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Male sterilization; Vasovasostomy; Vasoepididymostomy
In the United States, vasectomy emerged as a popular method of permanent contraception during the 1960s. Within a decade, 750,000 men were undergoing vasectomies each year. Vasectomy rates markedly declined in the 1990s and have now leveled off at about 500,000 a year. Worldwide, millions of couples use vasectomy as a method of permanent birth control. [For non-permanent methods of birth control, including condoms, see In-Depth Report #91: Birth control options for women. ]
The procedure works by surgically interrupting the route that the sperm take from the testicles (where they are produced) to the penis. After vasectomy, the testicles still continue to generate sperm, but their movement is blocked at the site of the vasectomy. Eventually the sperm die, and the patient's body absorbs them. During sex, semen is produced in the same amount as before vasectomy, but this fluid does not contain sperm.
The testes are where sperm are manufactured in the scrotum. The epididymis is a tortuously coiled structure topping the testis, and it receives immature sperm from the testis and stores it several days. When ejaculation occurs, sperm is forcefully expelled from the tail of the epididymis into the deferent duct. Sperm then travels through the deferent duct through up the spermatic cord into the pelvic cavity, over the ureter to the prostate behind the bladder. Here, the vas deferens joins with the seminal vesicle to form the ejaculatory duct, which passes through the prostate and empties into the urethra. When ejaculation occurs, rhythmic muscle movements propel the sperm forward.
Vasectomy should not be confused with castration. It has no noticeable impact on a man's ability to perform sexually, or on his sensation of orgasm and pleasure. It does not affect the balance of male hormones, male sex characteristics, or sex drive. Testosterone continues to be produced in the testes and delivered into the bloodstream. Sperm form a very small portion of semen, so patients notice no difference in the amount of semen produced during orgasm.
The male reproductive tract performs three functions:
The Traveling Sperm. The sperm's journey through the male body -- from the testes (the testicles) to the final stage (the orgasm) -- is long and complex:
Having a vasectomy is a serious decision. The surgery is intended to be permanent. The great majority of men who seek a vasectomy have been married for 10 years or more. Not all are good candidates, however. It is important that both the woman and the man completely agree that they no longer want to have children. They should also agree that permanent birth control is the right decision for them. Ideally, the couple should view the operation as a mutual commitment to an already successful marriage or relationship. Vasectomy generally is not a good idea if the couple's relationship is under great stress. It is not a cure for emotional or sexual problems between a man and woman.
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Cook LA, Van Vliet H, Lopez LM, Pun A, Gallo MF. Vasectomy occlusion techniques for male sterilization. Cochrane Database Syst Rev. 2007 Apr 18;(2):CD003991.
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Peterson HB. Sterilization. Obstet Gynecol. 2008 Jan;111(1):189-203.
Practice Committee of the American Society for Reproductive Medicine. Vasectomy reversal. Fertil Steril. 2006 Nov;86(5 Suppl):S268-71.
Tandon S, Sabanegh E Jr. Chronic pain after vasectomy: a diagnostic and treatment dilemma. BJU Int. 2008 Jul;102(2):166-9. Epub 2008 Jul 1.
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