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Med J Aust. 1983 Nov 26;2(11):564-7.

Vasectomy. What are the long-term risks?


Although vasectomy is becoming a popular method of sterilization, the results of animal studies have led to some concern about the association between vasectomy and subsequent atherosclerosis. After review of the available epidemiological data, it is concluded that there is no evidence that vasectomy is deleterious to humans.


In this review of the longterm risks of vasectomy, discussion covers the following: morphological changes in the testes after vasectomy; endocrine changes after vasectomy; psychosexual effects; immunological changes; and epidemiological studies. The degree of testicular damage after vasectomy depends on the distensibility of the vas deferens and varies from species to species. In men, there is an initial arrest in spermatogenesis for the 1st 3-6 weeks after ligation, followed by a progressive increase thereafter, until an equilibrium between sperm production and absorption develops. Histological studies have shown little change in testicular morphology. Hormonal changes after vasectomy are difficult to assess, because of the large fluctuations in serum levels of testosterone and gonadotrophins in the normal male. Some alterations in hormone levels have been reported, but these all remained within the normal range. No deleterious effect on endocrine function has been demonstrated after vasectomy. The results of recent research on the sexual effects of vasectomy performed in developed countries are almost uniformly positive. After vasectomy, men (and their spouses) reported improvements in sexual relationships and marital harmony and increases in libido and the frequency of sexual intercourse. Vasectomy also seems to have benign psychological effects. Men's self reports of their general health were not affected by this surgery. Feelings of regret after vasectomy in the developed countries were very rare and some studies reported no regrets at all. The presence of antisperm antibodies after vasectomy was initially reported in 1959, and it has subsequently been shown that 50-60% of vasectomized men develop sperm agglutinating antibodies, and 20-30% develop sperm immobilizing antibodies. If some of the antibodies are cross-reactive, the incidence ofautoimmune disease may be increased in vasectomized men. These antibodies may prevent pregnancy, even if a subsequent vasovasostomy is structurally successful. The most precise epidemiological study is one in which subjects and appropriately matched controls are followed up in parallel, and the incidence of morbidity is compared in the 2 groups. An alternative method is the case control study. 3 extensive studies are being sponsored currently by the National Institute of Child Health and Human Development in the US. 1 study is comparing the vasectomy status of men undergoing angiography. The 2nd of these studies is an ongoing study of the health and exercise status, including vasectomy status, of executives. The 3rd study is comparing the vasectomy status of men with myocardial infarction with that of healthy controls. These studies will show conclusively whether vasectomy is a risk factor for vascular disease.

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