What should you expect from a vasectomy in 2019? Here’s a checklist of what to look for and what to ask your urologist.
Sex is a contact sport unlike any other. I’m sure many images are going through your mind. And I’m not talking about tripping on the rug before you get into bed or hitting your elbow on the night stand. The idea of wearing a helmet is necessary for more than just the head. You want to be safe in a number of ways when it comes to sex.
Here are my Top 10 Sex Safety Tips for Exploring Your Wild Side…and for avoiding the E.R.
Just to recap:
- Always wear a condom! It’s basic, but it’s worth repeating. Wearing a condom helps you avoid unwanted STDs like herpes, syphilis, gonorrhea and chlamydia just to name a few.
- Never put anything on or around your penis that you may not be able to remove, like a metal constriction device.
- Never stick anything into the urethra opening (i.e., where you void) because it’s probably not coming out on its own.
- Don’t put anything in your bottom that you might need a doctor to remove—that’s a tough ER conversation.
- Sex involves a lot of friction, so use lubricant to avoid chafes and abrasions.
- Heavily scented soaps, lotions, conditioners and shampoos can be very irritating to the urethra so avoid them when alone or with a partner. Don’t turn your “burning desire” into “that burning feeling.”
- For those of you with foreskin, make sure it is pulled over the head of the penis because it can get stuck and when it does it’s not always pretty.
- If you’re going to use penile injections (which in and of themselves are very effective), make sure you inject correctly so you don’t end up with an erection that won’t go away or a curvature of the penis.
- Be careful which way you thrust and the positions you choose because you can break your penis.
- For those who enjoy pain—whips, chains and heels might add drama…but can also cause severe trauma!
At the End of the Day, Safety First
If you’re committed, the safest thing is to be with the one you love or at least the one you’re with. And if you’re committed and you’re going to be with someone else, be extra careful. Regardless, suit up (wear a condom), be safe and have fun!
Sexual safety will help you avoid injury and other health issues in the future, but sometimes sexual problems can occur despite your best efforts. If you think you have a condition that requires attention, please see a doctor. To see Dr. Zeitlin:
I often see patients who are potential candidates for vasectomy reversal and it makes me think of a smart urologist whom I have known for many years. We were at a meeting of a local surgical society and having a glass of wine and talking to a third mutual friend, who was a reproductive endocrinologist. The urologist told us that he had a patient that was 50 years of age and had a vasectomy 8 years earlier. He added that the man’s present wife was 29 years of age (this is not that uncommon in Los Angeles). He had just referred the couple for In Vitro Fertilization (IVF) with sperm extraction. He said he did this because the man was 50 years old. Unfortunately, while he was a good urologist, he didn’t specialize in—and knew very little about—infertility. After he walked away the reproductive endocrinologist looked at me and said exactly what I was thinking: that this was the perfect couple for a vasectomy reversal. The man had two kids and it had been less than 10 years since his vasectomy. The wife was young and fertile and ordinarily would not have needed IVF under other circumstances.
This was the perfect couple for a vasectomy reversal. The man had two kids and it had been less than 10 years since his vasectomy.
In patients less than 10 years from vasectomy the success rates for reconnecting the two ends of the vas together (thereby reversing the vasectomy) exceed 90% when there is sperm in the vas. The success rates are lower if there isn’t sperm, but the cost of a vasectomy reversal is less than one round of IVF. In addition, you can typically extract and freeze sperm at the same time as the reversal, so another sperm retrieval is unnecessary should the reversal fail.
So when is a vasectomy reversal the right choice?
Since the goal of a reversal is pregnancy, here are some good rules of thumb:
- In men less than 15 years from their vasectomies the rates of success and pregnancy are quite high.
- The younger the female partners, the greater the chance of making them pregnant following a reversal.
- A successful reversal is less expensive than one round of IVF; and most couples will need more than one IVF cycle to achieve a pregnancy.
- Unlike IVF, a successful reversal allows you to try every month to achieve a pregnancy.
While not all vasectomies are reversible, most are, and a reversal has many physical and economical advantages over IVF. Obviously, it’s wise to talk to your male fertility specialist about your options before proceeding and don’t hesitate to get a second opinion.
A 28-year-old man recently came to see me after he and his wife had been unable to conceive for a year. She was 26 and healthy. He smoked 2 packs per day and liked to drink as well. He was about 20 lbs. overweight. I looked at his analyses. His sperm count was borderline and his motility and morphology were low (see my article “Yes, but am I fertile?” for a detailed explanation). I examined him, finding normal results from head to toe except for some wheezing. His hormone tests all came back normal. After his fertility testing was done, I told him that if he would stop smoking and drink less that his wife would probably be pregnant in the next 6 months. He asked me what he would have to do if he didn’t want to quit smoking and drinking.
If he would stop smoking and drink less, his wife would probably be pregnant in the next 6 months.
I told him that he would need to start with IUI, which is commonly referred to as artificial insemination, while his wife would need to be stimulated with hormones. I added that if it didn’t work after a number of cycles they would need to go to IVF, which is in vitro fertilization. I stressed that they were young and if possible natural conception was the way to go. First, it’s a lot more fun; you can do it from the comfort of your own home—or anywhere else as long as you don’t get caught. Second, It obviates the need for hormonal stimulation and its consequences such as multiple order births. You know…less twins and triplets. Last but not least, it’s free—as long as she isn’t charging him.
The Avon Longitudinal Study of Pregnancy and Childhood looked at pregnant British couples, questioning them about their time to conception and the factors that affected it. Hull et al., published this study more than a decade ago in Fertility and Sterility. What they found was that not only was the women’s pregnancy delayed by smoking, but also by exposure to second-hand smoke. In addition, when the men independently smoked more than 20 cigarettes a day, the chances of having a pregnancy delayed beyond 12 months increased.
Men who are alcoholics are prone to testicular atrophy, which is a shrinking of their testes. However, when Olsen et al., looked at moderate drinking in “Does Moderate Drinking Affect Fecundability? A European Multicenter Study on Infertility and Subfertility,” they found that there was no correlation between moderate alcohol consumption and delay to pregnancy.
So if You Want to Have Kids…
So what’s the take home message? There are a myriad of reasons to quit smoking and to not abuse alcohol, but if you are trying to get pregnant, consider this: if you’re going to have a kid you should get used to those things anyway because it’s not good for you, your partner or your baby. May 31st is the WHO’s World No Tobacco Day…quit then, or just quit today. Either way, your future kid will thank you.
Whether or not you are a smoker, if you are concerned about your fertility or sexual health, please see your doctor. If you would like to see Dr. Zeitlin, please schedule a consultation.