Vasectomy Informed Consent and Advertising Need an Overhaul

What do you know about vasectomy? Enough to recommend it? I doubt it. If you had a vasectomy and had no problems, count yourself lucky, but don’t recommend the procedure based on your (or your spouses) individual results. For 10 to 15% of men, it doesn’t go as planned. You would have to talk to twenty to fifty men to find the 2 to 5% with severe and persistent pain or sexual side effects from the procedure. Actually, you would have to talk to even more, because most of these men remain silent. They are embarrassed in to silence by the cultural view that vasectomy is completely safe. If they complain of post-vasectomy problems, they are told “it is psychological.” The lay public accepts that vasectomy is safe, and that it has no long-term side effects. They also accept that it has NO EFFECTS on any sexual function.

See this glowing endorsement from a vasectomy website:
Men USUALLY notice:
No change in the semen· No change in sex drive· No change in climax sensation·
No change in the testes or scrotum· No change in erections

The operative word in the advertisement above is USUALLY. The informed consent should read more like this: Some men notice a change in the volume or consistency of the ejaculate (semen). Research suggests this may be related to changes in the secretory function of the prostate after vasectomy (Long-term effects of vasectomy on prostatic function in men. Naik et al, J Reprod Fertil. 1980, Endocrine and accessory sex organ function after vasectomy and vasovasostomy, Joshi UM, Arch Androl. 1981).  Some men notice a change in the expulsive force of ejaculation after vasectomy. The mechanism for this change is unknown. There is no treatment for this if it should occur and some men find this changes sexual pleasure. The majority of men do not experience large changes in libido (sex drive) after vasectomy and some studies suggest less worry over pregnancy can be a positive outcome. For men that develop persistent pain or post-vasectomy pain syndrome, there may be decreased interest in sex associated with pain during intercourse. Persistent pain after vasectomy develops in up to 15% of men in the first year and can become chronic (The incidence of chronic scrotal pain after vasectomy: a prospective audit. Leslie TA, Illing RO, Cranston DW, Guillebaud J. BJU Int. 2007). While most men experience no change in orgasmic sensation, a few patients have reported decreased sensation or a decrease in orgasm pleasure. There are no studies on this phenomenon. While many men have no noticeable changes in the testes or scrotum, some men develop sperm granulomas (an inflammatory reaction to sperm leakage). While the majority of sperm granulomas do not cause pain, some do and surgical removal is occasionally required (Spermatic granuloma: an often painful lesion. Schmidt SS. Fertil Steril. 1979). These small palpable nodules can causes scar tissue, pain, and anxiety in some men. Scar tissue after vasectomy can also change how the testes are situated in the scrotum, which can be distressing. Vasectomy has also been shown to cause testicular damage and fibrosis (scar tissue in the testes) in at least five different biopsy proven medical studies (Jarow JP, et al 1985, Jarow JP et al 1994, Whyte et al 1985, Raleigh D et al 2004, McVicar et al 2000).

The first “advertisement” is unethical and fraudulent. The second actually lists some real risks and their reported incidence with references from the medical literature. Why men are given pamphlets more like the first is hard to explain. Perhaps they are written for an eighth grade reading level. Maybe if men were told the truth, vasectomy acceptance would suffer. Why is this a bad thing? There are many other non-permanent birth control methods that do not require surgery and change bodily function or cause chronic genital pain. The current zeal for vasectomy is partly based on inadequate informed consent.

I run a support group for men with chronic post-vasectomy pain and have spoken with men from the United Kingdom, Canada, Singapore, the U.S., and New Zealand. One thing that comes up repeatedly in these unfortunate men is the lack of informed consent. They were told what was listed above, but were not given any real information with which to make an informed decision.

Vasectomy can cause chronic testicular pain in up to 15% of men in the first year after the procedure. Other long-term studies suggest that up to 10% of men have chronic pain. About 2 to 5% of men report severe pain or pain that affects sexual function. Men in forums on the Internet report changes in ejaculation, orgasm, and erectile potency. While most men do well (perhaps 85%), the men with bad outcomes are silent, angry, and feel betrayed by the inadequate informed consent. It is time for consent for this totally elective procedure to reflect all possible outcomes, including chronic pain, post-vasectomy pain syndrome, changes in orgasm, changes in ejaculation, and changes in testicular and prostatic function. The expected psychological effects of these changes should also be mentioned. It seems likely that any significant genital pain associated with sex could affect sexual response, potency, or sexual enjoyment, and in this way affect libido and mood. The psychological morbidity of chronic genital pain after vasectomy is not well represented in either the psychiatric or urological literature. It is time for studies on the sexual effects of vasectomy, not more studies on differing techniques to enhance effectiveness. The procedure is quite effective in preventing pregnancy, but at what cost to how many partially informed men?

Are men so fragile that they can’t handle the truth? Must they be placated with unrealistic ads promising increased libido and sex with no worries? Is it ethical to only include the positive outcomes in order to increase acceptance of the procedure? I don’t think so, and neither do the men with the poor outcomes. They not only have to deal with the ruination of their sexual function, but also the feeling of betrayal.  The ads that explain that this “simple 15 minute procedure done under local anesthesia” will “free you” and how you can be “your wife’s hero” are unethical and just plain wrong. Make sure you read the fine print and do your own research. I guarantee you, the information is out there and you will be surprised what you are not told.