2023-11-17 10:23:54
November 17, 2023
What a great idea for men to share the mental burden of contraception with women! While vasectomy, a method of “permanent contraception” for men, is attracting more and more interest in France, vasectomy without a scalpel is developing. Already practiced throughout the world, this simple and safe technique is encouraged by specialists from the French Urology Association (AFU). Explanations on the occasion of World Vasectomy Day, November 17, 2023.
With the #MeToo movement and women’s growing distrust of hormones, the still distant hope of the contraceptive pill for men, thermal contraception in the form of “heated underwear” unreliable at this stage, as well as antisperm antibodies at at a standstill, vasectomy seems to have a bright future ahead of it. In ten years, the number of these small surgeries has increased ten to twelve times in France. 23,306 interventions were performed in 2021 (Health Insurance figures) and demand continues to increase.
It should be remembered that until 2001, the procedure was prohibited because it was considered “an attack on the physical integrity of the patient”. The margin for progress is therefore significant, if we compare to one in three vasectomized men in Canada, 19% in the Nordic countries, 10% in the United Kingdom, 19% in South Korea, and 20 million men in China and India.
Men are satisfied
Vasectomy, a permanent, safe and effective contraception for men, “ is an increasingly requested intervention, especially as it is a small surgery which carries a low risk of infections or hematoma (in 1 to 2% of cases) », Comments Dr Charlotte Methorst, urological surgeon in Saint-Cloud. “ Patients are generally satisfied with this decision », she adds. Indeed, 97% of the men questioned said they were satisfied with having undergone a vasectomy, according to a survey conducted in 2022 by Dr. Wafik Touil (Toulouse University Hospital). The shift in contraceptive burden from women to men was the main motivation for 76% of them.
A minimally invasive procedure
Today, ” everywhere except in France, vasectomies are performed without a scalpel », recalls Professor Éric Huygues, head of the andrology and sexual medicine committee of the French Association of Urology (AFU). This globally recognized technique arrived a few years ago in France, and urologists would like to see it widespread due to the lower complication rate than conventional vasectomy. They have just included it in the 2023 recommendations, thus joining the international recommendations.
This minimally invasive vasectomy, using an incision of less than 10 mm and without a scalpel, has the principle of revealing the vas deferens, which carries the sperm from the testicles towards the exit, then closing it. Logically, the operating time is shorter (-30%), for a total duration of around ten minutes, under local anesthesia (or general anesthesia in the event of sensitivity or disease affecting the scrotum, or in the event of marked anxiety).
No negative consequences on sexuality
Don’t worry, there is no impact of vasectomy on libido, since testosterone levels are not affected. In addition, sperm represent only 3% of the volume of the ejaculate, the patient therefore becomes sterile without his ejaculation, nor his sexuality, being modified by the operation. On the contrary, freed from the risk of an unwanted pregnancy, couples often find a more fulfilling intimate life.
Less than 1% risk of failure
Vasectomy is not 100% safe: even following checking the effectiveness with a post-procedure spermogram, the risk of pregnancy is 1 in 2000. The contraceptive effect of vasectomy is not immediate, sperm living organisms that may be present in the vas deferens and seminal vesicles. An absence of spermatozoa or less than 100,000 immobile spermatozoa per mL confirms the effectiveness of the intervention, which is generally obtained following a period of 3 months and 20 to 30 ejaculations.
What if we feel regrets?
Vasectomy is a permanent contraception, potentially but difficult to reverse. Men’s desire to conceive following vasectomy is estimated between 6 and 7%, depending on studies. “ The reversibility of this prolonged contraception is not guaranteedindicates Professor Huygues, which makes it a method of sterilization more than contraception. » “Reopening” the vas deferens which have been surgically blocked is a possible operation, but the results are often disappointing. Performed within 3 years following the vasectomy, “vasovasostomy” offers a success rate between 30 and 70%. Beyond that, the probability for a man to conceive naturally drops drastically.
However, there are still possibilities of conceiving by collecting sperm from men and performing in vitro fertilization. Another solution is to store straws in a sperm storage center before the vasectomy.
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Source : Interview with Professor Éric Huygues, head of the andrology and sexual medicine committee of the French urology association (AFU) and follow-up to the CFU 2023 press conference (08/11/23) – 116th AFU Congress (2022 ) – World Vasectomy Day: World Vasectomy Day – The recommendations of the AFU andrology and sexual medicine committee regarding the management of vasectomy (2023) – Hupertan V, “Vasectomy without a scalpel: 3 lessons following 526 vasectomies without a scalpel” (presentation of November 18, 2022) – Touil W, Feedback from patients who have had a vasectomy and study of its impact, AFU 2022 Congress, presentation of November 18, 2022, Paris, France – Presentation by Huygues E ., “Vasectomy without a scalpel finally available” (November 17, 2022, CFU 2022, Paris.)
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Written by : Hélène Joubert – Edited by Emmanuel Ducreuzet
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