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Contraceptive
Methods

    About No-Scalpel Vasectomy

    Up to today, bilateral vasectomy is still one of the most effective ways to assure not to impregnate women again, that is, male
    sterilization or family planning.

    Before proceeding with it, let us have some common concerns set straight by revealing the currently available truth and facts of
    vasectomy as follows:

    1. Indication:
       It is to achieve "permanent" inability to impregnate women although its later reversal is possible but not in guaranty for result and
        very costly.

    2. Being best?
       No answer. But, doubtlessly, it is reasonable after being counseled with understanding the pros and cons of all available methods
       of contraception.  

    3. Being easier for men than for women?
       Yes, absolutely, technically it is easier for men than for women because it usually can be done under local anesthesia.

    4. How is vasectomy done and what are the methods to block the cut-off vas deferens?
       It can be performed successfully in supine position under local anesthesia for more than 99.5% of men by making one or two
        openings less than one centimeter to reach and grasp the vas, from which a section of some 2 cm of vas is transected and
        removed, and the cut-off ends are blocked / sealed with tying-up with a thread or just with burning to seal, depending on what the
        surgeon may feel most comfortable. To me, burning with electric cautery has been easiest and most effective to permanently
        interrupt sperm passing through vas deferens at ejaculation.

        The technique used is called no scalpel vasectomy or keyhole vasectomy, which was developed in China by Dr. Li Shunqiang
        at the wake of China's intense need for birth control in 1974, by using his specially designed very fine-tipped tissue dissector and
        vasal grasper. In 1984, non-scalpel vasectomy was introduced into the United States.

    5. How successful is vasectomy?
       Vasectomy will achieve a success in sterilization for more than 99.9% of times.

    6. Can vasectomy be reversed?
       Yes. The success of vasectomy reversal widely varies reflecting the timing after vasectomy and surgeon's skill, but I would like to
        remind you that vasectomy reversal can be very costly up to $10-30,000 as opposed to $1000-2000 for vasectomy, and usually the
        insurance may not cover the cost for vasectomy reversal.

    7. How should you expect at vasectomy counseling?
       Soon arriving at doctor's office, you register in for personal and insurance identification. Upon seeing doctor, s/he will ask and   
        confirm the state of general health and that of specific history about how you decide to undergo vasectomy, and perform physical
        examination to at least assure both vas deferens are palpable and accessible for the procedure under local anesthesia, and sign
        an informed consent for vasectomy. Then, a date for vasectomy will be scheduled to suit your and doctor's convenience and
        feasibility.

    8. What should you do on the date before vasectomy?
       Relax to have a good-night sleep and take shower before going to Doctor's office for vasectomy.

    9. What would you expect in the operative room for vasectomy?
       You will lie on a mobile or regular surgical table to expose the genital region for shaving, disinfecting, and aseptically draping for
        vasectomy.

    10. What may you feel during vasectomy?
           Of course, you will feel professional hands palpating, accessing, and manipulating the vas deferens for infiltrating local anesthetic
           solution to the vas and its all overlying tissues and skin. Almost instantly, a less-than 1 cm opening is made to approach the vas
           so to bring it out of the sac (scrotum), and an about 2-cm section of the vas will be cut off and removed, and  each end of
           transected vas will be sealed as described above in Question 4.

    11. What would you expect over next few post-surgical days?
           You expect feeling some soreness or ache or pain, for which there is usually no need to take pain medication, at most, you may
           use ibuprofen. In fact, I have almost never prescribed any pain medication because of no practical need. You may notice some
           bruise (ecchymosis) of various degree and / or local swelling and hardness. The degree of local discomfort may last or linger in
           rare cases for weeks reflecting the degree of local bleeding and expected inflammation; the odd to experience such should be
           less than 2-3 %.

    12. What may be the long-lasting undesirable effects?
           Rarely, say, less than 1% may have annoying or even unbearable pain, which may require additional procedures with vasectomy
           reversal after failing to conservative care with empirical use of antibiotics and / or anti-inflammatory drugs.  

    13. What should you do to avoid pregnancy after vasectomy?
           Always continue taking precaution against pregnancy with the ongoing contraceptive methods until microscopic semen exam
           after vasectomy shows no sperm for at least 2 times in 1 month apart. Usually, some 85% of post-vasectomy semen will show no
           sperm after some 15 times of ejaculation or in 2 months. Despite providing such post-vasectomy precaution, prior
           studies showed less than 50% of men after vasectomy will follow the instructions to have pot-vasectomy semen exam to assure
           semen is sperm-free.

    14. What is the odd to have re-canalization of vas deferens after vasectomy?  
           It should be less than 0.025% or < 1 in 4000. If occurring, it is usually within 6 months after vasectomy, but not always.
           Nevertheless, vasectomy is still the most reliable means of all contraceptions with its success rate of 99.95% or a failure of
           <0.05%.  

    15. Does vasectomy affect cardiac health or increase prostate cancer risk?
         The debates on these two concerns have been going on for decades but with their alternating pros and cons over time. Up to
           today, the dust from these debates seems settling down to affirm vasectomy has not been found to be linked with an increased
           risk of coronary heart disease an prostate cancer.


    Final Note
    Despite its known success rate approaching 99.95%, always accept the fact that no life event can be perfect or 100% in guaranty; if
    unrealistically insisting on not having any consequence, the only way to have such is not to have anything done, but sit still to observe
    the natural course of life. This is a life reality and nothing is free.
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