Psychological aspects of vasectomy in Malaysia

246 men, aged 21-59, living on rubber estates on the outskirts of Kuala Lumpur, Malaysia, were interviewed 1-4 years after vasectomy in a study conducted by the International Institute for the Study of Human Reproduction of Columbia University and the National Family Planning Board of Malaysia. Most of the men were of Indian origin; 223 were Hindus. The incidence and nature of psychological and medical complications were investigated, but this article treats only the psychological effects. The basic interviews consisted of verbal questionnaires; care was taken to avoid drawing attention to the researchers' interest in psychosexual effects. Men claiming regrets, fears, ill effects, and problems in married life after the operation were 9%, 11%, 54%, and 4%, respectively, of the total population. 11.8% of the men claimed to have a loss of libido. The percentages of men expressing regrets and fears decreased with increasing age, parity, and pregnancies of wife; age here is probably the overriding variable. When the vasectomy decision was joint, rather than the individual decision of either husband or wife, regrets and fears were significantly less (p.05 for both regrets and fears). No couple in the sample was without at least 1 living son, this suggesting that men without heirs will refrain from vasectomy in Malaysia. Higher proportions of men who had lost children reported anxiety. Men reporting psychosexual complications were reinterviewed in depth. In these depth interviews a variety of fantasies associated with the operation was revealed.     

Semen characteristics after vasectomy in the ram

The objective of this study was to monitor the changes in semen characteristics in vasectomized rams and to determine if infertility was present 14 days after vasectomy. Experiments were performed using five cross-breed rams, aged between 18 and 30 months. Semen was collected weekly by artificial vagina from 2 months before to 5 months after vasectomy. After sexual rest for 10 days, vasectomy was performed by the cranial midscrotal approach. In all ejaculates the volume, concentration, total sperm number, motility and morphology (normal spermatozoa, loose heads) were determined and sperm viability (SYBR-14/PI) was evaluated in all semen samples collected after vasectomy. In the first ejaculate obtained 14 days post vasectomy all rams showed a significant (P < 0.05) drop in mean volume (from 1.2 to 0.5 mL), total sperm count (from 5176.8 to 51.1 x 10(6)) and morphologically normal sperm (from 84.1 to 15.7%), when compared to the last prevasectomy collection. We could also demonstrate a positive correlation (r = 0.89) between the individual cumulative total number of spermatozoa after vasectomy and the scrotal circumference measured before vasectomy. Sperm motility and viability could never be demonstrated after vasectomy and normal spermatozoa continuously decreased concomitant with an increase in loose heads. On post mortem examination 5 months after surgery, spermatocele formation and multiple sperm granulomas were present in all five rams. Our results show that in the first ejaculate collected by artificial vagina 14 days after vasectomy, no motile and viable spermatozoa could be detected. Despite weekly collections during a 5-month period after sterilization, azoospermia could never be achieved.     

Weak autoantibody reactions to antigens other than sperm after vasectomy.

Autoantibody activity against various antigens was measured by indirect immunofluorescence in 97 men about to undergo vasectomy and 170 men who had undergone the operation up to six years earlier. There was a significantly higher prevalence of weakly positive autoantibody reactions among those who had undergone vasectomy. There was, however, no evidence that vasectomy could induce stronger autoantibody reactions such as those associated with autoimmune disease.     

Performed and refused vasectomy: a decade of waning popularity and increasing awareness of safety

Family planning clinics and a random sample of private physicians throughout the US were surveyed in 1972 and 1984 to learn the incidence of performed and refused vasectomy, and to discern attitudinal change over time toward delayed physical and psychological sequelae related to vasectomy. Data show that, after a dramatic rise in popularity in the early 1970's, incidence has fallen significantly in the intervening years. The greater decrease was reported by physicians. Clinics experience a lower refusal rate which may be partially explained by physicians' predilection to practice defensive medicine. Other factors, such as counseling quality and applicant eligibility criteria, show little difference. Concern about physical sequelae has diminished, as has the importance of psychiatric symptomatology as a screening tool. Delayed psychological sequelae remain more ambiguous, with physicians deemphasizing the potential phenomena but clinical staff becoming somewhat more concerned. Nevertheless, both groups refused roughly the same % of applicants for psychological reasons. These conclusions are based on the responses of performers of vasectomy who had voluntarily registered with The Association for Voluntary Sterilization. All regions of the country were represented with return rates of 60% to 75% for the private physicians (114) and all registered clinics (72) in 1972, and 97 physicians and 78 clinics in 1984. The clinics attained the higher rates.     

Two laboratory experiments on inbreeding avoidance in the Mongolian gerbil

Individual relationships within demes are of importance in the context of inbreeding avoidance. The effect on reproduction of sexual competition between fathers and mature sons within family groups was studied by means of vasectomy of the fathers. No reproduction occurred in such families during the first 6 months following the operation despite the presence of mature sons. Onset of reproduction in mature non-sibling male—female pairs was compared to the onset in sibling pairs. Although the gestation period in the gerbil is about 25 days, the median time for the first litter to be born was 31 days in the non-sibling group and 90 days in the sibling group. These results suggest the presence of inbreeding avoiding mechanisms in the Mongolian gerbil.     

Incidence of disease after vasectomy: a record linkage retrospective cohort study.

OBJECTIVE--To determine whether vasectomy is associated with an increased risk of several diseases, and in particular testicular cancer, after operation. DESIGN--Retrospective cohort study using linked medical record abstracts. SETTING--Six health districts in Oxford region. SUBJECTS--13,246 men aged 25-49 years who had undergone vasectomy between 1970 and 1986, and 22,196 comparison subjects who had been admitted during the same period for one of three specified elective operations, appendicitis, or injuries. MAIN OUTCOME MEASURES--Hospital admission and death after vasectomy or comparison event. RESULTS--The mean durations of follow up were 6.6 years for men with a vasectomy and 7.5 years for men with a comparison condition. The relative risk of cancer of the testis in the vasectomy cohort (4 cases) compared with that in the other cohorts (17 cases) was 0.46 (95% confidence interval 0.1 to 1.4), that of cancer of the prostate (1 v 5 cases) 0.44 (0.1 to 4.0), and that of myocardial infarction (97 v 226 cases) 1.00 (0.8 to 1.3). There was no evidence of an increase associated with vasectomy in the incidence of a range of other diseases. CONCLUSIONS--Vasectomy was not associated with an increased risk of testicular cancer or the other diseases studied. With respect to prostatic cancer, while we found no cause for concern, longer periods of observation on large numbers of men are required.     

Endocarditis caused by Staphylococcus warneri on a normal aortic valve following vasectomy.

Endocarditis caused by Staphylococcus warneri and necessitating valve replacement occurred in a previously healthy 32-year-old patient following vasectomy. No sign of an underlying valvular defect was noted during the operation. S. warneri is a recently identified species of coagulase-negative staphylococci. Endocarditis caused by coagulase-negative staphylococci is uncommon in young, healthy patients with normal heart valves and has not previously been described as a complication of vasectomy. Similarly, infections caused by S. warneri have not previously been described in humans.     

Clinical, ultrasonographic and pathological features following unilateral vasectomy in rams

The effects of vasectomy on testes and related structures of animal species and men are largely disputable. These possible effects were studied in the ram, an established experimental animal model used to investigate genitalia pathophysiology. In each of five rams, vasectomy in the left spermatic cord was carried out; subsequently, the clinical and ultrasonographic features were monitored up to 12 months post-operatively. The rams were sequentially euthanatized 1, 3, 6, 9 and 12 months post-operatively; gross- and histo-pathological examination of their testes and related structures were carried out. Four of the five rams developed sperm granulomas at the proximal to the testis end of vas deferens or/and at the tail of the epididymis; these were palpable from the first and the third month after vasectomy, respectively. Ultrasonographic findings on the vasectomy side were increased size and echogenicity of the epididymal tail, as well as anechoic areas, representing sperm granulomas, visible in the epididymal tail 1 week after vasectomy and in the proximal to the testis end of vas deferens 4 weeks after vasectomy. Gross pathological findings were limited on the vasectomy side and included adhesions between the parietal and the visceral vaginal tunic, enlarged and firm epididymal tail and presence of sperm granulomas at the epididymal tail or/and at the proximal to the testis end of vas deferens; the granulomas contained creamy material. Histopathological changes were observed mainly in the epididymal tails, consisting of a central mass of spermatozoa, surrounded by a layer of macrophages, surrounded in turn by loose vascular connective tissue rich in lymphocytes and plasma cells. With the exception of signs of mild hypospermatogenesis observed in one ram euthanatized 9 months after surgery, and of a slight increase in seminiferous tubule diameter and in seminiferous epithelium height in the rams euthanatized 6 and 9 months after surgery, which are both findings of no clinical importance, no clinical, ultrasonographic, gross- or other histo-pathological changes were observed in the testicular parenchyma during a 12-month post-operative period. These results demonstrate that vasectomy has little if any detrimental effect on the morphologic characteristics of the spermatogenesis in rams.     

Who has a vasectomy reversal?

A comparatively small proportion of sterilized men request vasectomy reversals, and the size of the proportion (which UK estimates place between 1% and 1.5%) depends on awareness of the availability of reversal. In this study, the characteristics of 200 cases of vasectomy reversal (the 1st 200 such operations performed in the UK) were analyzed. All 200 had been completed by 1981, the mean time from vasectomy to reversal being 4.8 years. The time figure varied according to the reason for requesting reversal, and was particularly short when the operation had been performed at the time of the partner's pregnancy. General practitioners and friends were particularly important sources of referral. 30% of the men were with the same partner and 70% a new partner. Vasectomy reversal cases tended to be younger than vasectomy patients as a whole but did not differ significantly in social class. Most requesting reversal wanted to have another child. Scattered cases requested the reversal after a partner's pregnancy termination. 12 men requested it for psychosexual reasons. In this series of reversals, spermatozoa were present in the ejaculate throughout the 20-week follow-up time in 80% of the men; the pregnancy rate was 44%. The study demonstrates the need for counselling prior to a vasectomy, especially with regard to the posibility of marital breakdown or pregnancy termination.     

Long-term effect of vasectomy on the biochemical composition of testes and sex accessory organs of the Indian desert gerbil, Meriones hurrianae Jerdon.

A long-term vasoligation operation in gerbils, Meriones hurrianae Jerdon did not reveal any consistent change in the weights of androgen dependent organs such as seminal vesicles, ventral prostate, epididymes and perineal complex (levator ani muscle and penis). Histological structure of the testis and caput epididymis remains normal after vasectomy. There was no effect of bilateral vasectomy on androgen production of the testes as reflected by fructose content of coagulating gland. No compensatory hypertrophy of the contralateral testis was observed in unilaterally vasectomized gerbils. The RNA content of the testis and epididymis and ascorbic acid content of adrenal gland did not show appreciable change. No change in protein content of the testis was found but a significant increase was observed in the protein content of epididymis after the operation.     

The Developmental Instability—Sexual Selection Hypothesis: A General Evaluation and Case Study

Developmental instability results from small, random perturbations to developmental processes of individual traits. Phenotypic outcomes of developmental instability include fluctuating asymmetry (FA, subtle deviations from perfect bilateral symmetry) and phenodeviance (minor morphological abnormalities). A great deal of research over the past 18 years has focused on the role of developmental instability in sexual selection. A driving force behind this research has been the developmental instability-sexual selection hypothesis, which posits that symmetry and lack of phenodeviance in secondary sexual traits are assessed by mates and rivals because they provide a reliable cue of individual genetic quality. The present article tests this hypothesis by evaluating its five main predictions using published results: expressions of developmental instability in secondary sexual traits should be (1) negatively correlated with mating success; (2) directly assessed by mates and sexual rivals; (3) heritable; (4) condition-dependent; and (5) negatively correlated with ornament size. The first two predictions receive considerable, though not ubiquitous, support from a range of animal species. However, FA in secondary sexual traits is generally not significantly heritable, indicating that FA is unlikely to reveal genetic quality that can be transmitted to offspring. Similarly, there is little evidence to support the predictions that FA is condition dependent, and that it is negatively phenotypically or genetically correlated with sexual trait size. Based on an evaluation of the evidence overall, it is concluded that this hypothesis is unlikely to be viable; it appears unlikely that mate choice for symmetry evolves by “good genes” sexual selection. Hypotheses that do not require asymmetry and phenodeviance to reveal heritable genetic quality may explain observed links between FA/phenodeviance and mating success. Results of a case study of Drosophila bipectinata are summarized, which reinforce this general conclusion. It is suggested that nonadditive genetic variation arising from an interaction between trait-specific developmental genes and genetic background may drive sexual selection for reducing developmental instability in some cases. Levels of developmental instability variation in a population may need to surpass a critical threshold for sexual selection to operate, possibly explaining some of the pronounced heterogeneity in the effect of developmental instability on sexual selection reported in the literature.     

A latent variable model of developmental instability in relation to men's sexual behaviour

A single trait's fluctuating asymmetry (FA) is expected to be a poor measure of developmental instability. Hence, studies that examine associations between FA and outcomes expected to covary with developmental instability often have little power in detecting meaningful relationships. One way of increasing the power of detecting relationships between developmental instability and outcomes is through the use of multiple traits' FA. The way multiple traits have typically been used is in trait aggregates. Here, we illustrate another way of examining relationships with developmental instability using multiple traits' FA: through structural equation modelling. Covariances between measures of FA and an outcome variable are interpreted within the context of an explicit model of associations between variables, which is tested for fit and the parameters specified within the model are estimated. We used nine traits' FA as markers of a latent variable of men's developmental instability, which was associated with the number of sexual partners. The results indicate a sizeable correlation between developmental instability and men's sexual history, despite small correlations between individual traits' FA and sexual history.     

Retentissement sexuel, conjugal et social d’une population d’hommes stériles consultants en Andrologie: le point de vue du psychiatre de liaison

Material and methods

The study population consisted of 39 subjects divided into two groups: 21 azoospermic males and 18 oligoazoospermic males. These men were selected in andrology departments over a period of six months. The andrology and liaison psychiatry departments of Lille university hospital established a general infertility questionnaire. This semi-structured questionnaire comprising 40 questions was based on clinical experience and describes the clinical and symptomatic context of infertility. An individual 50-item questionnaire was then used to analyse the psychosocial, marital and sexual effects of male infertility and the representation of the psychiatrist in the andrology department.

Results

One third of patients discovered the diagnosis of infertility when the biologist gave them the results of the semen analysis. Our patients initially envisaged marital, psychological and social problems, but very few sexual problems. They imagined that infertility was more disturbing for women than for men, from a psychological and sexual point of view. 82% of our subjects imagined that their partner had no sexual problems. 48.7% of them thought that their partner had no psychological difficulties related to their infertility. The oligoasthenospermia group considered that the partner had significantly more “psychological difficulties” compared to the azoospermia group. 41% of our patients felt guilty towards their partner because of their infertility diagnosis. 10.3% of patients presented sexual disorders before the diagnosis of male infertility and 25.6% presented sexual disorders after this diagnosis. Contrary to data in the literature, a major change of sexuality was not observed in the majority of the couples after the diagnosis. When sexuality changed, it generally consisted of a reduction of the frequency of sexual relations. Among the patients who reported sexual difficulties, only 40% related them to infertility. 50% did not report any relationship between the psychological difficulties related to infertility and the sexual difficulties. Contrary to the data in the literature, neither the loss of spontaneity during sexual relations, nor the complementary investigations necessary for artificial insemination had any influence on sexuality. 89.8% of our patients are ready to change their sexual practices in order to be more fertile without causing any sexual or psychological problems. However, only 34.3% of patients reported a concern about reproductive efficacy during sexual relations. A more marked sexuality/reproduction dissociation was observed in oligoazoospermic males than in azoospermic males. 28.2% of patients reported that talking about their sexual and/or psychological problems with a psychiatrist was helpful.

Conclusion

Many contradictions and underestimations were observed in the answers to the questions. We confirmed the existence of a psychological and sexual distress, but which was quantitatively less severe than that described in “gynaecological” populations. However, a real psychological and sexual distress does exist in our population, which is why we propose from the outset a psychosomatic and sexological treatment of infertility in order to prevent the onset of these sexual difficulties. Our questionnaire was based on clinical experience and helped our patients to identify their psychological and sexual difficulties related to infertility and its treatment. It would therefore be useful for the practitioner, andrologist or psychiatrist, to help the patient express the effects related to this “new medicalized sexuality”.     

Repercussions of castration and vasectomy on the ductal system of the rat ventral prostate

Diseases, such as cancer and benign prostatic hyperplasia, are related to disruption of the mechanism regulating the balance between cell proliferation and apoptosis in prostatic cells. Since castration and vasectomy might alter that balance, this study evaluates the cell proliferation, apoptosis and height of the secretory epithelium of the ventral-prostate ductal system post-castration and vasectomy. Immunohistochemical (PCNA and Ki67), cytochemical (Fuelgen reaction) and morphometric investigation have been carried out. Cell proliferation indices decreased significantly in both regions of the ventral-prostate ductal system after castration compared to the sham-operated group. The apoptotic index increased significantly after 48 h, declining 7 days post-castration. The cell proliferation indices did not differ after 48 h significantly; however, they increased 7 days post-vasectomy in both regions. The apoptotic index did not differ significantly in either time post-vasectomy. Castration caused an imbalance in favor of apoptosis, whereas vasectomy caused an imbalance in favor of cell proliferation.     

A study of the morphology of the Leydig cells of the rat after unilateral vasectomy.

A study to examine possible modifications in the number and/or morphology of the Leydig cell following vasectomy was done on 45 adult male rats. Rats were classified into 3 groups of 15 in which Group 1 had undergone left-sided vasectomy by section and double ligation, Group 2 had been subjected to a left-sided sham operation and Group 3 were intact controls. 5 rats from each group were killed 2, 4 and 6 months after the surgical procedures. Examination revealed insignificant variations in the vasectomized testes' weight and no differences in Leydig cell number when compared with contralateral and control gonads. The Leydig cells appeared histologically normal and differences between vasectomized and control groups were not found. Finally, no differences were found between the testes from vasectomized and control rats. Results demonstrated that examination of the testes revealed insignificant modifications in Leydig cell number or structure and that steroidogenesis in the testes was normal.     

Compensatory payments and vasectomy acceptance in urban Sri Lanka

The effects of different levels of compensatory payment for vasectomy on sterilization acceptance were examined in 496 vasectomized men in urban Sri Lanka. The results indicate that compensatory payments significantly enhanced the participation of economically poor men in vasectomy programs, especially those who had already achieved a large family size. The proportion of poor acceptors (those with a monthly income of Rs 1000 or less) increased with higher levels of payment; the acceptor's level of education was negatively correlated with the compensation amount, and the mean age of the youngest child was higher among those who received higher payments. 60% of vasectomy acceptors reported using contraception immediately before the vasectomy, suggesting a high level of motivation not to have another child. Respondents cited high effectiveness, no extra expense, and no side effects for their wives as the main reasons for selecting vasectomy over other means of contraception, regardless of the amount of payment received. Only 5% said cash payment was an important reason for choosing vasectomy, and this response did not vary significantly by level of payment. There was no influence of payment level on postoperative complications or satisfaction. While compensatory payments significantly enhanced the participation of poor men in vasectomy programs, they were not effective in attracting poorer men with few children or those whose last child was relatively young. Overall, this study's findings suggest that the decision to provide compensatory payments and how much to provide should be based on economic and political factors, not on the grounds that higher compensatory payments have led to the recruitment of ineligible men or that the promotion of vasectomy has been at the expense of a loss in the quality of services provided.     

Evolutionary implications of developmental instability in parthenogenetic Drosophila mercatorum. II. Comparison of two strains with identical genotypes,but different modes of reproduction

Developmental instability is particularly pronounced in parthenogenetic strains of Drosophila mercatorum. All parthenogenetically produced eggs in a given strain have the same genotype, but even when reared in the same environment, only approximately 5% of the eggs initiating development ever reach adulthood. A sexual analogue of a parthenogenetic strain was created to investigate the basis of this developmental instability. The two strains have identical genotypes (except for the Y chromosome in males of the sexual strain) and differ only in mode of reproduction. The sexual strain had a much lower rate of developmental instability than the parthenogenetic strain, suggesting that the instability is caused by the mode of reproduction per se and is not due to homozygosity, disruption of coadapted gene complexes, or any other feature of the parthenogenetic genome. The increased rate of abortion with parthenogenetic reproduction is caused by a proportional increase in the normal panoply of errors that occur in sexual reproduction but at a much lower rate. Attempts to establish other sexual analogues of laboratory parthenogenetic strains revealed different male sterility factors within several parthenogenetic genomes that could potentially act to prevent hybridization with sexually reproducing ancestors during the incipient stages in the evolution of an entirely parthenogenetic lineage.     

The influence of vasovasostomy on antisperm antibodies in rats

Serum antisperm antibodies were studied in Sprague-Dawley rats after vasectomy and vasovasostomy. Animals received a bilateral vasectomy, a vasectomy followed 3 mo later by vasovasostomy, or sham operations. Blood samples were obtained at 1, 3, 4, and 7 mo, and antisperm antibodies were assayed by an enzyme-linked immunosorbent assay. After vasectomy reversal was performed at 3 mo, antisperm antibodies were significantly higher in rats in the vasovasostomy group at 4 mo than in animals that had a persisting vasectomy or sham operations. At 7 mo, the antisperm antibody level for the vasovasostomy group was approximately double that for the vasectomized rats. Spermatic granulomas occurred in 76% of rats after vasovasostomy. Antisperm antibody levels were higher in vasovasostomized animals with granulomas than in those lacking granulomas. The results suggest that vasovasostomy may stimulate an antibody response to sperm rather than lead to a reduced response, as was anticipated upon removal of the obstruction. Spermatic granulomas may serve as sires for continued antigenic challenge. The observed increase in antisperm antibodies after vasovasostomy in Sprague-Dawley rats may be related to their relatively low immunologic responsiveness to vasectomy, with vasovasostomy serving as a second major immunologic challenge, aided by the formation of an additional granuloma. In the more responsive Lewis strain, we previously observed a rise in antisperm antibodies after the initial vasectomy, with no further increase after vasovasostomy.