery may not be readily available in settings like ours, and that it takes a lot of repeated performing of this procedure to get really good at it. It is very difficult to do enough of these procedures to gain the skill when people won’t even have vasectomies in the first place. Further, no one will invest in such expensive equipment if it is not being used.

To successfully address contraceptive needs, we must embrace all available options.

The golden rule in contraception is that there is no one size that fits all. Therefore, the more the options, the merrier.

Men may have been left behind but this is their time to shine. Vasectomy must find its place alongside condoms even as we await the outcome of the male hormonal contraceptive trials that Kenya is participating in.

This provides variety for couples to choose from and balances out the gender scales a bit more!

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