The truth about men and vasectomy

There are different methods of birth control available for men and women.

Unlike women who have a wider variety of options to choose from (hormonal and non-hormonal including pills, syringes, IUDs and others), for men, the options are limited.

Condoms are more popular because they are cheap and easily accessible. Other than pregnancies, they prevent sexually transmitted diseases such as gonorrhoea and HIV/Aids.

Vasectomy or male sterilisation is a surgical procedure to cut or seal the tubes that carry a man’s sperm to permanently prevent pregnancy.

The process takes about half an hour to complete and most people are able to recover and resume a normal life almost immediately compared for example, to the women’s tubal ligation which is a complicated surgery. And yet, it is unpopular with men.

In the conventional vasectomy procedure, the doctor makes two small cuts in the skin on each side of the scrotum to reach the tubes that carry sperm out of the testicles known as vas deferens.

Each tube is cut and a small section is removed. Finally, the ends of the tubes are then closed, either by tying them or sealing them using heat, and the cuts are stitched.

Statistics show that the number of men who have gotten vasectomy is much lower than women who go for tubal ligation. Even in Western countries where men are considered more liberal, the number is still low. Canada leads the list with 22 per cent of men of reproductive age having had a vasectomy.

This compares to the UK with 21 per cent, New Zealand with 19.5 per cent and the US with 11 per cent. In Africa, only 0.1 per cent of men had undergone vasectomies by 2016.

According to a recent report by Kenya Obstetrical and Gynaecological Society (KOGS), only 1 per cent of Kenyan men have undergone a vasectomy.

There are many reasons why vasectomy is still largely an uncommon form of birth control among men.

One of the main reasons is the lack of information. Even with the information and lots of research available about vasectomy, there are a lot of people (both men and women) who have minimal to zero information.

A lot of men have not been sensitised about vasectomy and thus do not know what it is and have no idea that it exists as an option. There are some, especially in most rural settings, who have never heard about it. For such men, of course, vasectomy is not an option when and if they ever consider family planning.

However, for those who have heard about it or have an idea of what vasectomy is, another challenge arises - misinformation.

In many countries, vasectomy is surrounded by a lot of myths and misinformation. For instance, there is the immediate fear of physical pain during and after surgery.

“First of all, it sounds like a painful procedure,” says Anthony, who preferred to give only his first name.

“The balls (scrotum) are very sensitive. Any pain around there is something no man wants to experience. It is like being kicked in the balls.”

“It is not like being kicked in the balls.” I protest.

“Maybe not,” he laughs, “you are right. Nothing beats being kicked in the balls.”

New technology and medical improvements have rendered the procedure almost painless with the introduction of ‘no-scalpel’ vasectomy.

In this new technique, the doctor feels for the vasa under the skin and holds them in place with a special clamp. Instead of making two incisions, like in the conventional method, the doctor makes one tiny puncture. They then gently stretch the opening so the vasa can be pulled out and sealed. Because the incision is so small, it requires no stitches.

Another popular myth is that vasectomy reduces sexual prowess and enjoyment during sexual intercourse. Some fear they might not be able to orgasm during sex, while others think that getting a vasectomy would affect their ability to ejaculate.

“I cannot imagine climaxing and having nothing come out,” says Rodgers, 27. “It can be so embarrassing, especially if you like the girl.”

For Susan, she believes that such men do not have orgasm. “I hear they cannot. What is the point then (of sex) if you cannot?”

Contrary to this belief, a man is still able to orgasm and ejaculate even after getting a vasectomy. The only difference is that the ejaculation does not have sperms (since their movement has been inhibited by blocking their channel) and thus cannot cause pregnancy, otherwise nothing else is affected.

Fear of emasculation is also another big challenge. Many men view vasectomy as something that could deprive them of virility or vigour. Even for some men who have decided not to have children, it still is not an option for this reason.

The fear stems from the fact that a lot of people think vasectomy and castration are the same thing and do not differentiate the two.

It is perhaps why the few men who undergo vasectomies often do so secretly and are rarely willing to speak out in support of the practice.

For instance, last year when Nick Ndeda, a media personality in Kenya, publicly announced he had undergone vasectomy, there were a lot of negative responses and comments on social media, with some men calling him a ‘woman’ since he could no longer sire children like the rest of them.

Another major reason why men do not go for vasectomy is the ‘What if?’ factor. This is often the long-term fear and the uncertainty that surrounds the decision. The “what if I change my mind?” question and the fact that this is a permanent procedure.

Although reverse vasectomy now exists, the chances of causing a pregnancy are still low, and only about half of those who attempt such a reversal succeed in fathering children.

Historically, the idea of permanency has always scared a lot of men, even those who have decided not to have children. They would rather not try to have them while knowing that they can.

For instance, a powerful politician split up with his wife of many years recently, after she got pregnant by her younger lover, but tried to pretend that the baby was his.

Unknown to her, however, the formerly married man (with multiple offspring from his previous union) had a vasectomy, prior to meeting her, but had not told her.

All along, for 10 years, she thought she had an ‘infertility’ issue, and had even sought help from one of the top fertility experts in Kenya.

 Dr Sarita Sukijha, a fertility expert, says that family planning, in many parts of the world, is seen as women’s responsibility. The burden of family planning is often left to the woman while men are expected to deal with other ‘manly’ issues of the home.

For many African men, vasectomy is simply un-African and is considered a Western world thing. Then there is the religious barrier where some religious denominations discourage any form of birth control among their followers.

However, talks are on by researchers and scientists about a birth control pill for males similar in function to the hormonal contraceptive pill for females that already exists. Although the pill has been developed, it is yet to be endorsed for public use.

This is because the major tests required to be carried out before any drug is released are still inconclusive.

Dr Sarita says the reason this has taken a while is “because, unlike females who only produce one or two eggs in a month, males produce hundreds of millions of sperms every day, with about 250 million sperms in each ejaculate.”