Editing Vasectomy (section)

==Medical uses==

A vasectomy is done to prevent fertility in males. It ensures that in most cases the person will be [[Infertility|sterile]] after confirmation of success following surgery. The procedure is regarded as permanent because [[vasectomy reversal]] is costly and often does not restore the male's sperm count or sperm motility to prevasectomy levels. Those with vasectomies have a very small (nearly zero) chance of successfully impregnating someone, but a vasectomy does not protect against [[sexually transmitted infection]]s (STIs).<ref>{{Cite web |title=Vasectomy - Mayo Clinic |url=https://www.mayoclinic.org/tests-procedures/vasectomy/about/pac-20384580 |access-date=2023-04-19 |website=www.mayoclinic.org}}</ref>

After vasectomy, the testes remain in the scrotum where [[Leydig cell]]s continue to produce [[testosterone]] and other male hormones that continue to be secreted into the bloodstream.

When the vasectomy is complete, sperm cannot exit the body through the [[penis]]. Sperm is still produced by the testicles but is broken down and absorbed by the body. Much fluid content is absorbed by membranes in the [[epididymis]], and much solid content is broken down by the responding [[macrophage]]s and reabsorbed via the bloodstream.{{Citation needed|date=March 2024}} After vasectomy, the membranes must increase in size to absorb and store more fluid; this triggering of the immune system causes more macrophages to be recruited to break down and reabsorb more solid content.{{Citation needed|date=March 2024}} Within one year after vasectomy, sixty to seventy percent of those vasectomized develop [[antisperm antibodies]].<ref name=hattikudur/> In some cases, [[vasitis nodosa]], a benign proliferation of the ductular epithelium, can also result.<ref name=deshpande/><ref name=hirschowitz/> The accumulation of sperm increases pressure in the vas deferens and epididymis. The entry of the sperm into the scrotum can cause [[sperm granuloma]]s to be formed by the body to contain and absorb the sperm which the body will treat as a foreign biological substance (much like a virus or bacterium).<ref name=christiansen/>

===Efficacy===
{| class="wikitable floatright plainrowheaders"
|+Risks of vasectomy
|-
!scope="col"| Frequency
!scope="col"| Risk
|-
| 1 in 1400
!scope="row"| Unwanted pregnancy (failure of vasectomy)<ref name=griffin/>
|-
| 1 in 11
!scope="row"| For comparison: unwanted pregnancy w/ typical use of pill<ref name="Trussell 2011"/>
|-
| 1 in 6
!scope="row"| For comparison: unwanted pregnancy w/ typical use of condom<ref name="Trussell 2011"/>
|-
| 1 in 40
!scope="row"| Infection after surgery<ref name="bji.sagepub.com">Nevill et al (2013) Surveillance of surgical site infection post vasectomy. ''[[Journal of Infection Prevention]]''. January 2013. Vol 14(1) [https://archive.today/20130411181657/http://bji.sagepub.com/content/14/1/14.abstract]</ref>
|-
| 1 in 7
!scope="row"| Pain at 7 months after vasectomy<ref name=leslie/>
|-
| 1 in 110
!scope="row"| Pain at 7 months affecting quality of life<ref name=leslie/>
|}

Vasectomy is the most effective permanent form of contraception available to males. (Removing the entire vas deferens would very likely be more effective, but it is not something that is regularly done.<ref>{{Cite web|url=https://www.vasectomy.com/question/are-any-of-the-doctors-here-willing-to-remove-my-entire-vas-deferens-7155|title=Is it possible to have my entire vas deferens removed? - Vasectomy Questions & Answers &#124; Vasectomy.com|website=www.vasectomy.com}}</ref>) In nearly every way that vasectomy can be compared to [[tubal ligation]] it has a more positive outlook. Vasectomy is more cost effective, less invasive, has techniques that are emerging that may facilitate easier reversal, and has a much lower risk of postoperative complications.

Early failure rates, i.e. pregnancy within a few months after vasectomy, typically result from unprotected [[sexual intercourse]] too soon after the procedure while some sperm continue to pass through the vasa deferentia. Most physicians and surgeons who perform vasectomies recommend one (sometimes two) postprocedural semen specimens to verify a successful vasectomy; however, many people fail to return for verification tests citing inconvenience, embarrassment, forgetfulness, or certainty of sterility.<ref name=christensen/> In January 2008, the FDA cleared a home test called SpermCheck Vasectomy that allows patients to perform postvasectomy confirmation tests themselves;<ref name=klotz/> however, compliance for postvasectomy semen analysis in general remains low.

Late failure, i.e. pregnancy following spontaneous recanalization of the vasa deferentia, has also been documented.<ref name=philp/> This occurs because the [[epithelium]] of the vas deferens (similar to the epithelium of some other human body parts) is capable of regenerating and creating a new tube if the vas deferens is damaged and/or severed.<ref name = "rolnick">{{Cite journal|url=https://jamanetwork.com/journals/jamasurgery/article-abstract/536907|doi = 10.1001/archsurg.1924.01120070191008|title = Regeneration of the Vas Deferens|year = 1924|last1 = Rolnick|first1 = H. C.|journal = Archives of Surgery|volume = 9|page = 188|url-access = subscription}}</ref> Even when as much as five centimeters (or two inches) of the vas deferens is removed, the vas deferens can still grow back together and become reattached—thus allowing sperm to once again pass and flow through the vas deferens, restoring one's fertility.<ref name = "rolnick"/>

The [[Royal College of Obstetricians and Gynaecologists]] states there is a generally agreed-upon rate of late failure of about one in 2000 vasectomies—better than [[tubal ligation]]s for which the failure rate is one in every 200 to 300 cases.<ref name=rcog/> A 2005 review including both early and late failures described a total of 183 recanalizations from 43,642 vasectomies (0.4%), and 60 pregnancies after 92,184 vasectomies (0.07%).<ref name=griffin/>