Myth and fear still surround the vasectomy, writes Angie Mezzetti discovered in her research.
As a permanent form of contraception the vasectomy or "snip" as it is often referred to has been around for years. For couples who are sure they don't want any more children it is often recommended by family doctors
"A vasectomy is better than a vase of flowers to show your partner how much you love them," according to Joe who got his done four years ago. "I haven't looked back and it was a relatively painless procedure."
His attitude seems to be typical of the "new man's" approach to this permanent method of contraception.
"Increasingly because many men are witnessing their wives or partners having the babies, they are more aware of what women go through," according to Dr Oliver Lynn in Drogheda who has patients referred to him from all over the North East. He believes it is a sign of the new more caring male. "Often the wife has been on X,Y or Z for years and there is a genuine feeling of wanting to take responsibility by the man."
Dr Sheila Jones medical director of the Irish Family Planning Association in Dublin, echoes this observation from her work in their centres in Cathal Brugha Street and Tallaght.
"Some men worry about their partner's health and it's his way of demonstrating he is taking his responsibility seriously and it shows a mature and caring relationship."
Not all men are motivated by selflessness though as one man considering having it done said that he felt that afterwards "there could be no excuses".
A vasectomy should be looked on as a permanent form of contraception, according to Dr Jones. Like all professionals in this area the IFPA see this as a three part procedure. The initial counselling, the operation itself and the follow-up to make sure that all sperm have been cleared from the semen. Most important for the couple and particularly for the man is counselling prior to the procedure.
"We always tell clients to look at this as irreversible," she says. "It used to be that the couple had to be over 30 and their youngest child at least six months old out of fears over cot death. This is not the case now however but it is really important that the couple be in a relatively stable relationship and are both agreed that this is what they want. We would always advice that it not be done at a time of crises."
At the counselling session, the procedure is explained, common myths are dispelled and questions are explored and answered. Some common myths include worries that sex drive will be affected, that there will be no "liquid" or lubrication produced during sex and that the man will have to refrain from sex for many weeks.
Dr Lynn says he explains to his patients that semen is still produced when the man ejaculates but that it no longer contains sperm, by telling them that 'the river still flows but the fish have been taken out of it'.
Sex drive is unaffected once the man has had time to recover from any initial discomfort, pain or bruising and often the opportunity for sex is actually increased because the woman's fear of becoming pregnant is gone, once the man has been told he is cleared.
Frank who had the snip done in Dublin before Christmas last year said there is certainly more spontaneity to his love life now. "I was really planking before the job was done and it did hurt quite a bit on one side," he says, "but looking back it was a doddle."
The actual operation is quite straightforward according to Dr Andrew Rynne of Clane Medical Centre, Co Kildare, but he says sometimes it can be quite hard to find the vas deferens (the spermatic tube that conducts sperm from the testis) under the skin.
Once it is anchored and local anaesthetic is applied the doctor will go back and pick up the vas through a small incision about half a centimetre long. A special forceps is then used to pick up a small loop of vas.
Normally they take out a section of it about 1.5 cms long and he says the testicular end should be left open while the other end is sealed. Any sperm produced will then fall off into the scrotum and be cleared away naturally by the body. Male hormones continue to be produced as normal.
The operation itself takes about 10 to 15 minutes. Dr Jones adds: "Most men say it is easier than a visit to the dentist and if there is any pain or discomfort afterwards a couple of paracetamol will normally alleviate it."
The IFPA carry out about 10 vasectomies a month in their new facility at Cathal Brugha Street. After an initial recuperation time in the clinic with a cup of tea or coffee the man is advised to go home and rest for a couple of days and some may wear a scrotal support.
The third part of the vasectomy is making sure that the semen is clear. This usually takes about three to four months. Two samples are taken at 16 and 18 weeks post op for laboratory analysis to check that there are no sperm present. Occasionally a man is not cleared at this stage and further tests may be required.
"Some men believe they have to hold off from having sex in the first few months but this isn't so as it takes about 20 ejaculations to be clear any reserves so it is very important to use another form of contraception such as condoms until then," according to Dr Jones.
Dr John O'Keeffe of the Morehampton Clinic in Dublin says his patients usually drive themselves home and that less than 10 per cent come in with their partner for the operation. About half of his patients say they don't bother with pain killers and one them told him that he had his vasectomy on a Friday and root canal work done the following Tuesday and that the vasectomy was a cakewalk by comparison.
"The hardest part of the whole thing is making the decision," he says which is why he believes counselling is fundamental. He recommends complete rest for the first few days after the procedure and no contact sports for at least three weeks. In response to a survey he carried out, most patients said they were able to resume normal sexual activity after about six days.
While all practitioners advise patients that vasectomy should be considered irreversible, increasingly doctors are seeing men who want to be fertile again in a new relationship. "Because of the increase in marriage breakdown and now divorce, approximately three to four \ a year will seek to have it reversed," says Dr Andrew Rynne who in such cases refers them to another specialist.
Success rates years ago for reversal were quite poor especially if more than three years had elapsed since the vasectomy. "They are more successful now, however, because we can borrow from IVF technology," he says.
Vasectomy is free on the General Medical Card but otherwise will cost between €380 and €600. Some doctors will have an initial consultation/counselling fee of about €90. Vasectomy is not covered by VHI or BUPA but the cost can be claimed on your Med 1 form for tax purposes at the end of the tax year.
Barry who has had a vasectomy says it was money well spent where he was concerned and that the only thing that bothers him is when he hears others saying its unnatural or tempting fate as he believes that this is ridiculous.
Dr Oliver Lynn says men who have had it done are the best advertisement as many come to him because word of mouth testimony from others, especially brothers-in-law. "Where a couple are sure their family is complete it is the ideal solution for contraception and the best thing about it is that it is maintenance free."'