Does vasectomy have long-term effects on somatic and psychological health status?

Abstract

All the major international articles on the somatic and psychological consequences of vasectomy published over the last 10 years have been reviewed and analysed. Although some experiments on animals have revealed harmful effects, none of the large-scale epidemiological studies has pointed to any increase in health risks (cardiovascular, hypertensive, psychiatric) in vasectomized men. The contradictions which arise between the clinical and large-scale epidemiological studies may be the result of methodological or experimental conditions. As our knowledge stands at present it can therefore be considered that vasectomy has no major effects on the physical or mental health of men.

PIP: This paper reviews the literature on somatic and psychological consequences of vasectomy published in the past 10 years. Although there is some evidence in animal studies of harmful effects, these findings are not supported in the epidemiological and clinical studies. The somatic aspects are discussed in terms of hormonal and accessory gland function consequences, immunological data on animals and men (clinical studies of cancer, atherosclerosis, and urolithiasis, and epidemiological studies). Psychological aspects are viewed in terms of the effects on sex life, attitude toward family and children, repercussions on mental health, and second thoughts after vasectomy (displeasure, dissatisfaction, and regrets). The summary of clinical and large scale epidemiological studies indicates that there aren't any long term side effects of vasectomy on the health of individuals examined. The results are considered valid and reliable and a complete confirmation of long term safety of vasectomy. That some evidence was produced clinically on side effects may mean the results reflect methodological or experimental conditions, or the need for case control studies among male high risk groups. 2 points are made about the lack of statistical power and selection bias. Vasectomy may act as a co-risk factor. The risk is low and only appears in some groups of already high risk men with hypercholesterolemia and familial hypertension. The total number of high risk men is low, which means lack of statistical power. The 2nd point is that accessibility may present a selection bias, where patients elect not to have a vasectomy because of bad health or doctors may reject individuals in bad health or long term risk factors. The psychological aspects as reported show 90% of men satisfied with having has a vasectomy. There is not notable change in frequency of sexual relations or sexual desire. Studies have not been done which take into account cultural differences, and do not reflect comparisons with the before period. Interpretations and cross study comparisons lack uniformity and clarity. Reduced sexual relations could be considered appropriate for a couple requesting sterilization, and frequent sexual activity post operation could mean insecurity. Future studies might monitor closely the real life experiences to answer the why vasectomy, how adjusted, and so on. All the studies are restricted by limited options questions. Of concern is whether the man selected the right choice. Compared to costs, failure rate, and complications of tubal ligation, it is hoped that vasectomy continues as a viable and available method for couples.