Questions on Vasectomy

After the birth of their third child, Richard Kaufman, 31, and his wife Libby agreed that they wanted no more children. They also decided that chemical and mechanical means of contraception were unsuitable for them. So two weeks ago, Kaufman reported to the Margaret Sanger Research Bureau in Manhattan for a vasectomy, the male sterilization procedure that is becoming one of the most popular forms of birth control in the U.S.

In 1960 an estimated 40,000 Americans underwent the operation; now the number is approaching 1,000,000 a year. Vasectomy is being performed at 129 clinics, 153 hospitals and countless doctors' offices. It is rapidly becoming the most sought-after type of elective surgery.

Now that the rush to vasectomy has attracted close to 3,000,000 recruits, a few reservations are developing. Follow-up studies indicate that some patients suffer psychological problems after the operation. There is also suspicion--still very tentative--that physical problems can follow for a small number of men. Dr. John Bernard Henry, director of clinical pathology at the State University of New York's Upstate Medical Center, has suggested that vasectomy occasionally causes upsets in the immunological system as the body reacts to the retention of sperm. Though sperm cells cannot be released after the operation, the testicles continue to produce them. Reabsorbed by the body, the sperm products sometimes cause an immune response that in turn may destroy or immobilize newly produced sperm cells. This could conceivably increase a man's susceptibility to disorders related to autoimmune reactions like rheumatoid arthritis. While there is no proof as yet of his theory, which is based on unsubstantiated reports of ten cases, researchers agree that further investigation is essential.

Severed Circle. As a technical procedure, however, vasectomy is simplicity itself. After administering a local anesthetic, the doctor locates the vas deferens, the thin (3-mm. diameter) tube that carries sperm from the testicle to the seminal vesicle, where it is mixed with other components of the semen (see diagram). Once he has found it, he makes a small incision, draws out the vas and severs it, often removing a small section and tying the ends back on each other so that they cannot rejoin. He then repeats the procedure on the other side. The operation, which costs up to $150 and rarely takes more than half an hour, has no physical effect on a man's sex drive or capacity to achieve erection or ejaculation; it simply keeps the sperm out of the seminal fluid.

Though some men feel as if they had been kicked by a horse, most experience little more than a few days' discomfort after the operation. Richard Kaufman, one of the hardier types, found the procedure "considerably less painful than having a tooth filled." He went right back to work afterward.

The vast majority of vasectomy patients elect the operation because it is simpler and cheaper than the traditional methods of female sterilization and because they agree with Jim Bouton, the ballplayer-turned-broadcaster, that "birth control is as much a man's responsibility as a woman's."

Like veterans of World War II, some enthusiasts advertise their discharge from the reproductive ranks by proudly wearing special vasectomy pins in their lapels. The pins consist of a circle with an arrow pointing up and away, the universal symbol for the male; the circle, like the vas, is severed.

This missionary approach has tended to obscure some of the disadvantages. Among them:

> Vasectomy is not instantly effective. Because sperm cells may remain in the seminal vesicles and other parts of the reproductive system, doctors advise their patients to continue using contraception until follow-up tests show a negative sperm count. Although most men become sterile within a few weeks, some have remained fertile for as long as six months.

> Vasectomy should be regarded, for all practical purposes, as permanent. The reproductive plumbing can often be reconnected, but restoration of fertility is rare.

> Vasectomy does not revolutionize sex. Patients who understand that sterilization is not castration feel no sense of loss upon becoming sterile and generally find their sex lives unimpaired and occasionally improved by the procedure. But impotence has occurred in those who were, knowingly or not, uncertain of their masculinity before vasectomy, while patients who submit to the surgery believing that it will strengthen a shaky marriage are invariably disappointed. Helen Wolfers, a researcher at the London School of Hygiene and Tropical Medicine, studied 95 men who had undergone vasectomies and found that ten had sexual problems following the operation. Interviews revealed that most had reluctantly agreed to vasectomy in an attempt to solve marital problems.

Most doctors agree with New York's Dr. Joseph Davis, president of the Association for Voluntary Sterilization Inc., that the best way to deal with post-vasectomy problems is through advance counseling. Davis and his colleagues carefully screen each candidate for the operation, explaining the procedure and its aftereffects. Interviews can identify those who are most likely to have belated second thoughts. In a dozen years, Davis has turned down 5 % of those who came to him for vasectomies; the rest of his customers seem satisfied.

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