david

Hi Max,

Your post touches on some common themes here - therefore my reply is likely
to touch on common answers!

Firstly, I think "Chickened out" is probably the wrong way to put it. Your
post strongly emphasises the fact that in your case you decided not go ahead
based on your individual research, and not because of any fear of medical
procedures. Clearly you have made the right decision in your individual
case.

We always say here that you should only go ahead with vasectomy if *you* are
absolutely sure that it's what *you* want to do. If men are pressurised into
having a
vasectomy they often regret it. The satisfaction rates of the procedure are
high in cases where the man is making the decision of his own free will, and
lower in cases where pressure is applied. This is what this group has always
advised, and there is published medical research into this. The following
link is to one such study. There are other studies and articles I could
point to - I chose this one simply to prove that the points made are far
from new.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=4618204&dopt=Abstract

"No pressure should be exerted on any man to undergo the procedure. This
article traces the historical use of vasectomy for eugenic and other social
reasons, besides birth control. Men should not be told: 1) that it is the
best present they can give to their wives, 2) that it is reversible, 3) that
men experience greater libido or feelings of better general health, 4) that
it was ever used for rejuvenation, 5) that it is a way to contribute to the
solution of the world's problems. Men should be told that vasectomy is a
very effective method of permanent contraception with few medical
complications and comparatively little pain. The free, unprompted, informed
decision of a man to terminate his own fertility is the only legitimate
reason for vasectomy."

It should be pointed out that many of the negative stories you can find in
cyberspace relate more to regretting making a decision under pressure that
they were not happy with, as opposed to specific medical complications.


You could read this two ways, but clearly you mean that *your* decision to
not go ahead having done some research replaced *your* decision to go ahead
in the first place. I understand the reasons you made your decision, and
respect the fact that in your case it was the right decision to make. I
would suggest that your personal decision is by no means the inevitable
conclusion men make having done research. Many men read the same materials
as you have done, and don't form the same conclusion. Having read the same
materials as you did, making the opposite conclusion does not make that
decision uneducated, or un-informed.

Hmm. Strange choice. You don't seem like a betting man to me. Vasclip got
the OK from the US regulatory bodies early this year, based on a study (done
by the manufacturer of the device) that had a very small sample size, and
was of a very short duration. There aren't that many urologists performing
the procedure using vasclip currently. There is *NO* information on the
short or long term risks of the device - I'm sure your research
told you that? To go ahead with this new device based pretty much entirely
on the claims made by the manufacturer from a very small, short study *is*
taking a gamble, and you really don't seem the type.

I'd recall the device "Norplant" at this point. 10 years after it's
introduction the manufacturers "voluntarily withdrew" it from the markets in
most of the
world due to problems and lawsuits. Vasclip may well be the answer, and
ultimately replace vasectomy - it may equally well suffer the same fate as
Norplant. I personally wouldn't gamble on it until more is known. The idea
of a removable clip is not new - the group website details early research
into the idea nearly 40 years ago. The main problem is that scar tissue
developed round where the device was inserted making it difficult to
remove. One assumes they have solved this, but the trial data doesn't
mention the issue.

The statement "all surgical procedures carry some risk, but that the
vasectomy was relatively risk-free" is an accurate statement. Dentistry
carries a risk, but one all of us undergo on a regular basis,
non-prescription drugs carry a risk and we all make decisions on these risks
on a regular basis. We assess, and take risks every day. Nobody is saying
vasectomy is "risk free" on the grounds
that it isn't. What *is* crucial is to do plenty of objective research into
risks in order to make an informed decision. Unlike all other forms of birth
control, vasectomy is very old and well established. The procedure has been
studied for nearly 200 years. Contrary to some of the "information" you
might read on the web, the do***entation of risks is actually extensive.
Condoms are an exception to this statement on the grounds that it has a
longer history than vasectomy, and was exclusively used as a voluntary birth
control method.


could not believe it.


It is true that there are personal stories located on the web that are
negative. The ideal place to put them IMHO for many reasons. It's also true
that there are personal stories that are positive - these should also figure
in any objective research.


What should be explained here is that "PVP" is not a specific condition.
It's an "umbrella" term for a whole bag of symptoms that may or may not be
related to vasectomy, and may or may not be caused by it. The more accurate
description is CTP "Chronic Testicular Pain". The other non-explained point
is that no specific definition of the condition exists. Generally speaking
most people would accept the definition as being "Unresolved CTP after 3
months", many researchers and studies don't stick to this definition, and
include symptoms such as bruising, swelling, post-op infections in the
definition of post-vas CTP when they are in fact normal.

One of the major conditions that come under the "umbrella term" is
Epididymitis. It is true that it can be a complication of vasectomy where
the sperm is not absorbed and causes "back pressure". However, it's also a
common urological condition that affects all men equally - vasectomised or
not. Causes being bacterial infections, UTI infections, STD and a whole raft
of other causes. If this occurs, the reason for conservative treatment in
the first instance is that the Epididymitis has a high probability of being
caused by one of the above as opposed to the vasectomy. If it continues,
then
clearly it's passed from being a routine urological condition to being
post-vas CTP and requiring appropriate treatment.

Regarding the "Missouri" website above, I do believe I know the do***ent to
which you refer. What it's doing there is a bit of a mystery, as the author
(Mike Hall) is a British ex-pat living in Spain. The fact that it does live
on a particular server does not mean that the page content is endorsed by
the server owners. I can think of several reasons a page can legitimately
live on a server, and have personally had quite a few of my pages living in
various places as I have been allowed access for various reasons. That does
not mean that the site owner(s) have shared my opinions, or endorsed my page
content.

Part of doing research is looking for the story behind the headlines. How
often have you read an article in a newspaper where the headline grabbed
your attention, and the content had no relation to the headline? I believe
that this applies to the do***ent referred to. It's not a medical paper,


personal opinion as opposed to a discussion on medical research. The
references at the bottom of the page (not referenced in the text) came from
the group website's original medical journal abstracts page.

I'd also point out that this personal opinion is quoted as being a "Medical
quotation" by another site. Indeed, it comprised some 30% of the "evidence"
cited.

Clearly it's a good idea to read articles written from all viewpoints in the
decision making process. It's also clearly a good idea to apply the same
level of
scrutiny into the statements and claims made by all do***ents.

Regarding the figures you attribute to doctors websites(less than 1%), these
often
lump long term complications into the same bucket as short term (easily
resolvable) problems.

There is no accurate figure for post-vas CTP incidence, and as you rightly
point out they vary by ridiculous amount depending on what you read. Partly
due to the fact that
there isn't a strict definition, partly because a proportion of cases are
standard urological conditions and not related to vasectomy, and in part due
to the inherent problems of questionnaire based research. Post vasectomy CTP
has long been recognised as a condition. Is the reason we don't hear a great
deal about it due to the condition being genuinely rare? One of our regulars
(Sean) eloquently pointed out in another forum that "PVP is a risk - NOT an inevitable outcome".

Again- this is a true statement. I think the issue here is
what is discussed in the initial consultation. Counselling is definitely
very variable - however that is thankfully set to change. In the UK, there
are new
guidelines for sterilisation counselling and procedure in the final stages
of implementation. One of the guidelines points is that men should be told
there is a risk of CTP. When the guidelines come into force, doctors will
have to give written information to patients that explains the risks and
benefits, and will reference the evidence that the recommendations are
based upon. In the US there *may* be something similar in the pipeline.
There is a new do***ent on Medline that seems to be similar to the UK
guidelines, but I'm not going to pay $30 for it.

To a certain extent this is true - a crystal ball is not part of the doctors
little black bag. The same argument also applies to any other treatment -
there are risks, and no guarantee as to who will suffer them. There are
however certain conditions that should rule out having a
vasectomy, and it's important to discuss the past medical history as part of
the consultation as that may bring up potential difficulties. If you simply
go to a urologist and give him cash, he's probably not going to know your
medical history. I'd suggest a GP referral in all cases.

There are treatment options, but part of the problem of diagnosis is the
fact that post vasectomy CTP is not a specific condition, and not
necessarily related to vasectomy either. If post-vas CTP was a specific
condition, there would be an accepted normal method to treat it. In the
first instance, routine
urological conditions have to be ruled out - hence doctors won't jump into
surgical options day 1. In the second instance, the surgical options
available work best when tailored to the specific condition or problem.
Denervation can be up to 98% effective, but in meticulously selected cases.
Reversal had a good success rate assuming the problem is back-pressure. In
some cases epididymectomy is the most effective treatment. It's necessary to
select the right treatment for the right condition.


As above - it's recognised that counselling generally needs to improve, and
here in the UK that is quite near. If the new do***ent on Medline is similar
to the UK one, then it's hopeful that things will improve in the US too.

The age old discussion here is on what should be told to prospective
patients. It's my view that men should be told of all known risks (including
post-vas CTP). They should be offered the research material any statements
or recommendations are based on. They should also be made aware of the
various scares and research done into perceived or potential risks - again
being offered the research materials behind any statements/ recommendations.

The term for this being "Evidence based guidelines". The primary motivator
behind the new UK guidelines is a study into actual/potential litigation
from people who are unhappy with sterilisation procedures. The RCOG
recognises that counselling is patchy, and the new guidelines are pretty
strict on informing people of risks, and discussion thereof. From the text
of the do***ent, it's quite clear that failure to follow the guidelines
opens up the path for litigation.

It's my opinion that standardised counselling that includes written
information on risks/benefits is a good thing to push for, and the most
likely way to make sure that all men are by law told of the known risks.
However, I'm not supported in this aim by everyone. My input to the panel
reviewing the UK guidelines was that the section on vasectomy was well
written, and should be handed out in it's entirety.


In your view there are un answered questions, and therefore you don't want
to go ahead. That's your decision, which I respect. However, as I said
earlier not everybody would make the same decision based on the same research.


Certain sectors (producers of the stuff) certainly thought that, but there
has always been people that didn't agree. There is a lot more information
out
there about HRT, and the risks are better known now than at first.

As above - not "Everyone" did. "Everyone" certainly did not include the
dairy industry, who I seem to recall had many vigorous campaigns extolling
the virtues of butter over margarine.

That isn't the case either. You've already said several times that all
doctors say "All surgery including vasectomy carries risk". Therefore I
wonder exactly who is advising you that it's totally safe? It *does* have a
good, very long term safety record but as it's surgery it is not risk free.

David
http://www.vasectomy-information.com

recentlyfixed@yahoo.com

Well Max, you'll probably generate some discussion with this subject
since you've focused on one of the critical issues of vasectomies, and
any surgery, for that matter. IMHO, that would be information
disclosure, risk, and informed consent.


I didn't know what PVP was until after my own vasectomy and found out
about it both personally, and through searching the internet. Being
fairly modest, I would also add that the entire vasectomy experience
was somewhat embarrassing and humiliating.


I am sitting here five months after my own vasectomy, with my own dull
ache that's sometimes better than other times, hoping that somehow it
will all gradually get better over time. My libido has seemingly
dropped, and things just aren't quite the same as they were before,
probably due to both the vasectomy I had and the mental distress of my
own experience. You have found the information I have also seen,
which has led me to conclude it is pointless for me to return to the
doctor unless my pain and problems become much worse than they
presently are.

However, I will readily agree with other posters here that it is easy
to find stories of men with bad experiences, because they are looking
for an outlet and for help. There are also plenty of stories about
good experiences, and I am sure lots more that we never see because
those men move on with their lives and we never hear from them.


We all need to remember that urologists, doctors,etc. are all just
human like us, and they have a job and a business like most of us.
They are interested in making money, and have lots of patients to see,
often having an overly full schedule. Thus, when someone presents for
an elective procedure, they probably assume you know something about
the procedure, and they present a minimum amount of information, give
you a physical check, and answer any questions you have. My
experience was that I was given little information, and somewhat
misled about my procedure. However, if we are proactive, informed,
and involved in dealing with the doctors we will likely get answers to
our questions and be able to make much more informed decisions. I
often wonder if part of the problem is that those performing
vasectomies never get feedback from patients except in the extreme
problem cases, thus they have the mistaken belief that there are few
risks and problems to disclose.

Congratulations to you. Fortunately you did some homework and
investigation, and then made an informed decision that was best for
you. My hope is that anyone considering this surgery is thoroughly
informed,knows the risks and benefits, and makes the best decision for
themself.

BTW, what's the rest of your decision? Back to birth control, a tubal
for the wife? Seems that all have some sort of risk involved.

max wawrzyniak

Thank you for taking the time to respond to my post.
I find that we agree on some points but not others, and
occasionly you seem to have missed my point, possibly due
to my not being clear.

My wife initially "pushed for," and I initially agreed to, a vasectomy
because
we had both heard that it was a simple and safe procedure with few
risks. After she read what I read, she totally changed her mind.

She had heard none of this before, and pointed out that she would never
pressure me to undergo a procedure involving , quite frankly, so many
unquantitified risks, when that was her reason for not wanting to
undergo a "tubal."

There is no "pressure" at this stage of the game.

And I have no qualms about "turning the switch" off permanently
at this point in my life. That is a "non-issue."

I disagree: I do not believe that having balls as big as "cataloupes" or
"g****fruit," has anything to do with "regret" over a decsion.

The medical community seems to be "stuck" on that one issue.

Your response, so heavily focused on that issue, does little to alter
my opinion.

"Many men read the same materials


Very true. But many also state that they did not see these materials.

The point is that they should have, and the doctors should have
seen to that. You obviously agree that there is a problem with
"disclosure," and that is my main point. Everyone has to make their
own decision, and I am not in favoring of "banning" vasectomy.

We both agree on the disclosure problem.


I agree 100 percent!

This is what the urological clinic I was going to go to has to say about
it:


NEW: Vasclip - Less Invasive Alternative to Vasectomy
The Vasclip is a new medical device that provides a less invasive
alternative to vasectomy. About the size of a grain of rice, this
implantable device with a small, locking clip, is placed on each of the
patient's two vas deferens by a physician.

While the patient is under a local anesthetic, the Vasclip is implanted and
locked around each vas deferens, closing the vas deferens on itself,
stopping the flow of sperm. The physician does not need to cut or cauterize
the vas deferens, as is done with a traditional vasectomy.

Post procedure pain, swelling, and infection are significantly reduced when
the vasectomy procedure is done with the Vasclip device. Recovery time is
also reduced.

Is this "full disclosure?"

Note the last line: should these people be making that statement?

And they are not the only ones; there are other doctors saying the same
things

Accurate, yes.

A hiker is lost in the woods; he meets a hunter; the hiker asks the
hunter, "where am I?" The hunter replies, "in the middle of the woods."

That is also an "accurate" statment.
And about as usefull. This is not "full disclosure."


Point well taken, but I will offer this link stating an even higher
percentage, possibly as high as 1/3:

http://www.vasectomymedical.com/vasectomy-pain.html

Yes, and there are ways to quantify risk.

I will go further and say that if a doctor is going to tout
the safety and simplicity of a vasectomy on his website,
and provide farely graffic descriptions of the procdure, he
should also be stating the known possible complications.

To "bring them in the door" with a "rosey" website, and
then disclose possible complications at the interview stage
is irresponsible. Obviously, I would never have scheduled
an appointment if the doctor's website had disclosed more.

Why should I have to pay for the interview when this disclosure
could have been made on the website?

Remember, you do not want to pay $30.00 for that report.


I would point out that this is a "lifestyle" issue for most, and
not a "medical" issue.

These patients are not ill or injured, and there is "zero" medical
risk to NOT having the proceedure.

For this reason alone, the "bar should be set higher" as
to disclosure.

recommendations."


We agree here. And I think that we agree that it is not being done.

I note your use of the word "scare," a rather strong word, when other
words could have been used.

Which leads me to speculate as to the motivations of those doctors
opposed; are they genuinely concerned with the patients' welfare?
Or are they concerned that an admission of possible complications
at this stage of the game will lead to a "lawyer feeding frenzy" in
the courts?

What is your opinion as to their motivations?

Are the risks of vasectomy really "better known now than at first?"
As you point out, vasectomies have been around for 100 years
or so. Why are there still so many unanswered questions?
And remember that, when it comes to vasectomys, doctors
are "producers of the stuff." and also therefore subject to
scrutiny.


I certainly appreciate your time and effort spent to respond to my
post; I have read into your dialogue that you are an honest and
caring individual, although if you have a financial interest in the
procedure, I have to keep that in mind as well.

Certainly a "majority" of men have no long-term problems with
vasectomies. but a "majority" starts at just-over 50 percent, which
means that the minority could be 49 percent or .49 precent, which
are very different numbers.

After 100 years of performaing an elective (let's not lose sight of
that) procedure, I would have assumed that the risks would be more
clearly identified, and definetely more clearly disclosed.

Respectfully


Max

max wawrzyniak

">

First of all, let me say that I sincerely hope that you are
able to find a solution to your problems that you find
satisfactory.

As to "what now?", I made a stop in the "back aisle" of the
drug store on the way home Friday.

And if it comes down to one of us having an "operation,"
it will be me, even after all I have read.

You know, I was kind of looking forward to the freedom
from worry that this would have provided.

And I was definetly looking forward to the "sympathy " that
my suffering, for a few days to a week or so, would have
earned me.

It was purely by chance that I stumbled across the information
that I did, and it "floored me." I never expected it.

And I contend that the reason I never "expected it," is because the
medical community has done an excellent job of keep a "lid" on
it.

The words "safe and simple" will be found on virtually every doctors'
website.

I wish you good health.


Sincerely

Max

ron

Go do it, you won't regret it!

david.brown@tesco.net

Hi Max,

I'd like to start the post by "Declaring my interest". I am one of the
co-founders of this newsgroup and the webmaster of the group website
http://www.vasectomy-information.com.

Long story shortened - the newsgroup was started after I met one of
the
other founders on some techie newsgroup. He was asking about vasectomy
there
as the group was mainly men, and he figured that there would be
someone in
the group who had undergone vasectomy and would talk to him. We
eventually
got round to asking the question "Why isn't there a vasectomy group in
Usenet" and (with others) set about creating this group.

The other guy was the first webmaster of the group site, and I sort of
inherited it at a later date. My financial interest is a negative one
- the
site costs me approx £10 per month to host. In addition if I use
applets or
services from third parties there is additional cost involved. It all
comes
out of my "Beer budget".

I'm English, but I try to make the site as multi-national as possible.
We do
get a *lot* of visitors from places other than UK/US including many
countries where English is not the primary language. What I try to
promote
is "Informed choice" - that includes going deeper into studies and
articles
than many people do, and providing commentary/information on how
statistics
are made up. I believe it's essential for people to know the
background
behind any specific quote or claim if it's going to be used in
decision
making.


We probably agree on more than you think. Thanks for clarifying the
story re
not being pressurised and your wife agreeing once she read the info.


that

I was making a generalisation with the comment. Many of the negative
stories
I have read (and that is a lot) *do* have lack of research and
pressure as
the main
theme. Probably more so than ones who complain of specific medical
conditions. A lot of the positive stories also feature balls as big as
g****fruits, and graphic descriptions of post-op infections. Generally
in
that male boastful style of course. One of our regular posters here
once
made the remark that all stories (both positive and negative) contain
some
measure of over-egging.


I'm not trying to alter your opinion!!!


same

There are a lot of men who didn't do any research until afterwards and
wished they had. These men certainly did not see these materials. My
point
relates to those men who have done their research prior to vasectomy.
As
webmaster of the group site, I have a fair amount of experience in how
people find the site, and what they look for once there. I'd say that
some
98% of site visitors find the site by the simple search term
"vasectomy",
and when they get there they are much more likely to look for
information on
complications that anything else. I know this from the search terms of
the
onsite search engine, the pages they look at, and the off-site links
they
follow.

In the top ten pages this month are the medical journal extracts page,
reversal stories, "Dutch study", long-term pvp stories. The negative\0
stories
always top the positive stories in hits and post-vasectomy pain.com is
the
third most popular link.

All of this suggests that men are doing research into complications,
yet the
feedback on various aspects of the site is that men are glad to have
found
all this information in one place, and reading it mostly helps confirm
their
decision to go ahead. Some people are put off vasectomy having read
the
materials.


Absolutely. This is why I'm in favour of any move to standardise
counselling. Every man thinking of undergoing the procedure *should*
be
given the information by the doctor. Some are better at it than others
it's
fair to say. This is one of the purposes of the group - to fill in
information gaps.


and


cauterize

when

Well, it could be argued that it's "Full" in the sense that they are
telling
you all they actually know. However, as that is specifically bugger
all then
it doesn't help. I think the text is a direct lift from vasclip's
website

They can make that statement on the basis of the trial results. I'd
point
out that the trial was a) paid for by the manufacturers of the device,
b)
small sample, c) short term and d) no independent research seems to be
available.

I recently bought a scanner. I didn't even bother reading the
manufacturers
blurb - I skipped straight to user reviews. Similarly, I'd not
undergo a
procedure based on the manufacturers or promoters blurb either.

I thought you were about to say that the hunter shot the hiker!!! I
agree
that whilst being accurate it isn't helpful as to the specific risks,
and I
point people to places that discuss the risks as opposed to sites that
merely come up with that type of statement.


do***ent

This statement comes from the following study (available on the group
website medical journals extract page)

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1537032&dopt=Abstract

In a study to assess the incidence of chronic testicular pain
following
vasectomy, it says that "Chronic testicular discomfort was present in
33%
of patients". OK - but the study raises more questions than it
answers.

The sample size was 172. They didn't say if this was the number of
questionnaires they sent out, or the number that responded.
Questionnaires
are
quite a common research tool, but it's usual to state the number
polled, and
the number of respondents.

So how is the 33% made up? A total of 56 patients, 30 of which did not
describe the condition as "Troublesome". 9 patients sought medical
help,
and 2 patients required further surgery.

How can you have a "serious and debilitating condition" where 53.6% of
those
who have it say it's "Not troublesome"?

Why did only 5.2% of the total sample size seek further medical
assistance?

Is the fact that only 1.16% of the total sample size needed further
surgery
significant?

Bottom line is that people are making the claim that 33% *is* the
incidence
of PVP based on some 56 men, where 30 of them didn't find it
"Troublesome".

You would expect that nearly all the men who had pvp regretted having
a
vasectomy, however that is not the case. The study says that "Only 3
patients regretted having had the vasectomy because of chronic pain.".
That
represents 5.3% of the 56 men.


Absolutely. Some do, some don't. However, the information on doctors
websites often concentrates on practice location, services offered,
contact
details etc. Some are better than others - one UK site we link to even
publishes a practice audit listing percentages of specific
complications and
number of phone calls/re-consults after the vasectomy.

There is no code of practice for websites, and to be realistic there
probably never will be. There are various voluntary schemes to ensure
that
the information on a site is balanced and accurate such as the HON
scheme
http://www.hon.ch that the group site is an accredited member of. However, as
many
sites are not offering information there is no real need for them to
subscribe to such a scheme I'd say that whilst the guidelines doctors
work
under re counselling are in their current state the internet is the
best way
men have of finding information.

It may be the opinion of doctors that the consultation is the proper
place
to discuss information, hence they don't put a great deal on the
website.
I'd suggest appraising oneself with information on the web, and
writing out
a list of questions for the consultation of points you need answers
to. If
the doctor is a good one he'll be able to answer them fully and
honestly.
Many doctors do actually want patients to do research and have some
understanding prior to the consultation. It is beneficial to them to
have a
patient well versed, and able to understand issues discussed.


One way of viewing this is that to find any doctor's website on the
internet
you *will* have stumbled across many other sites in the process - some
of
them doctors sites, and some of them information sites. In this case,
it's
likely you would have dipped into some other sites you found on your
search.
I would certainly not go to the doctor these days to discuss any
procedure
without having looked up general information on the internet. I would
suggest that I'm not alone here. Last month 14,848 people found the
group
website. That is the main index page, and does not include various
pages
they came to the site on. I have no data on other sites of course, but
it
does rather imply that people *do* look up the procedure on the
internet
before booking consultations.

Maybe a word of explanation here. The UK guidelines were available on
the
RCOG site as a public discussion do***ent. As a member of the public,
I most
certainly had my say. The discussion do***ent has passed the public
consultation stage, so is not currently on the site. The existing
guidelines
are though. The do***ent was freely available, and as a UK citizen I
have an
interest in what happens here.

I found what I *think MAY* be the US equivalent on Medline. The
do***ent it
apparently replaces has virtually no information on vasectomy, so *if*
it's
the do***ent I think it may be, then I have my doubts if the update
will be
any more informative. I am not willing to pay to see the do***ent
primarily
because I'm particularly short of cash at the moment, and in any case
I'm
not a US citizen. If I was sure it was the US equivalent then I would
be
willing to splash the cash, but I'm not sure it is. Besides, at some
point
it will be summarised on the net, or be available publicly.

The UK guidelines discussion do***ent is available at
http://www.vasectomy-information.com/pages/rcogdraft.pdf It's a 1.5Mb
download.


Absolutely - it's a lifestyle issue for all surely? However, it's
still a
medical procedure.

Is there a "zero risk"? In my case, I decided to have a vasectomy
during the
time my wife was pregnant with our son. We had decided that the family
would
be complete, and I decided that vasectomy was the answer. We had had
condoms
split, my wife had actually got pregnant whilst on the "mini-pill". In
our
case, vasectomy was the least risk scenario - all procedures and
options
considered. The decision was not taken "Jointly" - I made the decision
and
informed my wife what was going to happen.


I don't agree that it's a strong word. There are organisations and
individuals (religious and political) opposed to vasectomy, and the
common
technique used is always scare tactics. Lots of banner headlines, but
little
or no actual evidence backing claims. Often what you do read is
seriously
misrepresented. I would point to the "Dutch study" here as one such
example
(there are others). It's oft-quoted as research into PVP on Dutch men
when
it's nothing of the sort. It's a small study done in Michican that
had a


some of
the findings of this small US study onto the entire male population of
the
Netherlands. It's now passed into folklore as "Fact". It's my opinion
that
men have the right to know what is behind banner headlines.


The oft-heard argument is that doctors make money from vasectomy and
that's
their only motivation. The cost in the US varies from $250 to $1000.
I'd
suggest that they don't make that much profit after a consultation,
the
procedure and aftercare, staffing costs and overheads. Especially at
the low
end of the scale. Urologists often receive set fees from insurance
companies. Urologists are expected to offer vasectomy as one of the
services
they perform, but there are probably much more lucrative area's of
their
practice. Some doctors concentrate solely on vasectomy, and unless
they
really process lots of them I'd doubt if it would be particularly
lucrative.

Do they have patients interests at heart? I may have a particularly
cosy
vision on this, but I'd say yes. The guy who did my vasectomy was my
GP.
He's attended various childhood illnesses of the kids, and been called
out
to my wife in the middle of the night during pregnancy - he definitely
had
patients interests at heart. As for the others, well, I don't
subscribe to a
mental picture of some demon guy dragging people off the street to
chop
their 'nads for cash with no concern for their well-being. I think
you'd be
hard put to find anyone meting that description! They clearly need to
make a living, but that does not mean they are all quacks and
charlatans.

"Admission of possible complications" + "lawyer feeding frenzy". I
believe
you specifically refer to PVP here, as opposed to the possible
complications
such as bruising, haematoma, infection etc etc. In the UK, most legal
cases
re vasectomy seem to have concentrated on the pre-vasectomy
counselling. If
you can prove that the doctor did not mention a know risk then you may
have
grounds for action. I think the same applies in the US. They pretty
much
have to mention possible failure and the usual post op complications
to
cover their arses. Other than that, the picture is murky as to what
they
should or shouldn't say.

For example, should they discuss conditions that have been looked into
as
being associated with vasectomy but subsequently dis-proved?
Personally, I
think that written information should be made available that includes
this
type of research, and the UK guidelines fully discusses these issues.

Should they warn about PVP? Most research over the years has concluded
that
they should, and that is what I believe should happen. The reason I
fully
support the UK guidelines is that they make this mandatory.

The picture in the UK is different to the US, despite broadly similar
percentage take-up of vasectomy. In the UK the National Health Service
provides most vasectomies at no cost to the patient, and the doctor
does
them as part of the services of the practice for the set salary he
gets from
the NHS. The motive in the UK is therefore not a financial one, and in
the
UK vasectomy isn't "sold". If you want to have it done, you need to approach the doctor.

I'm not sure what questions are "Unanswered". I agree that doctors
should be
scrutinised. The group website has links to places where you can check
on
the doctors qualification and licensing in both the UK and US (and a
couple
of other countries). In addition, we have always said that asking the
doctor
how long he has been doing the procedure, how often he does the
procedure
currently and his personal record on complications (and how he would
treat
them) are perfectly legitimate questions to ask.


As above, I do not have a financial interest.

I'd disagree here. The first published study was 1830 BTW. Anyway,
there is
no shortage of information available. The group website has quite a
few
articles and extracts from journals, and that's just the tip of the
iceberg.
There are also some do***ents that discuss the studies done in the
past.
There is well connected from Harvard Medical school
http://www.vasectomy-information.com/pages/wellconn.pdf that discusses
the
evidence (physical and physiological) in detail,
http://www.vasectomy-information.com/links/docguidecom.pdf that summarises
some 139
studies, and the RCOG discussion do***ent above amongst others.

I think we both agree that more information should be given than often is currently.

I know that is a technical definition of the word majority, however I
would
use the term in the context of "Substantial majority". The 49/51%
argument I
would class as not a substantial majority, and regard it as being
"roughly
equal".


Regards,

David
http://www.vasectomy-information.com

max wawrzyniak

Thank you for reponding to my response:

As these messages are getting very "wordy," I
will keep this one short and to the point.

I am told that approx 500,000 vasectomies are
performed in the USA each year; I assume a much larger
total for the world as a whole.

Why are we reduced to attempting to assess the risk
of complications by looking at old studies with few
participants. One study you quote from in your
response had 172 participants, and you point out
the deficiencies in the report. And that study is now 11
years old.

Another study, from 1996, only had 182 participants.

And, of course, these two studies do not seem to totally
agree with each other.

And thank you for pointing out the problems with the
alleged "Dutch" study; I had seen it but not yet studied
it well (my education in vasectomies only started a
week ago.)

After decades of hundreds of thousands of vasectomies,
is this the best data that a man has in order to make a decision
that could have life-altering consequences?

It was not good-enough for me, so I backed-out.

I was paddleing in my home-made kayak this morning, and
as I glided along on silent waters, I could not help but think
how I would hate to lose the ability to climb into a kayak
or to build one: or to dread pulling up my trousers or to fear
stomping on the clutch pedal of my truck.

As I suppose all men do, I long for latexless ***, but with
so many lurking opportunities to suffer from injury or illness,
do I really need to add yet another?

Although I am not a gambler, I am not "risk-adverse" except
when the risk seems excessive, or the risk can not be estimated,
and I have found little research as of yet that would allow me to
"get a handle" on the risk of this procedure.

And finally, whether we are talking about a "majority" or a
"vast majority" or a "super majority," it might be wise to
rmember the words of Cindy from the "personal stories"
section of your website;

"If anyone is considering having a vasectomy done, please research what can
happen. Although statistically the percentages are low, what if you are that
one? Just like my husband. It has greatly changed our quality of life."

I thank you for the discourse and wish you success in

all your ventures..

Max

bababooey@drlauramail.com

On Sat, 15 Nov 2003 04:51:37 GMT, Max babbled on about Chickened Out proclaiming:

-}I am 45 and married to the most wonderfull 38-year-old woman.
-}No kids, and we have agreed not to change that. Recently My
-}wife complained that she had been taking responsibility for
-}the birth-control and she is right: It is my turn to guard
-}the door.

Has she always been this much of a complainer? No offense; I just find it puzzling that
it is something to complain about. Not about having to use birth control - I've always
complained about that! However, whether the onus is on you or her, at least to me seems
trivial. I guess it's because I realized that because of her medication it would cancel
out any birth control pills she would have taken. But I never declared that it was "her
turn". Very odd.

-}She suggested a vesectomy as it was less-risky
-}and less expensive than getting her tubes tied.

Less expensive? You have to pay to have it done?

-}After an
-}initial reluctance, I agreed and scheduled a prelim. with
-}a urologist for Dec. 3 (soonest date open).

Nothing wrong with talk. Despite the subject line, it's the least you can do - talk to him
before making a final decision.

-}I have always been "light-headed" when it comes to medical
-}procedures and needles and such.

I'm a veteran of sorts. A vasectomy really is NOTHING compared to the brain surgery I've
had to undergo from time to time. Don't worry about being light-headed; you will be lying
down. You could learn some simple breathing exercise to help you relax. Also, the worst
part for me? The waiting room! Waiting and waiting a half hour past my scheduled
appointment really stirred up a LOT of anxiety. If I had to do it over again I'd lear
relaxation techniques beforehand. After I left the waiting room and in to have it actually
done it was a piece of cake. Compared to the waiting. Serious!

-}My biggest fear with the
-}vesectomy (since it is simple and safe, right?)

Simple is a relative term. So is safe, but I can at least say that yes it is safe.

-}was that I would faint and embarras the hell out of myself, just like I
-}did when I had a mole removed.

The doctor is a professional. He knows how to do it. (Could be a "she" but I'd rather let
a guy do it, thank you.). If you faint he'll think nothing of it. Maybe give you a cloth
for your forehead. Besides, his job will be easier with you unconscious. But I'm betting
that will NOT happen. So you don't need to feel embarrassed. It's not as if he'll talk
about it with his colleagues at the water cooler. Otherwise my doctor may have had a
bigger laugh with ME simply because I'm not really "hung", something that has always
bothered me. No, they just do their job. Then it's to the next victim, I mean... patient.
IOW don't worry about it. They won't mind.

-}I went to surfing the internet
-}and found out that this doctor uses the "vasclip," which sounded
-}better than a scalpel, and noted the statement that "all surgical
-}procedures carry some risk," but that the vasectomy was relatively
-}risk-free. So I continued to surf happily along when I ran smack
-}up against PVP.

Oh. Um... oops. I know nothing about the vasclip. Don't worry about the "all surgical
procedures carry some risk" as that's a general disclaimer. Consider the risk being that
you may end up sterile <g>. PVP. Yes. That can spook anyone.

-}I could not believe it.

Believe it.

-}I found story and story of individuals who were suffering long-term
-}and greatly from this "simple and safe" procedure. I read about
-}chronic pain ranging on a scale from "dull ache" to "electric cattle
-}prod to the balls."

Um, there's sad truth to this, yes.

-}I read about doctors telling patients to see if
-}the pain goes away in a year or two,

Well **** that doctor. No not literally, he's not worth it. A year or two? Try one month.
Tops. If you still feel pain during normal activity -- get help. If the doc won't listen,
find one who will. A year or two indeed. Not for me, thanks.

-}or that the pain was not caused
-}by the vasectomy, or that the pain is "par for the course," and to be
-}a "man" and bear it.

Kick him in the nuts and make him eat his words. Usually I don't advocate such a drastic
measure, of course, but anyone who tells you that crap is asking for it.

-}How many people have these problems with vasectomys? The estimated
-}percentage ranges from less than one percent (as per the doctors'
-}websites) to a high of 20 percent (University of Missouri, Columbia
-}website).

You've come to the right place. You sound spooked and guys here can offer you feedback.
Hi, I'm Sean. Age 36. I have one daughter, age 3. I had my vasectomy last February. I'm
pleased to say that for me there were NO lasting effects (other than being sperm free)
from the procedure. I was sore for about 2 weeks - it gradually eased up during that
time. I counted the time until I was able to have my ***** ****ysis and was overjoyed when
they said I was all clear. I'd say it was worth it. You will hear of horror stories.
Frightening ones. Some may even be true! Chances are that you will not have any problems.
However there's always a chance that something will mess up. Remember that surgery takes
different forms. The simplest, or one of the simplest would be getting stitches on your
face from banging your head or getting hit with a hockey puck. Risk? Sure. You can get
infection. But you would certainly get infection if you didn't have the stitches. Take
your pick. It seems the more involved the procedure, the greater the risks. Every time I
had brain surgery I feared that the doctor would sneeze, accidentally slice my brain in
half and that would be the end of me. I was terrified each time. Unfortunately since each
time was an emergency scenario or at least an urgent one, I had no choice but to have the
procedure (called a "revision" with my condition not related to a vasectomy at all). I
knew the risks. I also knew that I *WOULD* go into a coma without a revision. Damned if
you do, damned if you don't. Pick the lesser of two evils. So a vasectomy was really
nothing in comparison. It was the only surgical procedure I've ever had while I was awake!
They even knocked me out to remove my wisdom teeth. Another comparison.... my wife's
C-Section. She never had surgery before and was very frightened. I assured her that I
would not let anything happen to her. If there was a problem I'd do everything in my power
to protect her. It can be scary for a lot of people. Surgery. No matter how major or how
"minor". Discuss your concerns with the doctor. Especially PVP. Some have said that
they've had their vasectomy reversed (vasovasectomy) and that solved the pain problem.
Consider that as a last resort but I hope you won't need it.

-}Yet, the urologists only say that "all surgery carries some risk."

As I said, it does. They don't want some unforseen technicality to creep up and realize
you weren't "warned" in some way or another. I guess what I mean is they probably don't
intend to scare you, so much as they want to cover their butts, in terms of liability.

-}What they don't say is that they haven't a clue who will have problems
-}and who will not; What they do not say is that they have no clear
-}method of treating the problems when they do occur. What they don't say
-}is that this procedure carries some very specific risks and that anyone
-}considering it should be aware of the risks.

They can't treat the problems unless they happen. They can't predict it. Crystal balls
(excuse the pun) are hardly compatible with medical science. But you are now aware of the
risks, obviously and you have to weigh in these factors.

-}I have changed my mind; I will not risk my health or my career for an
-}elective procedure surrounded by so many un-answered questions.

OK. You made your choice I presume. Nobody is forcing you, except maybe your wife. If you
made a definite decision, don't be bullied by her, us, the doctor, or anyone else. If
nothing else I would have these questions you speak of answered before committing yourself
to a vasectomy.

-}Everyone thought hormone replacement therapy was safe and beneficial to
-}women.
-}
-}Everyone throught margarine was safer to eat that butter.
-}
-}And everyone thinks that vasectomys are safe, simple procedures.

Depends on your point of view. As for the margarine bit, many contain palm oil which I am
allergic to. Butter is safer for me.

-}By the way, I did not "chicken out;" I made an educated decision
-}that replaced an "uneducated" one.

I for one did not accuse you of chickening out. You could have been sperm free. You could
have been in needless agony. Nobody knows. I've always said it's a risk. Some of us are
willing to take it knowing that it doesn't always turn out positively. I don't think
anyone can fault you for ****yzing the situation to the best of your ability.

-}And I can only say "thank you" to all of you who have shared your
-}experiences with strangers on the internet. I very much wish
-}you good health and a happy, pain-free life.
-}
-}Max

You too Max.

david

OK - same here

One site I saw claimed about 43 million men worldwide have undergone it as a
BC method in recent years.

Again, I think you mean PVP here as opposed to other complications. I'll
look to see if there is any newer research and post to the journals index
page on the site. Small studies tend to be the norm in all medical areas,
but there is no lack of data.

I use the studies partly because they are behind the often seen headlines
and to illustrate how studies can be misused. Also to show that it *is*
necessary to look deeper than the headline. Also to show the fact that the
studies themselves are often contradictory. I've been adding some studies
that look into long term satisfaction with the procedure and adding them
slowly to the journals page. They usually come out with figures of 98%+ of
men are satisfied and would recommend it to a friend. This is obviously at
odds with the figures of 33% pvp. Somewhere lies the truth, and it's pretty
much down to each individual to judge what that is depending on their
cir***stances.


It's on the website, and footnote 4 is the figure from the US study used to
come up with the figure of Dutch men with problems.

I only referred to a couple of studies, but if you look on medline you will
find whole rafts of them http://www.ncbi.nlm.nih.gov/entrez/query.fcgi

Fine!

There are various threads in body building and cycling forums regarding
sport and vasectomy that make interesting reading re recovery and returning
to the sport. Mostly extremely positive.


can

that


I wish you luck in all you do! Regards,

David
http://www.vasectomy-information.com

trifold1@netscape.net

I can add little to the excellent responses you have already received.
My main impression is that you have not sufficiently considered the
risks of tubals, hormonal birth control, and condoms. Nor the ways
treatment can be effective in the very rare cases of chronic
testicular pain that may be attributable to vasectomy. (By the way, I
would add to those treatments already mentioned the possibility of
reopening sealed vas tubes therenby relieving sperm backpressure.)
Taking these things together--the evidently low risk of vasectomy, the
countervailing risks of other methods of birth control, the
availability of effective treatments for rare cases of pain
post-vasectomy--for me it was not a difficult choice. And I've never
regretted it. But everyone has to take risks in life. You and your
partner are choosing one set of risks. Millions of other couples of
gone the other way.

trifold
http://www.vasectomy-information.com