Many Real Men Have Unreal Fears About Vasectomies

The first thing Ian Tresman wanted to know when he decided to have a vasectomy was what the operation was like for a regular guy who’d been through it. To the distress of the 41-year-old Web page designer, all the information he found about vasectomies on the Web, in bookstores and in libraries read like medical journal entries.

“It was a quite a big decision to even consider a vasectomy,” said Tresman, who lives outside London with his wife and his two daughters from a previous marriage. “I wanted to know what it was like from a personal point of view.... Reading about it in textbooks is not quite the same.”

Tresman, who had a vasectomy in February 2001, decided to go public with his own story for the good of mankind and mankind’s respective partners. Thus was born www.my-vasectomy.com, a Web site that, “in words and pictures,” documents his surgery through all the stages (photos are rated on a “squeamish” scale of 1 to 10).

Tresman’s wife, Caroline, took the photographs, which are accompanied by his written account of the procedure. Comic relief punctuates the medical-school-style photographs in the form of vasectomy jokes. For example: A man visits his doctor to inquire about a vasectomy and the doctor asks whether he’s talked it over with his family: “Yeah,” he responds. “They’re in favor, 15 to 2.”

The decision to have a vasectomy is no small matter, as it must be considered irrevocable. Although urologists sometimes perform reversals, there are no guarantees of success. Roughly half a million U.S. men receive vasectomies a year. Most of them are white; black and Latino men receive the fewest vasectomies, according to Planned Parenthood Federation of America.

Complications are rare from the procedure, which blocks the vas deferens, the tubes that carry sperm during ejaculation, according to the American Medical Assn. Of every 1,000 men sterilized, fewer than two will cause pregnancy in the first year. It takes about 15 ejaculations to eliminate the sperm that remain in a man’s system after the operation.

Sexual functioning is usually unchanged following a vasectomy, according to the AMA. And there’s an added benefit: Most men report experiencing enhanced sexual pleasure because fears of unwanted pregnancy are relinquished, according to the AMA and urologists. In the rare cases when men lose sexual desire or sexual function, doctors say, it usually has to do with emotional issues present before the vasectomy.

Nevertheless, many men approach vasectomies fraught with fear. “It did cross my mind [after the surgery] that maybe all the textbooks are wrong and the vasectomy could have some effect on my performance in the sexual arena or on my ability to go to the loo,” Tresman said. “But I figured that if that had been the result, I would have heard about it from other men. Most men are afraid of it because it is an operation that is down there, and men are a bit attached to down there.”

But will a vasectomy cause impotence? “They all ask the same question in a different way,” said Jacob Rajfer, a professor of urology at UCLA School of Medicine. “Will I become impotent? Will I be less of a man than I was before? When you say, ‘This will make you sterile’ to some men, the perception is not only will they not be able to father children, but some other functions may not work the way they did before. Sterile connotes something more to some men than what it actually is. It is equating manliness with that organ and what it has to do when asked to perform.”

Jokes and double-entendres about vasectomies ruining male potency may override medical information that shows overwhelmingly they don’t, said Rajfer. “It takes a lot to squelch these myths.”

Psychological reasons for sexual dysfunction can be as varied as the men themselves, said Steve Lipsius, a psychiatrist and certified sexual-dysfunction therapist based in Washington, D.C. Men suffering from a lack of sexual pleasure, which could stem from performance anxiety or other, deeper reasons, may lay blame on a recent vasectomy, he said. Some men use sex to validate their masculinity rather than for pleasure, Lipsius said. An underlying element of the sexual experience for such men might include reproductive potency.

“To the extent that being masculine has to do with being able to impregnate a woman, a man might experience erectile dysfunction and unfairly blame it on a vasectomy,” Lipsius said.

Usually, urologists have pre-operative consultations with men who are considering a vasectomy, with their respective partners. Single men also seek vasectomies but urologists usually advise them to have a surgery known as an open-ended vasectomy, which is easier to reverse.

During a vasectomy, urologists have the option to either close both ends of the severed vas deferens--the traditional method--or to leave the testicular end open, hence the term open-ended.

Urologists usually advise couples to think of vasectomy as irreversible, a “final solution.” Men who have not fathered children or who are concerned about unforeseen tragedies that could result in the loss of children or a wife are also encouraged to consider the open-ended vasectomy.

Since the late 1970s, improved microsurgical techniques have made sterilization reversal possible, although only about 10% of men seek reversal. Not surprisingly, many reversals are sought by men in second marriages to younger women.

A Danish survey conducted in 1990-91 found that 7% of the 244 men who had been sterilized eight to 10 years earlier regretted their decision. Nearly all of those with regrets had started a relationship with another woman.

Both partners in a relationship should agree that a vasectomy is the right decision, said Arnold Belker, a urologist in Lexington, Ky. “My first question to a couple sitting across from me is, ‘Whose idea was this?’” he said. “I have heard a woman say, ‘I told him to get this done or don’t come near me.’ I recommended that they get counseling, not a vasectomy.”

The best scenarios are with couples who feel they have enough children, who agree that a vasectomy is the right choice and who are all too happy to be free of the burdens of birth control.

“I was happy as a lark,” said Ray Lack, a building contractor who lives in Westchester with his wife and two children. “We had a boy and a girl and we were in our late 30s. I was just blessed and thought let’s go from here and get it done.”

As for reports of enhanced spontaneous sexual romps after vasectomies (call it the honeymoon period), the Lacks, who pursued a vasectomy when their second child was 6 months old, report that with a new baby and work, they were too worn out for that.

But Tresman has this to say about his post-op sexual forays: “As for sex, it’s pretty much when you like it next. But three days after the op, we managed to test [apprehensively] that everything was functioning satisfactorily. Hooray! ... And now three months on, libido is unchanged ... looks and feels exactly the same as before.”

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Birds & Bees, a column about relationships and sexuality, runs Monday. Kathleen Kelleher can be reached at kathykelleher@adel phia.net.