Vasectomy – Male contraception

The aim of a vasectomy is to prevent sperm from reaching the semen by disconnecting the sperm duct. The resulting ejaculate is therefore sperm-free, eliminating the risk of pregnancy. Sort of like a cheap shark fin soup without the shark fins (sperms).

Vasectomy is the contraception of choice for 6%–8% of married couples worldwide. Vasectomy is a minor procedure that provides effective and permanent contraception. In fact, it is far more effective than many other methods of contraception, including female sterilization.

Prior to a vasectomy, it is important and both husband and wife be present together to be counseled by a specialist on the implications of the procedure. It is important that the completeness of family is ascertained and that both husband and wife had discussed beforehand and agreed that it is the husband who should undergo a vasectomy to attain permanent contraception.

A vasectomy typically takes 20-30 minutes and is done under local anaesthesia (LA) with or without sedation or under general anaesthesia if the patient is squeamish about pain. After LA is administered, a small nick is done on the scrotum. The sperm duct or vas deferens is exposed and cut with 1-2cm of the duct removed. Then, the ends will be diathermized (using heat to destroy tissue) to close the channel of the duct and they will be bent upon itself and tied. After that, the two tied ends are buried in different tissue planes to reduce the chances of them rejoining.

After a vasectomy, patients should take plenty of fluids as well as take the pain killers provided. He should rest at home, limit activity, and wear a scrotal support for the next 48 hours. He must see his urologist if there is any pain or swelling of the scrotum or fever.

It is important to note that vasectomy does not provide immediate sterility! It is important to use another form of contraception until after occlusion of vas is confirmed by the absence of sperms or rare non-motile sperm on post-vasectomy semen analysis done at 8 to 16 weeks or after 25 ejaculations after the surgery. Patients should refrain from ejaculation for approximately one week after vasectomy.

Some short-term surgical complications are 1-2% risk of blood clot formation, and infection. On the other hand, the most common long-term complication of a vasectomy is chronic scrotal pain that affects 1-2% of men. The risk of pregnancy after a vasectomy is 1 in 2000 for men who have post-vasectomy azoospermia which is caused by spontaneous re-canalization of the sperm duct.

Around 3-6% of men who have undergone vasectomy may opt for a reversal later in life for various reasons. Unlike vasectomy, a vasectomy reversal is a procedure that is much more technically challenging, requiring the use of an operating microscope. In addition to this, the result of vasectomy reversals after 10 years is poor at about 39%. Besides vasectomy reversal, other options for fertility after vasectomy include sperm retrieval with in vitro fertilization. These options are not only expensive, but they also may not always be successful. Hence, pre-vasectomy counseling is of utmost importance.

Article contributed and written by

Dr Peter Ng (Consultant Urologist)

Dr Beatrice Chua Yoong Ni

Subang Jaya Medical Centre

References and further reading:

https://www.urologyhealth.org/urology-a-z/v/vasectomy

https://www.auanet.org/guidelines/vasectomy-guideline

https://theconversation.com/explainer-how-does-a-vasectomy-work-and-can-it-be-reversed-110780

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4854082/

 

To print a pdf copy, click HERE

Benign ovarian cysts

The ovaries are the female reproductive organs that contain eggs and will release them on a regular basis (usually monthly in the majority of the women). It also produces female and male hormones. An ovarian cyst is abnor¬mal growth in the ovary and can be either solid or cystic. It can be divided into either a benign (non-cancerous) or malignant (cancerous) type. Benign or non-cancerous cysts do not invade neighboring tissue the way malignant cyst does. The exceptionally large ovarian cyst often turns out to be benign.

The term ovarian cyst refers to abnormal growth in the ovary that contains mainly fluid, although occasionally some solid component may be present as well.

Symptoms and signs

Read moreBenign ovarian cysts

Hysteroscopy (diagnostic and operative)

The hysteroscope is a small lighted telescope used for visual examination of the cervix and the uterus to help diagnose and treat abnormalities in the cervical canal or the uterine cavity. If it is used to look for the cause of the presenting problem, it is term as diagnostic hysteroscopy. If it involves some form of surgical procedures such as removal of growths (endometrial polyps or fibroids), removal of the lining or separation of adhesions, then it is called operative hysteroscopy. In many cases, both procedures are done concurrently – the so-called “see and treat” approach.

Reasons for the procedure

  • Evaluation and treatment of abnormal uterine bleeding.
  • To look for the displaced and removal of the intrauterine device (IUD).
  • Evaluation for infertility (difficulty in conceiving) or recurrent miscarriage.
  • Uterine polyps, fibroids or adhesions (which is called Ashermann’s syndrome).
  • Obstructed fallopian tubes.
  • Congenital malformations of the uterus

Read moreHysteroscopy (diagnostic and operative)

Anaesthesia and Analgesia in Obstetrics and Gynaecology

Dr. William Morton demonstrated the first public administration of ether anaesthesia in the operating theatre of the Massachusetts General Hospital on the 16th October 1846
That day is remembered as a milestone in anaesthesia and celebrated as World Anaesthesia Day.
From that date onward, many progresses have been made in the field of anaesthesia, and more so specifically for the practice of obstetrics and gynaecology.

On the 16th August 1897, a German surgeon by the name of Dr. August Bier administered the first spinal anaesthetic. Spinal anaesthesia becomes one of the most popular methods of administering a patient pain free from surgery of the lower limbs, lower abdomen and Caesarean sections and is still widely used.

Read moreAnaesthesia and Analgesia in Obstetrics and Gynaecology

Suction evacuation for miscarriage

Suction & evacuation is a technique of emptying the uterus of a pregnancy. It can be used to terminate a pregnancy or to remove a fetus that has died. It involves the removal of a fetus and accompanying tissue of the pregnancy from the uterus with instrumental evacuation through the vagina and is usually performed in the first trimester of pregnancy.

Reasons for procedure

Read moreSuction evacuation for miscarriage

Cervical Intraepithelial Neoplasia (CIN)

Cervical intraepithelial neoplasia (or CIN) refers to the presence of abnormal cells seen on the cervical cytology smear. These abnormal cells are obtained from the lining of the outer cervix and can range from mild to severe changes. A diagnosis of CIN changes is not cancer. However, the severe form of dysplasia can be considered a precancerous condition and may eventually progress to cancer in several years if not treated.

The cervical cytology smear was previously referred to as Pap smear. Currently, the newer cervical cancer screening uses a liquid based cytology and the commonest one used are: Thin Prep or Sure-Path. These are better and more accurate compared to the conventional Pap smear test.

Classification of CIN 

Read moreCervical Intraepithelial Neoplasia (CIN)

Laparoscopy in Gynaecology

Laparoscopy is a procedure that allows visual examination and surgical treatments of the pelvic and abdominal organs pathology. The procedure is performed with a laparoscope, which is a small lighted telescope.

INDICATIONS – When is it necessary

  • Evaluation and treatment of women who has difficulty in conceiving.
  • Evaluation and treatment of known or suspected endometriosis.
  • Pelvic infections
  • Removal of diseased fallopian tubes, ovaries, cysts or uterus
  • Undiagnosed pelvic pain
  • Uterine fibroids
  • Voluntary sterilization (tubal ligation or occlusion for permanent family planning)
  • For diagnosis and treatment of a variety of other pelvic or abdominal disorders

Read moreLaparoscopy in Gynaecology

Caesarean Section

WHAT IS IT?
Delivery of a baby through an incision in the mother’s lower abdominal and uterine walls and is performed when a vaginal delivery is not possible or is unsafe. This procedure is also called a C-section or Lower Segment Caesarean Section (LSCS).

 

 

 

REASONS FOR PROCEDURE

Danger to the mother or baby from one or more of many causes, including:

  • Baby’s head too large to pass through the birth canal.
  • Baby in the wrong orientation – head up (breech) or transverse.
  • Failure of cervix to dilate (failed induction of labour).
  • Abnormal placenta location obstructing the birth canal (placenta praevia).
  • Failure of normal labour progress.
  • Situation where urgent delivery is indicated such as fetal distress or severe illness in the mother (such as severe hypertension or sudden fits).
  • Infection such as HIV or acute herpes genitalis infection in the mother.

Special situations: pregnancy resulting from assisted reproductive technology (ART), maternal request

Read moreCaesarean Section