Dr.Joe's Data Base

Ask NOAH About: Vasectomy

Vasectomy


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What is Vasectomy?
Who Has a Vasectomy?
Is Vasectomy the AppropriateChoice?
What Other Forms of Contraception Are Available?
How is Vasectomy Performed?
What Are the Complications and Long-term Risks After Vasectomy?
Can Vasectomy Be Reversed?
What Are the Usual Emotional Ramifications of Vasectomy?
Where Else Can Help Be Obtained About Vasectomy?

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What is Vasectomy?

The male reproductive tract performs three functions. It enables a man to
produce offspring, provides him with a supply of male hormones, and enables
him to experience sexual pleasure. Sperm are produced in the testes; when
they mature they travel to the epididymis, a C-shaped storage chamber
adjoining the testes composed of a 20-foot coiled tube. The sperm's journey
through the epididymis takes about three weeks, at which point they pass into
one of two muscular channels, the vas deferentia. Each rigid and wire-like
vas deferens composes part of the spermatic cord. From there, the sperm
travel to the ejaculatory ducts. Right before ejaculation, fluid from the
prostate gland and seminal vesicles mix with the sperm in the ejaculatory
ducts to form semen, which is forced through the urethra during orgasm.

Vasectomy is an effective, inexpensive, and easy-to-perform procedure, which
results in permanent contraception. It involves the surgical interruption of
the vas deferentia so that the sperm can no longer enter the ejaculatory
ducts and fertilization cannot take place. Vasectomy has no effect on sperm
production itself. The testicles continue to generate 50,000 sperm an hour,
which continue to develop and leave the testicles, but are then blocked in
the vas deferens at the site of the vasectomy. Eventually the sperm die, and
the patient's body absorbs them. During sex, the body will continue to
produce the same amount of semen, but the fluid will not contain sperm.

Vasectomy should not be confused with castration; it does not alter a man's
sensation of orgasm and pleasure. The operation has no noticeable impact on a
man's ability to perform sexually, nor does it affect the balance of male
hormones, male sex characteristics, or sex drive. As always, testosterone
continues to be produced in the testes and delivered into the blood stream.
The patient will not feel any different physically from the way he felt
before. Vasectomy is, however, a sterilization procedure; once it has been
performed, a man can no longer father a child.

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Who Has a Vasectomy?

During the 1960s, vasectomy began to emerge in the United States as a popular
method of permanent contraception. Only about 45,000 American men underwent
voluntary sterilization for contraceptive purposes in 1960. Within a decade,
however, 750,000 men were undergoing vasectomies each year. This increase
occurred at the same time that many women were abandoning "the Pill" because
of possible health hazards publicized during this period. Oral contraceptives
were prescribed in high doses at that time and were said to increase the
chances of heart attack, stroke, and possibly cervical cancer. The number of
men electing vasectomy leveled off in the mid-1970s to the current rate of
about half a million each year. Today, about one married couple in eight uses
sterilization as a contraceptive method, either vasectomy for the man or
tubal ligation for the woman.

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Is Vasectomy the AppropriateChoice?

The great majority of men who seek vasectomy have been married for ten years
or more and have a stable relationship. A man is a good candidate for
vasectomy if he and his partner have all the children they want; if they
cannot or do not want to use other methods of family planning; if his partner
has health problems that may make pregnancy unsafe; if he wants to enjoy sex
without fear of unwanted pregnancy; or if he does not want to pass on a
hereditary disease or disability. Even if all these factors are present, a
couple must consider all options carefully before deciding on this procedure.
Vasectomy should be accepted only when both partners completely agree that
they no longer want to have children. After deciding that permanent birth
control is the best solution, the couple should also decide between vasectomy
for the male and tubal ligation for the female partner.

Vasectomies may not be right for men who are unsure about having children in
the future, whose current relationships are unstable or going through
stressful phases, who are considering the operation just to please their
partners, or who are counting on having children later on either by storing
sperm or depending on surgical reversals of their vasectomies.

Considering Future Changes. Recent changes or stresses, rather than rational
long-term considerations, may influence the decision for permanent
contraception. These could include an illness, temporary financial crisis,
death in the family, or birth of a child. Vasectomy should not be thought of
as a way to cope with short-term problems. Experts recommend that couples
wait one year if they face these situations or seek marriage counseling or
psychotherapy to be sure that they are not making a decision they will regret
later.

Before deciding on a vasectomy, the patient and his partner should be clear
about the reasons for having this procedure. The couple must feel comfortable
with the concept of having no more children and should consider all scenarios
for possible future life changes. If the man changes his mind after a
vasectomy, he will have to undergo a major operation to reverse the procedure
with no guarantee of restoring his fertility. The couple should agree that
they are finished having children together. They need to consider how they
would feel if their current relationship ended, either by divorce or the
wife's death. In such cases, the man might find a new partner who wanted a
child by him. What would happen if one or more children died? If financial
stress is triggering the decision for a vasectomy, would improved affluence
make a difference in determining the desire for children? Age is also a
factor. For many young men, who still have many major life changes ahead of
them, vasectomy is probably not a wise choice.

Psychologic Implications. The word "sterilization" has a deep emotional
connotation for many people. Even though a couple may rationally accept the
idea of a vasectomy, it is extremely important for each partner to be as open
as possible about any negative feelings they might associate with the
procedure. For instance, a woman might believe--incorrectly--that a vasectomy
is emasculating, but she might not want to express this idea to her partner.
On the other hand, some women may fear that vasectomy may make their partner
more attractive to other women and encourage outside affairs. (Research from
the 1970s indicates, however, that married men who have been sterilized are
not more likely to indulge in extramarital sex than fertile men.) Some
studies have indicated that men with poor bodily self-images, including
concerns for their own physical health or sexual abilities, are likely to
have a difficult time adjusting psychologically to vasectomy. Men who have
the operation only for the sake of their partner's health and not because
they want the procedure for their own reasons may also have difficulties.
Such thoughts in either partner can have devastating consequences on a
relationship if they surface only after the procedure has been performed.
Openness with each other is imperative in order to make a decision that is
clear of any hidden negative apprehensions. Neither partner should be too
embarrassed to request counseling if the emotional aspects involved in making
the decision are too difficult to solve between themselves.

Stability of the Relationship. Ideally, the couple should view the operation
as a mutual commitment to an already successful marriage or relationship.
Good candidates are those men who are part of a couple who considers their
family complete and permanent birth control as one method for maintaining the
family's stability. Vasectomy is generally not a good idea if the couple's
relationship is under great stress; it is not a cure for emotional or sexual
problems between a man and woman.

As Alternative to Other Methods. As many as 40% of couples seeking vasectomy
have experienced a failure with their previous method of nonpermanent birth
control. Such failures can occur from misplacement of a diaphragm, an
incorrectly implanted IUD, or by noncompliance when using an oral
contraception regimen.

Some people contemplate vasectomy when use of a condom, diaphragm, or foam
interferes with their enjoyment of sex. Freedom from distraction during sex
is a secondary benefit of vasectomy, but should not be considered the primary
motivation for the operation.

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What Other Forms of Contraception Are Available?

Contraceptives for Male Partners. Withdrawal before ejaculation is a form of
natural contraception, but it is not very effective and most people find it
unsatisfactory. The only other form of male contraception currently available
is the condom. Although the average rate of pregnancy for couples who rely on
condoms for protection is 12%, if the condom is used correctly and is of good
quality, the risk for pregnancy in a year is only 2%. When the condom is used
with spermicidal lubricants, either foams, creams, or jellies, protection is
increased. The spermicidal lubricant also prevents tearing. (Other types of
lubricants can also be used to prevent tearing, although petroleum jellies,
such as Vaseline, should be avoided, because they can corrode the condom.)
Condoms made of latex rubber that are contoured for better fit and that
contain a spermicide are effective but are less safe than condoms used with
vaginal spermacides. Condoms made from animal membrane should be avoided
because, although they prevent pregnancy, sexually transmitted infections be
transmitted through them. The condom should be put on before intercourse when
the penis is erect; long before ejaculation, the male can discharge drops of
semen that can cause pregnancy. Even with a vasectomy, men who are not in a
monogamous relationship with an HIV-negative partner should always wear a
latex condom during sex for protection against sexually transmitted diseases;
vasectomy is not protective.

Equivalent Contraception for The Female Partner. There are many contraceptive
options for women, butonly three offer protection as effective as a male
vasectomy.

Oral Contraception. For women, oral contraceptives, when taken as directed,
have an unintended pregnancy rate of 0.1%--the same as for vasectomy.
Typically, however, women who take the pill have a pregnancy rate of 3% due
to user error or real method failure.

Levonorgestrel Implants.Implants of levonorgestrel (Norplant) offer another
effective long-term contraceptive option. In this procedure, six pellets
containing the hormone are surgically implanted beneath the skin of a woman's
upper arm. The pellets slowly release progestin, thereby preventing pregnancy
even more effectively than oral contraceptive pills. Recently reports of
distressing side effects, including bleeding, headaches, high blood pressure,
and bruising, have caused women to question this method. In addition 5% of
women report problems with removal, including severe pain and, in some cases,
scarring. Only 10% request removal, however, and implants provide
contraception for five years. Check-ups should be done every six months. Not
all women are appropriate candidates, but it is safe for most, and the
implants are 99% effective.

Tubal Ligation. Tubal ligation is the primary surgical sterilization
procedure for women. The operation involves tying, cutting, or burning the
fallopian tubes, which blocks the egg from traveling from ovaries to the
uterus. More than 600,000 tubal ligations are performed annually. This
procedure is more difficult than vasectomy and has a higher rate of
complications. Reversal is an expensive procedure that is not always
successful.

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How is Vasectomy Performed?

Preoperative Procedures. The doctor who performs the vasectomy will ask the
patient to sign a consent form beforehand that states that the patient is
aware of the risks involved. The patient should be sure all of his questions
have been answered before signing the consent form.

Sperm Banking. Storing frozen sperm in a sperm bank before vasectomy might
enable the patient to have children afterward. Before the vasectomy, the
patient collects sperm, which are frozen and stored until he wants to have a
child. While it is possible to bank sperm for a later pregnancy, only one in
four patients achieve pregnancy, and it is a very expensive process. Experts
believe that a patient who wants to bank sperm should probably reconsider
having a vasectomy, because such a decision may indicate doubts about giving
up his ability to father a child.

Standard Vasectomy. Vasectomy is a minor operation that takes about 30
minutes and is usually performed in a doctor's office or a family planning
clinic. Before the operation, the scrotum is shaved and cleaned, and a local
anesthetic is injected into the skin of the scrotum. The surgeon makes a tiny
incision on one side of the scrotum and locates one vas deferens. The vas is
isolated, pulled up into the incision, and clamped at two sites close to each
other; the segment between is then removed. The surgeon seals the two ends
with clips, suture, or cauterization using an electric needle. The vas
deferens is then gently replaced back into the scrotum. The procedure is
repeated on the other side of the scrotum. After a short rest, usually about
half an hour, the patient can leave; someone else should drive the patient
home.

If the operation is performed under local anesthesia, the cost is from $150
to $1,200. Most insurance policies will cover vasectomy provided as a minor
outpatient procedure but will not cover vasectomy provided in a major surgery
operating room.

Postoperative Care. The patient should rest for at least one day. When the
effects of the local anesthetic wear off, within an hour or two, most
patients experience a dull ache in the testicles and groin. This pain
generally disappears within two days, although the patient may feel sore for
a few more days. The doctor may suggest that the patient wear an athletic
supporter, place an ice pack over the dressings, and stay in bed on his back
to help reduce postoperative pain. Some oozing of blood onto the gauze pads
is normal during the first day or two after the operation. The doctor may
prescribe a painkiller such as Tylenol or codeine for those first few days,
continuing with mild over-the-counter pain relievers if discomfort persists.
Aspirin, which can cause bleeding, should be avoided. Nearly all men recover
completely in a few days. The patient should not perform any heavy physical
labor for at least two days. Sports and heavy lifting may be resumed two to
three weeks after surgery.

Once the patient feels comfortable, he can resume sexual activity--usually in
about a week. The couple must, however, continue to use conventional birth
control methods for awhile; live sperm still exist in the ejaculatory ducts,
and pregnancy remains a risk for as long as a few months [see Failure,
below]. He may experience some discomfort in the groin and testicles at first
due to the contraction of the vas deferens during ejaculation. This
diminishes as the tissues heal.

No-Scalpel Vasectomy. A method of vasectomy was developed in China in 1974
that does not require a scalpel, which began to be used in the U.S. in 1985.
The no-scalpel vasectomy (NSV) differs from a conventional vasectomy in the
method of accessing the vas deferentia. An improved method of anesthesia also
helps make the procedure less painful. In this operation, the doctor feels
for the tubes under the skin and holds them in place with a small clamp.
Instead of making two incisions, the doctor makes one tiny puncture with a
special instrument, which is then used to gently stretch the opening through
which the vas deferens can be pulled. The vas is then blocked using the same
methods as conventional vasectomy., although a procedure known as Schmidt's
method that uses cauterization by a red-hot wire has the lowest failure rate
of all reasonable vas occlusion methods.

There is very little bleeding with the no-scalpel vasectomy. No stitches are
needed to close the tiny opening, which heals quickly and leaves no scar. The
technique takes about 10 minutes and is performed in a doctor's office or a
family planning clinic. It is just as effective as conventional vasectomy,
with less than a one-percent chance that a man's partner will become
pregnant. The discomfort is usually less than with standard vasectomy,
because there is less injury to tissues and there are no stitches.
Postoperative care is similar to that of conventional vasectomy. The patient
should lie on his back and apply ice packs for 8 hours. Mild pain killers may
be required during the first day, although aspirin should be avoided.
Infections and bleeding, occasional complications with standard vasectomy,
are reduced using no-scalpel surgery. Other complications, including sperm
granulomas, epididymitis, and sperm antibody production, occur after both
procedures. [For more information, see sections on Postoperative Care, above
and Postoperative Complications, below]. Failure rate is less than 1%--the
same as that of conventional vasectomy. Many American surgeons can now
perform this operation; updated lists of these surgeons are available for
those interested in this procedure [see Where Else Can Help Be Obtained for
Vasectomy?, below].

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What Are the Complications and Long-term Risks After Vasectomy?

Postoperative Complications. Vasectomy is a low-risk procedure and the
complications, which occur in about 10% of patients, are usually easy to
control. No deaths resulting from vasectomy have ever been reported in the
United States.

Allergic Reaction. A few men may have an allergic reaction to the local
anesthesia and develop itching and hives.

Bleeding. Frequently, blood may seep under the skin, so that the scrotum and
penis appear to be bruised. If there is no dangerous swelling, this painless
problem usually disappears without treatment within a week or two. If the
patient bleeds excessively in the days after the operation and requires more
than two or three gauze changes per day, he should call his doctor.

Hematoma. In about 2% of cases, bleeding inside the scrotum can cause a
painful swelling known as a hematoma. In these cases, the scrotum swells up
shortly after vasectomy. The doctor should be called immediately. Risk for
hematoma is less in no-scalpel vasectomy.

Infection. Infections occur in about 4% of men after standard vasectomy. The
risk for infection is reduced using no-scalpel vasectomy. The incision site
may become infected, causing a redness and swelling around the incision.
Antibiotics, antimicrobial creams or ointments, or both, along with hot baths
several times a day, will usually clear the infection in a few days.

Sperm Granulomas. After vasectomy, sperm often leaks from the vasectomy site
or from a rupture in the epididymis, the tightly coiled thin tube that
connects the testicle to the vas deferens. Sperm has very strong antigenic
qualities; that is, the immune system views sperm as foreign agents and
attacks them. Sperm leakage provokes an inflammatory reaction. The body forms
pockets to trap the sperm in scar tissue and inflammatory cells. Firm balls
of tissue are then formed about one-half inch in diameter; these are known as
sperm granulomas. They rarely cause problems. In about 2% of cases, sperm
granulomas obstructing the already blocked ends of the vas deferens can
generate pressure buildup in the epididymis, causing a rupture from the
pressure of the fluid. If the epididymis ruptures, the testicles can become
enlarged and inflamed. A damaged epididymis can be repaired, but if the
patient later wishes a reversal of the vasectomy, disruption of this tiny
tube makes success much less likely [see Can Vasectomy Be Reversed?, below].

Chronic Orchialgia. In about one percent of all vasectomies, the epididymis
becomes so congested with dead sperm and fluid that the patient feels a dull
ache in his testicles. This condition, called chronic orchialgia, usually
disappears within six months.

Epididymitis. Epididymitis occurs when an inflammation at the site of the
vasectomy causes swelling of the epididymis. This condition occurs within the
first year and can be treated with heat and anti-inflammatory medications. It
usually clears up in a week.

Long-Term Risks of Vasectomy.

General Health. Reports that vasectomy might be dangerous to a man's health
have persisted since the 1970s. Preliminary observations of humans and
animals suggested that vasectomy might be associated with heart disease,
hardening of the arteries, blood clotting, kidney disease, or arthritis. Two
major recent studies of large groups of men, however, found no significant
risk to a man's overall health. In fact, both studies found that men who had
vasectomies actually experienced a slightly lower risk for coronary artery
disease, and one study also found lower risks for stroke, high blood pressure
and chest pain. One of the studies even found that men who had vasectomies
had a longer life span than those without the procedure. (In both studies,
however, these reduced risks were not considered significant.) Most medical
experts, including special panels convened by the National Institutes of
Health and the World Health Organization, have concluded that vasectomy is a
safe procedure.

Prostate and Testicular Cancer. Recently, vasectomy has been implicated as a
possible cause of prostate cancer. Prostate cancer is the second most common
cause of cancer death among American men after lung cancer, and 30% of all
American men over 50 show some evidence of prostate cancer cells. A link
between vasectomy and prostate cancer could have a serious impact on the use
of vasectomy and on overall contraceptive practice in the United States.
Findings from epidemiologic studies investigating the relationship between
vasectomy and prostate cancer have been conflicting. Two studies published in
the spring of 1993 found a positive association; 20 years after the
operation, men with vasectomies had a risk more than 80% higher than those
without vasectomies. This should be put into perspective, however. There were
only 59 cases of prostate cancer out of more than 13,000 vasectomized men
over a 13-year period.

After these studies were announced, a panel of more than two dozen experts
convened by the National Institutes of Health found little or no association
between vasectomy and prostate cancer. It is possible that the findings of a
positive association occurred by chance, or that men who undergo vasectomy
are more likely to have prostate cancer detected because they are evaluated
regularly by urologists. The panel issued a statement concluding that because
of the inconsistency and insufficiency of evidence for the vasectomy-prostate
cancer link, there is no reason to recommend a change in clinical and public
health practices. The panel recommended that vasectomy reversal is not
warranted to prevent prostate cancer and that screening criteria for prostate
cancer should be the same for men with and without vasectomies. Research
should continue to investigate any possible relationship, however, between
prostate cancer and vasectomy. Studies also do not show any association with
testicular cancer. [For more information, see Well-Connected's Report #33,
Prostate Cancer.]

Immune System. Vasectomy also provokes immune system changes. The operation
may cause a patient's immune system to attack his own sperm by producing
antisperm antibodies. Up to two thirds of vasectomized men develop antibodies
that attach to sperm and interfere with sperm motility. At this time,
however, the antisperm response appears to be a problem only if a man wishes
to reverse the procedure [see Can Vasectomy be Reversed, below].

Severe Psychologic Reactions. A small percentage of couples experience
serious difficulties of adjustment. Their emotional distress most often
manifests itself in sexual dysfunction, such as impotence, premature
ejaculation, or painful intercourse. In such cases, however, the vasectomy
probably is the catalyst but not the cause of such extreme reactions. One
recent study found that men who experienced impotence after vasectomy were
more likely to have female partners who were unable to accept the operation.

Failure. The chance for failure is about 0.15%, or 6 in 4,000 operations.
While not a failure of the method itself, live sperm remain in the
ejaculatory ducts for up to a few months during which period sterility is
incomplete. primary reason for method failure occurs when the cut ends of the
vas deferens may, in rare cases, reconnect through a process known as
recanalization. Other reasons include incomplete sealing of the tubes and
development of openings that allow sperm to pass through.

Residual Live Sperm. After the operation there are always some active sperm
left in the semen for several months, so it is essential that the patient and
his partner continue to use another method of birth control until his sperm
count is zero. Fifteen to 20 ejaculations are required to clear the viable
sperm from the reproductivesystem; usually it takes a few months before
sterility is complete.

A semen analysis is done about six to twelve weeks after surgery to ensure
that no live sperm remain in the semen. The semen is usually collected at
home in a small jar and delivered to the doctor's office where it is examined
under a microscope. A second semen analysis is usually performed again about
four months after the vasectomy. The patient is considered sterile only when
there is no sperm in his semen.

Recanalization. Another reason for failure is spontaneous recanalization, in
which the two ends of the cut vas deferens reconnect.This may occur if a
sperm granuloma and its interconnecting channels form a new route for sperm
to move from one cut end of the vas deferens to the other. Recanalization has
been known to occur after a man has achieved a zero sperm count and as late
as 17 months after vasectomy, but the overall risk for recanalization is only
about .025% or one in 4,000 vasectomies.

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Can Vasectomy Be Reversed?

About two out of every 1,000 men who have vasectomy later regret their
decision and wish to have the procedure reversed. The main reasons for
requesting a reversal are remarriage, the death of a child, or an improvement
in finances followed by a desire for another child. Fewer than 10% of
patients who request reversals do so because of physical or psychologic
problems following vasectomy.

Although a vasectomy must be considered irreversible, there is a surgical
procedure that may restore fertility known as a vasovasostomy. The severed
ends of the vas deferens are reconnected to reestablish the flow of sperm.
The reversal procedure is difficult, however; it involves sewing together the
two ends of both tubes, each with pin-head sized openings. If the vas
deferens is blocked, the surgeon may try to connect the epididymis to an area
in the vas that bypasses the blockage.

Reversal surgery is a major operation and far more expensive than the
original vasectomy (more than $5,000). It is even costlier if the procedure
involves connecting the epididymis, which takes about three hours. Reversal
surgery is usually not reimbursed by insurance companies. A patient who is
contemplating a possible reversal before undergoing a vasectomy may not be
making the right contraceptive choice.

Even if the vasovasostomy itself is successful, fertility can still be a
problem because of the immune system's activation after vasectomy, which
renders sperm immobile in some men. This problem can sometimes be overcome by
using one or a combination of treatments. Corticosteroid medications can
reduce antibody production. Poorly motile sperm can also be prepared for
artificial insemination into the woman's cervix, uterus, or fallopian tubes.
[For more information on this subject, see Well-Connected's Report #22
Infertility in Women.].

Improvements in surgical technique have improved the chances of a reversal's
success. The pregnancy rate following vasectomy reversal ranges from 16% to
85%. Most surgeons report their own success rate as greater than 50%. Success
depends on several factors, including the doctor's skill, complications from
the original operation, and the time lapsed since vasectomy. A successful
reversal is most likely in a man whose epididymis is unblocked and able to
transport healthy sperm.

Reports show that when a reversal is performed within two years of a
vasectomy, the patient can expect sperm counts to return to normal. If the
reversal is performed more than ten years afterward, only about one third of
patients regain normal sperm counts. Even a normal sperm count does not
guarantee a pregnancy; the woman's fertility also comes into play as well.

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What Are the Usual Emotional Ramifications of Vasectomy?

The decision to end fertility is not a simple one. During the first few
months after surgery, it is recommended that the patient and his partner
spend time reassessing their self-images and repatterning their relationship.

Many men go through a brief period of self-consciousness, wondering whether
others notice some difference in their masculinity. About half of vasectomy
patients keep their operations a secret. They may believe that the operation
is tainted by the stigma of emasculation and knowledge of it would degrade
them in the eyes of their friends and family. For most men, this
tentativeness passes quickly; in a few men, however, problems of male
self-image persist and require counseling. Some men may have feelings of loss
about ending the part of their lives involved with creating a family, and
they may experience depressed and angry emotions similar to mourning. These
negative feelings usually resolve over time, as the patient goes on to the
next stage of his life.

Much more often, men who have vasectomies feel relieved that the worry about
pregnancy is over. The patient may feel freer, more spontaneous, and able to
concentrate more on himself, his children, his job, his partner, and his
future. Most couples respond well to their new-found contraceptive freedom.
About 30% of couples report that they have sex more often following
vasectomy, enjoy it more, consider their marriage stronger, feel healthier
and more relaxed, and have no regrets about the operation. At least 90% of
men who have had a vasectomy say that they would make the same choice again
and that they would recommend the operation for men in similar circumstances.
Wives seem to feel even more positively about the operation--more than 95% of
the partners of vasectomized men report satisfaction with the procedure.
Younger and older couples and those with children and those without are
equally likely to have favorable reactions to vasectomies.

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Where Else Can Help Be Obtained About Vasectomy?

AVSC International
79 Madison Avenue
New York, NY 10016
(call 212-561-8000)

The association publishes booklets answering questions
about vasectomy, no-scalpel vasectomy, and sterilization reversal
as well as a monthly newsletter for members. They will also provide
names of local physicians who perform no-scalpel vasectomies.
Those requesting information should write for it and include a
self-addressed envelope.

National Institute of Child Health and Human Development
P.O. Box 29111
Washington, D.C. 20040
This government institute publishes a fact sheet,
"Facts About Vasectomy Safety" (call 301-496-5133).

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