Vasectomy: “There is a desire today to be sterilized earlier”

In 2021, more than 23,000 vasectomies were carried out in France (including around 2,000 in the Occitanie region), compared to less than 2,000 ten years earlier, according to figures from theHealth Insurance. On the occasion of World Vasectomy Day this November 12, Why Doctor takes stock of this little-known method of contraception, reimbursed by Social Security, with Professor Eric Huyghe, urologist-andrologist at the University Hospital Center (CHU) of Toulouse, head of the andrology and sexual medicine committee of the French Urology Association (AFU).

Why Doctor: What is vasectomy?

Professor Eric Huyghe: The word means “section of the vas”. It is an operation which consists of interrupting the male genital tract, by cutting the vas deferens to prevent sperm from passing through and joining the seminal fluid. Once these ducts are cut, the sperm is devoid of spermatozoa and the man is therefore sterile. It is today the most effective contraceptive method: there are only five failures out of a thousand, or 99.95% successes.

Vasectomy without a scalpel: the operation lasts around fifteen minutes under local anesthesia

How does the operation take place?

The method that I practice at Toulouse University Hospital is called vasectomy without a scalpel. [À la différence de la chirurgie traditionnelle où il faut inciser la peau des bourses sur 1 cm de chaque côté, ndlr], it requires specific instruments which allow the vas deferens to be grabbed under the skin and taken out through a single 5mm opening between the two testicles. The operation lasts around fifteen minutes, and is done under local anesthesia. In France, the majority of patients who have a vasectomy do it under general anesthesia, often because, at first glance, they fear the operation under local anesthesia.

Vasectomy has experienced a real boom in France in recent years. What is the profile of patients who have a vasectomy?

The typical profile is a 35-year-old patient who already has children, often two, and does not wish to have more. That said, today there are more and more young people, between 20 and 30 years old, without children, who decide to have a vasectomy. It happens that patients confide in particular about their environmental concerns, believing that there are already enough people on earth, preferring to adopt rather than have a child… People under 30 and without children represent approximately 10% of my patients. Today there is a real current of thought around the desire to sterilize oneself earlier.

“A definitive contraceptive technique, but which can be repaired by surgery”

Vasectomy is supposed irreversible… What is it really?

Vasectomy is a definitive contraceptive technique, but which can be repaired by surgery: vasovasostomy consists of making a seam, a bridge between the severed vas deferens. It takes longer than a vasectomy: around 1h30 of work, with a microscope. In 85% of cases, we manage to reverse the process, but for this the vasectomy must not have been too invasive and removed too large a portion of the vas deferens: enough is needed to make the seam, otherwise it will is impossible to repair. Generally speaking, it is better to see vasectomy as a definitive means: you do not do a vasectomy for a year…

What misconceptions do patients have about vasectomy?

Contrary to what one might think, pain is not their main fear. What they fear is the impact on their sexuality. There is always a confusion between being fertile and being virile, being a “100%” man. At the Toulouse University Hospital, we recently carried out a survey of nearly 500 men treated for a vasectomy: around 90% of them said that it had no impact on their erection, their ejaculation, their desire, their pleasure, 3% believe that it is less good, and even 7% find that it is better than before. We can say that there is no negative impact. Even the volume of ejaculate remains unchanged, 90% of it being produced by the prostate and the seminal vesicles, therefore downstream of the cut area: with only 10% less volume, patients do not see the difference.

Vasectomy: “there are positive repercussions in terms of understanding between the couple”

Why use this method of contraception?

Vasectomy gives great satisfaction to men who have decided not to have more children. Generally speaking, there are positive repercussions in terms of understanding between the couple – it is a process that is done together in most cases. In many cases, men want to free women from contraception by taking it upon themselves. In France, vasectomy is a somewhat new phenomenon, but it is very widespread in other countries such as Canada, where one in three 50-year-old men have undergone a vasectomy, and the United States, with 500,000 vasectomies per year. , Korea, New Zealand, Mexico… Europe is also coming: in Belgium, the United Kingdom and even Spain, between 5 and 10% of couples use vasectomy as a means of contraception.

Aside from condoms and vasectomies, what other contraceptive options are there?

There are hormonal methods, with the male contraceptive pill, which allows men to take on the burden of contraception through regular monitoring, with frequent spermograms to check that everything is working well. But today’s young generation is not in favor of hormonal treatments.

Another solution: heated briefs. Like the pill, you have to wait several months before becoming temporarily sterile. To work, it must be worn at least fifteen hours a day (and not when sleeping!), not one less, and 365 days a year, otherwise you risk having to wait another three months for it to work. Most people use it for a few years, before having a child. It is an effective method for some, less so for others, depending on compliance and physiology. It decreases the chances of pregnancy, but it is not a contraceptive method that results in 0% fertility. It is difficult to give numerical estimates because, unlike condoms or vasectomies, heated underwear has not been tried by millions of people. But we must be around 70-80% efficiency.