Vasectomy Specialist Debunks Common Myths

 

The first article in a week-long series on vasectomies features a Q&A with Dr. Stephen Siegel on pain, myths, procedure, and permanence

Now that the new year is no longer new, we here at the Dads & Families section are celebrating an end of new beginnings with Vasectomy Week. First up on the table is Dr. Stephen Siegel, who is a diplomate of the American Board of Urology (board certified), an honors graduate of Duke University and Vanderbilt University School of Medicine. Dr. Siegel completed his general surgery training and urology residency at Yale – New Haven Hospital. Not only has he performed over 2,000 vasectomies, he had his done eleven years ago, after his third daughter was born. A father of three girls, Dr. Siegel practices at Urology Specialists, in Middlebury, CT.

GMP: The most common fear about vasectomy is the pain; what can men generally expect?

Dr. Siegel: Biggest problem that I see is that it is usually healthy young guys having vasectomies—they are not used to going to the doctor for anything, much less choosing to go for an elective procedure, with them wide awake and especially not “down there.” So their fear and anxiety is the biggest obstacle to overcome. Pain is not usually a major issue. There is a pulling sensation but not true pain like we usually think of pain.

GMP: Can you give a step by step of how it goes?

Dr. Siegel: I meet with the patients to go through the specifics of the procedure, to try to calm their anxieties and to talk about the main risks of the procedure—bleeding afterwards, infection, recanalization, and the old paper that [falsely] linked prostate cancer to vasectomies. I suggest that they wear tight underwear to the procedure for comfort afterwards. The day of the procedure they do not need to fast and I do not pre-treat them with any medication. I often invite their wives back to observe the procedure either for moral support or to harass them enough to reduce some of the anxiety. They should go straight home after the procedure—ice (a lot of guys use bags of frozen peas) on and off for the rest of the day and night, take it easy for the first 34 hours, no heavy lifting for 5-7 days (greater than 20lbs). It is OK to return to protected sex after 3-4 days. No unprotected sex until we get a semen sample that shows no sperm—the first one is checked usually 6-10 weeks after the vasectomy.

GMP: What are the most common myths about vasectomies?

Dr. Siegel: I often have patients ask if I do a “laser” vasectomy because that is “what my friend had.” Laser vasectomy does not exist. The least invasive procedure is the “No Needle, No Scalpel” Vasectomy. “No Needle” means rather then injecting the skin and vas to numb it up, we have a spray gun (looks like a fountain pen) that sprays lidocaine fast enough that it penetrates through the skin numbing the skin and the vas underneath.

I often invite their wives back to observe the procedure either for moral support or to harass them enough to reduce some of the anxiety.

The “No Scalpel” part is a great marketing phrase that states that we don’t use a scalpel to cut the skin.  That is true, but we still need to get through the skin to get to the vas—so we use a really sharp pointy tool to puncture the skin—same result as a scalpel, but “No scalpel” is utilized.

GMP: I’ve heard stories of guys straining themselves playing basketball or doing yard work months after the surgery and feeling a pinch/pull; is that common and what can be done about it?

Dr. Siegel: It is a rare entity where men have testicular discomfort after a vasectomy that can be long lasting. Sometimes this is caused by infection, or sperm granulomas. There are even reported instances where men have undergone vas reversals and this has caused the pain to improve. I have never had a patient need to consider a reversal. Most of the time NSAID’s like Motrin are all that is needed.

GMP: What’s the deal with reversals? How many do you see? What happens?

Dr. Siegel: Reversals can be done. Usually the rate limiting step is that insurance won’t cover them. So what takes me 5-10 minutes to do in my office now takes two hours under a microscope in the operating room. So costs are quite high. The success rate of the reversal is about an 85-90% patency rate—meaning that there will be some sperm in the ejaculate, but the pregnancy rate is only about 50%. This rate can go much lower if the vasectomy was done more then 10-15 years ago. Something about the testicle’s ability to produce healthy sperm is diminished when it has been obstructed for a considerable amount of time. We see patients on occasion for this and probably only do 1-2 of these procedures per year.

GMP: What advice would you give guys who are unsure?

Dr. Siegel: That a vasectomy is the safest form of permanent birth control. It can be done in 5-10 minutes in an office setting without the requirement of anesthesia—making it leaps and bounds better then a woman going for a tubal ligation. It is the best way to make sure that if there is a big sports weekend—they will be allowed to lie around and watch TV. We do see an upswing in vasectomy requests around March Madness. What could be better then a Thursday morning vasectomy and then getting permission to spend the next four days on the couch watching wall-to-wall basketball?

 

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About Robert Duffer

Robert Duffer (www.robertduffer.com) is the editor of the Dads & Families section of The Good Men Project. Winner of the Chicago Public Library's writing contest, his work appears in the Chicago Tribune, MAKE Magazine, Chicago Reader, Curbside Splendor, Time Out Chicago, Chicago Public Radio, Annalemma, New City, and other coffee-table favorites like Canadian Builders Quarterly. He teaches creative writing at Columbia College Chicago and lives in the suburbs with his wife, two kids, and their minivan. Follow @DufferRobert, Google+, facebook.

Comments

  1. AnthonyZarat says:

    Q: Is it true that the Affordable Care Act mandates that all insurance must cover female tubal ligation free of charge, but does NOT mandate coverage (or prohibit co-payments) for male vasectomy?

  2. Q: Doctor, what is your response to the information provided on websites like http://www.dontfixit.org/ which state the following side effects of vasectomy? Please provide links to specific studies.

    (1) chronic, long-term pain (based on survey patients, occurring in approximately 1/3 of patients), sometimes known as Post Vasectomy Pain Syndrome, which in severe cases can require complete castration and testosterone replacement to alleviate the pain (an abstract of a 2012 paper on the National Library of Medicine, NIH website states: “…the importance of counseling patients of the risks of PVPS with vasectomy cannot be overstated.”

    (2) “Blowout” of the tied-off vas due to buildup of pressure from the ongoing production of sperm in the testes (occurring in nearly 100% of patients according to Campbell’s Urology, a standard text book in the field).

    (3) Resulting auto-immunity (confirmed in 60% – 80% of patients based on blood tests according to Campbell’s Urology), with follow-on auto-immune disease responses.

    Thanks.

  3. Separate question to Mr. Duffer and the Editors:

    Note the highlighted, pull-out quote:

    “I often invite their wives back to observe the procedure either for moral support or to harass them enough to reduce some of the anxiety.”

    You did not question the Doctor further on this or comment on his remark.

    Do you see how this comment, and your lack of reaction / followup to it, could easily be seen to be supportive of harmful gender stereotypes (A) of wives as inclined to harass husbands going under the knife for sterilization, and (B) of men as worthy of harassment or as responding better to spousal harassment than, say, Xanax?

    • This doctor has the guys’ wives come in to “harass” them while they are literally being emasculated. Stunning comment from the doctor with absolutely no followup from the author.

      • LOLing Woman says:

        Are women who have tubal ligations being unfeminized???

        • I don’t know. That depends on how the woman in question feels about it.

          I do know this: No woman has the right to belittle a man’s opinion on this matter. She doesn’t have the right to be act aggrieved when the subject involves a man and his genitals — his body, his reproductive freedoms, his medical care. This is beyond her, way outside of her experience. A woman simply cannot understand.

        • She certainly loses a basic feminine trait, the ability to conceive a child. Do you think the doctor has husbands go in to “harass” their wives when they are nervous about the procedure?

  4. Your issue is with the hot verb “harass.” The connotations may be negative, but that was not the tone the doctor was using, nor was the context. It is common for spouses to rely on one another. The point I wanted to highlight was that the doctor recommends getting support from your spouse/partner.

    • Mr. Duffer —

      Any chance you could follow up with Dr. Siegel on the three clinical questions I posted above, and share the answers with us all here?

      Thanks, JustAMan

  5. I would just like to say that nearly 6 years later I still refer to the co-pay as the best $20 I ever spent.

  6. Barbara Schulte says:

    Back in 1989, I had a great doctor with the birth of my second child. Knowing our circumstances (we were really poor and had no insurance – we paid for our children’s births ourselves), he offered to perform a vasectomy on my then-husband, after office hours on a Friday, if I agreed to assist, for only $75.00.

    It was very interesting! The worst part was the shot. Then he performed one tiny incision, and he pulled what looked like a piece of spaghetti out of the slit, snipped and cauterized it, put it back, and did the same thing to the second tube. I don’t remember there being any blood. My ex sat around for a couple of days with frozen veggies in his lap, and then he was raring to go.

    My keeper husband has also gone through a vasectomy. I didn’t even get to witness that one, unfortunately. He has had some weird after effects, like he’ll get an itchy, tingly feeling in his testicles every once in a great while. Other than that, we are both very happy he did it, and we recommend it highly to men who don’t want any more children.

    • So, if I read this correctly,you have an ‘ex’ who’s now ‘shooting blanks’. I only mention this to point to the fact that with the divorce rate hovering around 50%, young, healthy men might want to think about it. That’s what happened to a friend of mine. Had a baby girl, wife decided that 1 was enough. He got snipped and a few years later they got divorced. Here he was, still a young man , but if he ever met someone else, there’s no way he could have anymore kids.

      • Barbara Schulte says:

        Yes, bobbt, he is shooting blanks. At 31 years old, he didn’t want any more children (which was a good thing, because he was a bad father), but due to his fear of another man touching his junk, he felt I should be the one to to get sterilized (which I was seriously considering). After going through the childbirth process with my exceptionally cool doctor, who shared a beer with him, my ex got over his fear.

        I agree with your warning on young men getting snipped. You never can tell how long a relationship is going to last, and you don’t want to make a decision like that without a lot of thought given to various potential futures. Hell, my ex probably thought that since I seemed to be oblivious to his dalliances, he had the ideal life-long marriage. Good thing I opened my eyes.

        I did want to point out that a vasectomy can be reversed. Success rates are higher the sooner you get the reversal done, so I’d advise your friend to look into that.

        • I realise you’r talking about an ex you’re not to fond of and if the doctor slipped and cut his d**k off you’d probably be allright with it, LOL! As the doctor says in the article, a reversal is at best 50% effective as far as achieving pregnancy, and NOT covered by insurance( as oppsed to they’re all too happy to cover the ‘snip’ since it means they won’t be paying for babies). At a party a little while after the deed with the same friend. His wife and her girlfriends (all a little ‘buzzed from alchohol) start ‘ragging’ on him , insunating that ,I don’t know’ he’s somewhat ‘Less of a man’ because he can’t make anymore babies? She apparently took it upon herself to tell all her friends while I was the only one he told. Most of the women present thought it quite funny.

          • You’re right, bobbt, had I know then what I came to find out later, I would have “accidentally” bumped into the doctor, not just because my ex cheated on me, but because of what he did to his daughter and what he tried to do to my 16 year old sister. Trust me, my anger is well deserved.

            And it probably has something to do with his horndog ways, but Chad, he was ready to go on Sunday, after having his vasectomy Friday afternoon.

            I can’t believe women would say a guy is less of a man because of a vasectomy. That thought never even entered my mind. If anything, he’s more of a man, because he made a decision like that. That’s showing some responsibility, in my mind. After struggling with various birth control options for several years, I love that we don’t have to worry about it anymore.

            • Barbara, I’m glad things worked out for you and your new man. I hope the choice you both made help keep you happy and healthy. It’s been many years since that party I described, but I NEVER will forget the site of that woman and her friends laughing at that poor man who did what he did out of love for a woman that definetally didn’t deserve it! I decided right there that I would NEVER get ‘snipped’. My friend had a couple of serious relationships after his divorce, but none lasted. He could never afford a ‘reversal’ (about 20K back then, I can’t imagine the cost today!) I never asked of course, but I couldn’t help but wonder if his inability to pro-create affected his relationships afterwards.

  7. I wouldn’t call this debunking myths… more of casting a generalized net.
    I am definitely a proponent of vasectomies. Hell, I’ve broadcast it to the world the last couple of weeks via 3 separate blog posts.
    Generalization #1: Though I poked fun at the seriousness of the pain in recent articles, it was still very real pain, though it only lasted long enough for the local anesthetic to take affect.
    Generalization #2: Sex after 3 or 4 days!? I call BS!!! I wasn’t about to bump my boys against anything for 2 maybe 3 times that long… and like most me, I love sex (my wife’s hot, who wouldn’t).
    The rest of it, I’ll take his word for. I will say kudos for bringing awareness to this permanent birth control method. I look fwd to the additional articles.

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