Post-vasectomy erectile dysfunction

Abstract

We investigated two groups of men with regard to vasectomy acceptance, and subsequent erectile dysfunction. Group I was a group of 45 men chosen at random from 254 vasectomized patients. Group II was a group of 18 men who, out of 180 patients treated for erectile dysfunction, attributed their dysfunction to previous vasectomy. We analysed the social background, motivation for vasectomy and postoperative changes of sexual life or behaviour of the partners. The partnership constellation, particularly the role of a predominant female partner seems to be an important feature for vasectomy acceptance. Low acceptance might cause erectile dysfunction.

PIP: Of 180 patients treated for erectile dysfunction in 1989-91 in Basel, Switzerland, 25 had previously undergone vasectomy. 18 of these latter individuals volunteered to be interviewed about their social background, motivation for vasectomy, and postoperative changes of sex life or partner behavior. All of these men attributed their sexual dysfunction to previous vasectomy. Somatic erectile dysfunction was, however, clinically excluded, thereby making the dysfunction of these men psychological in origin. For comparison, a group of 45 randomly chosen vasectomized men underwent the same psychosexual evaluation in the attempt to find a possible relationship between vasectomy and subsequent erectile dysfunction. The men were chosen from 254 vasectomized patients over the period 1986-90. The 45 controls comprise group one, while the 18 men who attribute their erectile dysfunction to previous vasectomy comprise group two. The mean age at time of vasectomy in group one was 39.1 years in the range of 23-59 years, while the mean age in group two at the time of vasectomy was 56.4 years in the range of 42-71 years. Vasectomy dated back on average 18.8 years. 98% of all patients interviewed were married or living in a steady partnership. 18% of patients in group one and 11% of patients in group two found the operation to be traumatic, while 13% of patients in group one and 17% of patients in group two reported fears of demascularization; these differences were not significant. It was significant, however, that 22% of patients in group two had the decision to undergo vasectomy imposed upon them by their partner. 4% of patients in group one and 22% of patients in group two reported a reduced libido within the first two postoperative years. Less frequent or weaker erections were reported by 2% of patients in group one and 27% of patients in group two. Decreased frequency of orgasm was reported by none of the patients in group one, but by 28% of the patients in group two. Ejaculation quality and orgasm by masturbation remained unchanged in all cases. Decreased sexual activity in the partner was reported by 7% of patients in group one and 33% of patients in group two. 4% of patients in group one and 28% of group two believed there was a connection between previous vasectomy and their own erectile dysfunction. In all patients with erectile dysfunction this occurred within two years of the vasectomy. 4% of patients in group one and 39% of patients in group two had changed their partners within the follow-up time. Generally, a patient's psychosocial environment is most important for the acceptance of vasectomy. A good acceptance of vasectomy is usually found among men living in traditional partnerships with a predominating male. Men in partnerships where the female predominates and where the female may have demanded that the male undergo vasectomy, however, may have difficulty later accepting and coping with such imposed decisions on reproduction. Patients requesting vasectomy should always be asked systematically about their motivation and the manner in which the decision was reached. A prospective study is underway to determine the characteristics of men who are predisposed to become sexually dysfunctional.