This page examines the page entitled "Let's cut to the chase".

Quote

Analysis

Three out of four of you who undergo this procedure will develop a permanent autoimmune reaction wherein your body will start to make antibodies that attack your own cells and tissues.

He's referring here to detectable levels of antisperm antibodies post vasectomy. In fact, most studies don't quote the antisperm antibodies rate at 75% plus! 50% - 70%³ is the usual rate given by most studies.

The implication is that by having a vasectomy you will develop antisperm antibodies - if you don't have the vasectomy, you don't have the antibodies. That's simply not true!

• Antisperm antibodies are detectable in 61% of patients before vasectomy¹

  Naturally occurring human antisperm antibodies have a peak incidence of 90% in both sexes before puberty, and then declines to about 60% for the rest of your life.²

  The men with the highest number of antisperm antibodies are naturally infertile men³

  Men with high pre-vasectomy sperm counts may have higher levels of post-vasectomy antisperm antibodies

  Infections in the genital tract, such as orchitis or sexually transmitted diseases, increase the risk for antisperm antibodies⁴

Despite the fact most men and women have naturally occurring antisperm antibodies in varying quantities before vasectomy, most researchers would agree that vasectomy does raise the number of men they are detectable in.

Scientists and doctors arent’t completely sure how this might affect your health, but there are reports of dozens of potential diseases that result form this type of autoimmune response including several forms of cancer, chronic infections and inflammation, sexual dysfunction and degeneration of genital tissues.

Well, actually they are. From the Harvard Medical School review of vasectomy⁴:- The antisperm response itself appears to be a problem only if a man wishes to reverse the vasectomy." Other major literature reviews including Schwingle & Guess³ also conclude this.

The major cancer organisations such as Cancer Research UK, the American equivalent and the World Health organisation have looked at the question of various cancers and vasectomy, and after much research have concluded that vasectomy is not a risk factor for any form of cancer including prostate, testicular and lung cancer. The specific study the claim is based on is Raspa⁵. He repeats the quotation many times on the site, and the bottom line is that Raspa says the opposite. The qualifying statement that Hauber deletes each time he uses this quote is "although not substantiated by clinical studies".

Schwingle & Guess³ probably have the best assessment of the studies that looked at immunological progressions:- "Clinical evaluations and several large cohort and case-control studies provided no support for the presence of an effect of immunologic disease, including testicular or kidney changes in humans. Furthermore, several clinical and epidemiologic studies failed to demonstrate any association between vasectomy and atherosclerosis in humans.

A study conducted to examine whether the presence of antisperm antibodies after vasectomy is influenced by coronary heart disease (CHD) risk factors reported that CHD risk factors were unrelated to antibody levels and did not confound the vasectomy status/antibody relationships. These studies in humans provide compelling evidence against any relationship between vasectomy and cardiovascular disease, together with the lack of ability to replicate the original results in monkeys. This is one controversy about vasectomy that has been completely resolved.

No changes in blood coagulation factor assays and measurement of thrombin monomer and circulating platelet aggregate ratios have been reported postvasectomy, resting concerns that vasectomy might potentiate thrombotic disease. Other studies have pursued the question of whether vasectomy changes testicular hormone production and endocrine function. These studies demonstrated that mean levels of FSH, LH, testosterone, and estradiol are within the normal ranges postvasectomy."

Three out of five of you will develop cysts in your genitals as a result of this procedure. The cysts can be quite painful and may need to be removed surgically. They may also recur and need to be removed again.

He specifically means sperm granuloma's here. They do occur in about 60% of cases, but in fact are mainly small and asymptomatic (patient is unaware of them). Of the men who do develop granuloma's they are only painful in about 2-3% of cases.³ It's also necessary to point out that spermatic granuloma's can have causes other than vasectomy including hernia repair⁶ and injury to the scrotum.

The role of the spermatic granuloma is a temporary one. They provide a temporary expansion of the epidermis during the time it takes for the body to adjust to absorb more sperm than it does anyway. 50% of the sperm you produce never leaves your body - they die and are re-absorbed. This process steps up a gear after vasectomy. Most researchers think that the development of granuloma is positive, rather than a negative in that patients who don't develop granuloma's are more likely to suffer from pvp later on. The percentage of granuloma incidence depends on the method of surgery and occlusion. In the main, spermatic granuloma's will resolve themselves without the need of surgical intervention.

Granuloma's can re-occur, but as in the hernia repair surgery it's rare. Generally speaking doctors would prefer the granuloma to heal itself rather than resort to surgery which may itself cause granuloma's.

According to studies on the subject, up to one out of three of you (it cannot be predicted who) will encounter chronic genital pain as a result of the operation for reasons that are not fully understood.

According to one study specifically. He's used this study many times on the site, and every time incorrectly.

It's a questionnaire⁷ study that asked about DISCOMFORT after vasectomy, and 33% did indeed say that they experienced discomfort. Over half of the men who said they had discomfort said that it wasn't troublesome, most of the men didn't seek help, only 2 required surgical treatment, and 3 (1.7%) men regretted having the vasectomy.

Congestive epididymitis is the most common form of chronic pain, and that's mostly resolved by antibiotics. It's difficult to be sure that this is caused by vasectomy, as congestive epididymitis is a common urological complaint, and the incidence is broadly similar in non-vasectomised men³. But he is correct in saying there aren't any predictors as to who may have congestive epididymitis. He's not correct to say that there aren't any predictors of who will suffer pvp though - Schwingle & Guess³ provide a list:- "Local infection, acute systemic infection, signs or symptoms of sexually transmitted disease, filariasis, elephantiasis, intrascrotal mass, or hypersensitivity to the anesthetic agents to be used. Conditions that may increase the risks or difficulties of performing the operation include previous scrotal trauma, large varicocele or hydrocele, previous surgery for cryptorchidism, inguinal hernia, and certain coagulation disorders."

In your desperation that results, doctors may propose removing substantial portions of your genitals in an effort to alleviate your suffering, however, but this does not guarantee that the pain will go away.

It's a favourite tactic to claim that doctors will castrate you (Orchiectomy), but that's simply not true. It's a simple tactic intended to scare men out of having vasectomy. There aren't any studies at the National Library of Medicine that look at the effectiveness of orchiectomy as a cure for pvp. In fact, surgical options are rarely required, and only used as a last resort if more conservative treatments are ineffective.

One of the surgical techniques for curing pvp is epididymectomy. That is removing all or part of the epididymus, but that can hardly be regarded as "substantial portions of your genitals".

There are techniques available to reduce the chances of chronic pain from the procedure by a factor of three, but most doctors prefer to use another method.

It would be nice if he'd actually state what he means sometimes - it wouldn't kill him! I believe he's referring to the "Open Ended" procedure. In this version, doctors leave the testicular end open, and some research indicates that this version of the procedure may result in fewer long term problems.

If doctors know about it, why do they choose not to use it? Simply because there is a trade-off. The open ended technique raises the level of spermatic granuloma to about 97% of men. Spermatic granuloma's can be painful themselves. The jury is out on if the trade off is worth it. Doctors are also concerned about the reliability of the procedure. But when fascial interposition is used, the reliability is generally about the same as conventional techniques.

The procedure has a documented failure rate of up to six percent, which is not that much different from the failure rate for condoms. The chief difference is that you can take a condom off.

I'm sure he's managed to find some obscure study to justify this comment - or possibly as on other pages simply made it up. However, there are reliable statistics available for both the condom and vasectomy.

The failure rate of vasectomy is 1 in 2000 after clearance has been given⁹ - a rate of 0.05%

"The average rate of pregnancy for couples who rely only on condoms for protection is 12%. In adolescents the risk with condoms is 18%. Even for those who use a good-quality condom correctly, the annual risk for pregnancy is 3%."⁸ There are a variety of figures available from various sources, but this is fairly typical.

Additionally, there can be damage to nerves and to blood and lymph vessels as a result of the surgery, which again may put you in the position of having doctors recommend more genital surgery and the removal of associated parts to correct these problems.

Well, unless you have the procedure done by the new guy whose learned how to do it from a 10 minute video presentation, the chances of anything like this happening are very rare indeed! According to Dr. N. Pollock (a specialist at treating pvp) "Rough" surgery" may be a frequent cause of the problem, and in an experienced surgeon this will be reduced. It's always been the advice that before you agree to have a vasectomy, ask your doctor about his experience in doing the vasectomy. Ask how long he's been doing them, how many a year he does, what complications he's experienced and how he would treat you if you developed long term pain.

Alternately, some doctors may tell you that you just have to learn to live with all this, and get along as best you can. After all, you took your chances, even though you probably didn't’t know what those chances were in advance.

Bearing in mind that sperm granuloma's mostly resolve themselves given time, this is usually the best advice. Going for a surgical option early on may well make things worse - not better. Surgical options are considered a LAST RESORT once the other treatments have been tried. Also, as conservative treatments work in most cases, it's a sensible way to proceed. The fact that the doctor (given a self-diagnosed patient) doesn't opt for reversal day 1 simply means he's following the accepted treatment plan that works for most without resorting to surgery unless necessary.

The potential results I have described have been documented in medical literature in various forms for nearly thirty years, yet remain largely undisclosed to the general public. Many doctors don’t even know about this information, and many that do know choose not to say anything to the patient before performing the operation.

I would disagree with this statement. Yes, studies have been available in very limited numbers, and no, they haven't remained undisclosed. It's true that with the advent of the internet, it's a lot easier for both doctors and patients to access information, but that's also true of every other medical procedure. We are asked to believe that the lack of disclosure ONLY affects vasectomy.

Many of the early studies dealt with effectiveness and acceptance, but there were some studies into after effects as well. By early, I guess we are referring to the time when vasectomy was becoming popular as a method of birth control back in the 1950's. In fact, vasectomy has been around for nearly 200 years and the first study was published in 1831.

As regarding doctors "Saying nothing", that's purely personal opinion. The current UK guidelines state in the printed information that doctors are required to hand out in consultation that there is a risk of ctp. The guidelines have had some input from doctors in the US, and there is a guideline in formation based on the UK version.

Some doctors have spoken out about the health hazards vasectomies create, but have been drowned out by a chorus of others saying, "Don’t worry about it."

I think this may refer to HJ Roberts and others who have published a series of books in the same genre as Hauber's book. Having read several books in the genre, I'd suggest that there is a great deal of opinion and very little published fact contained within the covers. Rather than being some sort of disclosure, these books merely add to a pre-existing genre - ALL of them claiming they are some sort of revelation of hidden secrets.

If a researcher comes up with something they find unusual and worthy of further investigation, others will take on further studies at some point. That's how new discoveries are made, and medicine advances. The fact that an individual's research findings are not repeated when other's follow up on the research doesn't mean that they are being "Drowned out" - it means that the results were not repeated in subsequent research. In respect of criticism of books, that's nothing new. If the book does not contain facts necessary to back up it's case, then being critical on those grounds is simply being honest. That doesn't amount to being "Drowned out" either. It's just stating facts.

Why would I call vasectomy experimental? After all, haven’t millions of men undergone the procedure? Yes, but the long-term effects are still largely unquantified.

Good question, and one without an answer I note. Yes, the long term effects are well known and documented, and no it's not experimental. How can you possibly state that a procedure that's nearly 200 years old, and has been used by millions upon millions of men over the last 50 years "Experimental"?

Researchers expect this phenomenon of chronic pain to increase as the population of over 50 million vasectomized men ages.

No - they don't actually. The World Health Organisation doesn't state this, nor are there any studies that corroborate this individual viewpoint.

Why arent’t these facts made plain? Well, for one they’re controversial. Research on the subject has shown varied results, but there has been a consistent stream of dozens of research articles over the years, which give cause for caution and for warning beforehand.

I think the question answers itself. If research shows varied results, the results WILL be regarded as controversial if somebody tries to claim research findings show something the majority of people involved with the research do not agree with.

It's the doctors role during counselling to discuss established fact. If the patient wishes to discuss unproven factors, then that's down to the individuals involved.

Yes, it's true that studies will make recommendations such as pre-operative counselling should be more widespread and uniform. Some research does indeed suggest that men are warned there is a risk of CTP. Even the RCOG guidelines make this recommendation⁹. What none of the studies that make the recommendation do is to quantify the risk. Reason being that the risk is very low. CTP that isn't resolved by the usual practices or one of the routine surgical methods is unquantifiably rare - we are talking individual case histories, not studies. It's fair that doctors warn there is a risk, but it's also fair that they point out that in most cases it is treatable. And although there is a risk, it's a small risk.

There are also economic and social forces involved, as an entire industry has grown up around sterilization.

It would be nice if he had expanded on this point and given some meaning to this bland statement.

As pointed out earlier, the vast majority have the procedure done via health care schemes and it's likely that the health care schemes negotiate a discount. Tubal ligation is probably going to make doctors more money because there is more work involved, yet given a choice many doctors would prefer to opt for vasectomy as it's statistically more reliable and statistically a lot less risky.

Then there are the legal implications, since recognizing these problems could lead to massive class action lawsuits. To me, this is like a male equivalent of failed breast implants for women with equally disastrous health consequences.

Why, when "Ambulance chasing" medical lawsuits are a huge industry for lawyers hasn't this happened? Why would the lawyers shy away from what is claimed is a huge pot of money for them? Why would vasectomy be any different from any other medical malpractice lawsuit?

The reasons the lawsuits haven't happened is because the numbers simply aren't there, and it's not worth the ambulance chasers time. If they were there, then we would have seen such lawsuits by now. There are occasional lawsuits into failure producing offspring, and the vast majority of cases these get thrown out as the patient has accepted on the consent form that like all methods of birth control it's not 100%. They often make the news as the cases are rare.