Man who underwent vasectomy: I did it out of love

SINGAPORE — Not many healthy men would willingly undergo genital surgery but Mr William Ong, 34, and Mr Alvin Chong, 45, were happy to go under the knife for the sake of family planning.

Both were in their early thirties when they underwent a vasectomy, a permanent form of contraception.

They had a portion of the tubes – called vasa deferentia – that carry sperm away from the testes cut and sealed.

The ejaculate of men who have undergone vasectomy does not contain sperm, and therefore will not result in pregnancy, said Dr Ng Kok Kit, senior consultant at Changi General Hospital’s (CGH) department of urology.

Mr Ong, who got himself snipped last November, said he went for the procedure “out of love” for his wife after considering other contraception options. He did not want her to shoulder the burden of birth control alone.

They have two children aged two and four, and another child is due in June – “an unexpected surprise” conceived several weeks before the scheduled vasectomy.

“Birth control doesn’t always have to fall on the woman. My wife has already gone through pregnancy and childbirth. (Going for a vasectomy) is my way of loving her. Furthermore, we’re certain we don’t want more children due to affordability issues,” said Mr Ong, a social worker and the sole breadwinner of the family.

While male sterilisation remains a niche practice in Singapore, this form of contraception appears to be catching on. The most common forms of birth control here are barrier methods and oral contraception.

The number of vasectomies carried out at the National University Hospital (NUH) has increased, from 21 cases in 2015 to 38 last year. CGH performs 20 such procedures each year.

The day procedure can be carried out under local anaesthesia. Patients will receive a certificate of sterilisation after undergoing a vasectomy, said Dr Ng.

Patients may either take the polyclinic route or make an appointment to see a urologist as a private patient, he said.

Costs of the procedure vary. The operation fee ranges from under S$167 to over S$216 for a subsidised patient, and under S$2,094 to over S$3,485 at private hospitals, according to the Ministry of Health’s website. The fee does not include other charges that patients may have to pay.

Patients who request for a vasectomy are usually married men in their thirties to early forties, and who have “completed” their family with at least two children, said Dr Joe Lee, consultant and director of Andrology and Male Reproductive Medicine at NUH.

“They usually do not enjoy sexual intercourse using the barrier form of contraception such as a condom,” said Dr Lee.

MOST EFFECTIVE BIRTH CONTROL; SEX DRIVE UNAFFECTED

Many of them would have also done their research and realised that vasectomy is one of the most effective forms of birth control.

According to CGH’s Dr Ng, a vasectomy has the lowest failure rate (0.1 per cent) among all methods of contraception.

“By contrast, tubal ligation – the other potentially permanent contraception method – has a failure rate of 0.3 per cent. Other methods have much higher failure rates – 1 per cent for oral contraceptives, 2 per cent for intra-uterine contraceptive device and 25 per cent for condoms,” he said.

Mr Chong, a teacher and father of three teenagers, said a vasectomy was a straightforward solution once he was done with having children.

“From my consultation at the polyclinic till the day of the operation, the doctors kept asking me over and over again if I was certain about going ahead with it. I got quite fed up and told them to ‘just give it to me’. It is a lot easier for me to do the procedure than for my wife to remember to take her (birth control) pills,” he said.

Contrary to popular belief, the procedure does not affect a man’s sexual function or sex drive.

“Sexual function or libido is dependent on the male hormone testosterone. This is produced by the testes and secreted directly into the blood supply of the testis, which remains intact (after a vasectomy),” said Dr Ng.

The blood vessels and nerves of the penis, which are essential for erectile function, remain intact as well. The man also continues to have ejaculate as the majority of the fluids come from seminal vesicles and the prostate gland, which are beyond the point where the vasa deferentia are cut, Dr Ng said.

Mr Chong declared: “After the procedure, you get the whole experience without the effect (of a potential pregnancy).”

Although he can no longer father any children, Mr Ong said the procedure has not made him feel less of a man.

“On the contrary, my wife felt that I was man enough to do it as it was something out of the norm. It actually enhanced our emotional intimacy,” he said.

In experienced hands, a vasectomy can be done “very safely”, said Dr Lee. Besides the traditional incision method, a no-scalpel technique is now available. The technique uses a special instrument, instead of a surgical knife, to make a tiny opening in the skin and results in a smaller wound.

After a vasectomy, the patient may feel some bruising and pain around the wound site, and the scrotum may be slightly swollen. The after-effects are usually self-limiting and the wound usually heals within a week, the doctors said.

“Potential complications include bleeding and infection. Rarely, patients may develop chronic pain around the scrotum. These (complications) can be managed conservatively most of the time,” said Dr Lee.

A REVERSAL IS CHALLENGING

While a vasectomy is a relatively straightforward procedure, the decision to undergo one should be carefully thought through, experts stressed.

They have seen patients regretting and wanting a vasectomy reversal, which is a far more difficult procedure that – according to Dr Ng – does not guarantee success in regaining fertility.

The NUH team sees fewer than five of cases of vasectomy reversals each year. “Men seeking reversals may have changed life partners or, in some tragic cases, may have lost their child,” said Dr Lee.

While the success rate of vasectomy reversals can be as high as 80 to 90 per cent, failures may still occur, Dr Lee warned.

The longer the reversal procedure is performed after the vasectomy, the lower the chances of conception, said Dr Ng.

“Success in rejoining the tubes does not mean that the patient will be fertile again. Beyond 15 years after a vasectomy, the chance of conceiving naturally following a vasectomy reversal drops to 44 per cent,” he said.

Requests for a vasectomy may be turned down or deferred when a patient is uncertain about permanent sterilisation or is deemed too young.

For example, a young single man may be asked to reconsider his options if he has not tried other forms of contraception or chooses a vasectomy because he has the wrong impression that it is convenient and can be easily reversed, said Dr Lee.

“We also decline requests if we detect that the patient’s decision was made under pressure from another party, possibly his spouse or parent, and he is actually unwilling to go for the procedure. Couple or family counselling is required in such cases,” he added.

Mr Ong, who openly shares his vasectomy experience with curious family members and close friends, said it is important for couples to have an open discussion before they decide on this contraception method.

“Ultimately, both you and your spouse must agree to it. A vasectomy should not be done as an underhand method (to prevent pregnancy),” he said.