Vasectomy

I. Anatomy and Physiology of the Male Reproductive Tract.- 1. Embryology and Functional Anatomy of Male Reproductive Organs.- II. Disorders of Spermatogenesis and Ejaculation.- 2. Orchiopexy and the Use of a Testicular Prosthesis for the Undescended Testicle.- 3. Epididymovasostomy for Epididymal Obstruction.- 4. Scrotal Exploration, Testis Biopsy and Vasography for Testicular Failure.- 5. Internal Spermatic Vein Ligation for Varicocele.- 6. Bladder Neck Reconstruction for Retrograde Ejaculation.- III. Disorders of Erection, Emission and Vaginal Penetration.- 7. Urethroplasty for Hypospadias.- 8. Genital Reconstruction of Anomalies of the Genitalia other than Hypospadias.- 9. Genital Reconstruction for Traumatic and Infectious Diseases.- 10. The Inflatable Penile Prosthesis for Treatment of Erectile Impotence.- 11. Grafts and Prostheses for Peyronie's Disease.- 12. Corporal Shunts for Priapism.- 13. Vasectomy.- 14. Vasovasostomy.- IV. Gender Reassignment.- 15. Orchiectomy, Penectomy, Vaginoplasty for the Male Transsexual.- V. Benign Disorders of the Male Accessory Glands.- 16. Prostatectomy for Benign Prostatic Hyperplasia.- 17. Epididymectomy, Seminal Vesiculectomy and Hydrocelectomy for Epididymitis, Seminal Vesiculitis and Hydrocele.- VI. Oncological Surgery.- 18. Penectomy and Groin Dissection for Carcinoma of the Penis.- 19. Orchiectomy and Retroperitoneal Node Dissection for Carcinoma of the Testicle.- 20. Total Prostatectomy for Carcinoma of the Prostate.- 21. Combined Radiotherapy for Carcinoma of the Prostate.

Surgery of the male reproductive tract

The increasing popularity of sterilization as a contraceptive choice among married couples underscores the need for knowledge about differences between couples choosing male and female procedures. Data from national surveys suggest some sociodemographic differences, but these variables account for only a small amount of the variance. This research looks at other sets of variables—specifically, information sources, influence sources, and reasons husbands and wives give for wanting sterilization—in a multivariate analysis of the choice of a male versus a female operation. Particularly for husbands obtaining a vasectomy, the importance of social support is demonstrated.

Husband or Wife? A Multivariate Analysis of Decision Making for Voluntary Sterilization

An intensive pilot survey involving direct contact with 47 young married couples with university education was conducted to determone their attitudes tiwards general (public) and personal choice and control by parents of the sex of offspring. Information as to premarital family status and present number and sex of children was obained. Questionnaires were completed before and after information had provided regarding new methods of fetal sex detemination, abortion, and related topics. Opportunity for discussion by husband and wife between sessions was allowed, but discussion with other was discouraged. Results indicate that sex choice will be accepted and employed by the majority of highly educated, middle-class individuals. While selection of the first-child sex is of negligible importance to most, planning for a second child with opposite sex to the first is strongly favoured. The tendency to prefer males is not as pronounced as reported in previous, less direct studies. The majority preferred a two-child family with one child of each sex. Prospective methods (e.g. a pre-coital, sex-selective pill, when available) were much preferred to retrospective methods involving abortion. Inthe meantime, fetal sex determination in the first trimester of pregnancy with selective abortion may soon be widely practised. New problems in marital and family adjustment, family planning, and social organization may arise with the advent of this new step in human sexual socio-econtingencies need further onvestigation at various socia-economic and educational levels and in different cultural milieus.

Parental predetermination of the sex of offspring: the attitudes of young married couples with university education.

Changing Profiles in Vasectomy Subjects in the Past Decade

In order to show that there is acceptance of vasectomy as a method of birth control by the public and that a large demand goes unmet due to presumed legal restrictions the unavailability of services or the unwillingness of physicians to perform the procedure the Vasectomy Service at the Sanger Bureau was established. The service itself is the main objective; research and training are secondary. After persons making initial inquiries have formally applied and their completed application is processed an initial interview and a presurgical medical evaluation are conducted. The procedure is explained and the candidates eligibility determied. The medical evaluation incudes the medical interview physical examination semen analysis blodo studies and urinalysis. Surgery appointments are scheduled not less than 2 weeks after the medical evaluation. The Bureau requires 2 azoospermic postoperative semen specimens before a letter of confirmation was sent informing the patient that other methods of contraception might be discontinued. The 236 clients seen in the 1st year October 1969-September 1970 were sent a questionnaire in November 1971. The mean age of the vasectomized men at the time of operation was 38.4; the mean number of living children of acceptors was 3.3 and only 3 men had no children. The men were highly educated and about 58% were in professional managerial or technical occupations. About 9% of the men had specific postoperative complications such as small hematoma bleeding or infection. About 14% had subjective complaints such as pain swelling and discomfort. Results of a follow-up survey 1-2 years later showed that postoperative complications in msot cases were mild and required no specific treatment and little or no absenteeism. It is necessary to streess that male sterility is not accomplished upon completion of surgery and contraceptive measures should be used until azoospermia is confirmed by postoperative semen analysis. Most of the men 71% became sterile within 3 months but 7% continued to show motile sperm in their ejaculates for more than 6 months.

A vasectomy service in a free-standing family planning center: one year's experience.

The experience in establishing the first outpatient Vasectomy Service as an integral part of a family planning service in a center that has offered other family planning services for 50 years is summarized. The Vasectomy Service was opened in October 1969 at the Margaret Sanger Research Bureau Inc. Service was the primary objective. From the inception of the Vasectomy Service at the Bureau until June 30 1972 1426 procedures were performed. Analysis of the 236 clients operated upon during the first year of operation as well as the results of an inquiry into the patients reactions to the surgery 1-2 years after it was performed showed that the nature of postoperative complications in the 189 respondents (80%) was generally mild required no specific treatment and little or no absenteeism in the population studied. There were only 2 complications that required absence from work. The surgical failure rate was 2.5% (6 cases); 4 cases were reoperated 2 refused reoperation; final failure rate was .85%. The mean time to reach postoperative azoospermia was 80 days. The service at the Sanger Bureau has served as a model for a number of similar services. At present vasectomy is being performed at 129 clinics 153 hospitals and countless doctors offices.

J.E. Davis

Papers

A vasectomy service in a free-standing family planning center: one year's experience.

A vasectomy service in a free‐standing family planning center: One year's experience