Majority of men qualify for vasectomy

HEALTH | VASECTOMY 

In 2014, Wilberforce Nddungu took the decision to have a vasectomy after abandoning the plan three times. He was not sure if he really wanted to stop having children. 

 "The doctors said I was undecided and wasting their time when I went to the clinic for the third time to have a vasectomy. Indeed, I went back home that day," he disclosed. 

Nddungu 64, who has three pairs of twins among his undisclosed large number of children went on to have five more children on the three occasions he failed to get a vasectomy. 

However, on the fourth occasion in 2014, he decided to get a vasectomy. 

 "The number of children I had, had become a burden. I also did it for my wife," he revealed. 

"She was having difficulty using female family planning methods, she would among others bleed, get dizzy, and get prolonged periods. It made me decide to get a vasectomy," he said. 

"The challenge with vasectomy is that most men think it will lead to loss of sexual drive or inability to enjoy sex," said Dr Ssikyomu Ssentongo, a team leader at Marie Stopes Uganda central outreach team that also carries out vasectomies. 

"The truth is you remain normal; the only thing is that you are not able to make your woman pregnant ever again, after three months of getting a vasectomy, when the method has taken effect," he explained. 

Carrying out vasectomy                                                                

A vasectomy (male sterilization) is considered one of the few fertility control methods that allow men to take personal responsibility for contraception or family planning. 

"It is a simple surgical procedure to cut or seal the tubes that carry a man's sperm, to permanently prevent pregnancy." 

"It involves giving an injection on the testis to remove the pain. Then using a tool to create a small hole where the drug was injected, we then expose a section of the sperm duct and cut out a small section and put a plaster which you keep on for three to four days." 

"The operation is usually carried out under local anaesthetic, where the patient is awake but does not feel any pain, and takes around 10 to 20 minutes," explained Dr Ssentongo. 

Dr Ssentongo explained vasectomy is more than 99% effective at preventing pregnancy. 

"It is a permanent irreversible contraceptive method offered to men who think they have had enough number of children and do not want to bear more children." 

"Since its irreversible, we expect only men who have attained enough number of children to undergo this procedure. It should be of free will and not forced." 

Global contraceptive patterns for 2013 show that only 2.2% of the men in the world have had vasectomies. 

Dr Ssentongo said for the procedure to be conducted, they assess for eligibility before it is done.  

"Those who are not eligible are those who haven't had children, those with one testis it may be risky, those who had scrotum surgeries, and those with diseases that may threaten conception. They may blame it on the procedure which they do not want." 

"We expect a man who has enough number of children (it depends on you) and is not going to regret getting a vasectomy. 

"Vasectomy is less invasive; we use anesthesia (give a drug that removes the pain) then do the procedure. It can be done in outpatient you don't need to go to the theater," he explained.  

Effectiveness  

The method will not take effect immediately after the procedure is carried o]t, according to Dr Ssentongo. 

"It takes about three months within which we expect one to have had 21 sexual intercourses because we cut out only a small section from the whole length of the sperm duct." 

"There are sperms which are closed above the level we have cut out, so they must be ejaculated out during those 21 sexual intercourses,"  

It means within those first three months, the partner either takes a method of family or use a condom to prevent conception during that time before the vasectomy method takes effect," he explained. 

Dr Ssentongo explained after three months one can come to any laboratory to check if their semen still has sperm in it. 

This is by doing a semen analysis to confirm if the semen does not have sperms which can make a woman pregnant. 

However, Dr Ssentongo stated that even for a man who is not able to afford semen analysis by three months; the method will have taken effect. The analysis is only to confirm before taking a risk. 

Risks involved 

There is not much risk we can talk of, perhaps bleeding from the point where we have done the vasectomy from, said Dr Ssentongo. 

"The other risk could be an infection but we have control over it by doing the procedure in a germ-free place, with sterile equipments, and the procedure  is by trained personal to avoid one getting infections afterward." 

"There could be pain in the scrotum but it's a minimal occurrence," explained Dr Ssentongo. 

He added that the sexual drive and performance remains normal, and may even increase because there is nothing like pregnancy to worry about. 

He stated that the only risk that remains is that of sexually transmitted disease from getting multiple partners out of confidence there will be no pregnancy occurring. 

Self-care after vasectomy 

Upon getting a vasectomy do not pour water where the plaster is on, it supposed to remain clean and dry, said Dr Ssentongo. 

"Be careful when taking a bath not to wet the plaster to keep the dressing clean and dry. Use a towel within those three days to clean your body to avoid flowing water which may carry germ from the body to the place of the plastered area and risk getting an infection." 

In addition, put on clean, loose fitting pants," he said. Eat well too.  

Dr Ssentongo also said during this time one is not expected to ride a bicycle however one can drive and ride a motorcycle and can still do work. 

"We give about a week or two to be off heavy duty but one can still do light work," he explained. 

He added that one is also given painkillers for taking at home. 

"Because our procedure is antiseptic, no one is infected during the process so we don't give antibiotics but just pain killers.  

"It is a minimal procedure, less tissue damage is done and we expect a quick healing," he stated. 

Getting more men to get vasectomy 

November 14-21, annually is World Vasectomy Day. It promotes male engagement in sexual and reproductive health to increase its demand. 

Ever since I got vasectomy I have managed to get about seven men in Wakiso alone to get vasectomy and they are very happy, disclosed Nddungu who has become a mobiliser for vasectomy. 

"There are others outside Wakiso, every time they meet me, they give me a token of appreciation for helping them have a manageable family and getting to be financially stable," he said. 

"I come from a family with many children, it cost me an education. I had four children and want to give them an education I never had," disclosed, Jamada Ssenyonjo 44, who also had a vasectomy on encouragement from Nddungu 

He had also abandoned the plan for a vasectomy on two occasions but decided to share the plan with his wife who was supportive and on the third occasion got a vasectomy in Kasangati. 

"I also survived raising children who are not my own, my wife got pregnant after I got a vasectomy, she left peacefully because we were both certain it was not my child. I'm now married to another woman who is okay with my status," disclosed Ssenyonja. 

Lessening the burden on women 

Times have changed there is a lot of responsibility, men accepting vasectomy are lessening the burden on women on having a manageable family, says Fiona Nakimuli 30, a mother and business woman. 

"Sometimes the female contraceptives have effects. For a man to say I have four, six children, let me stop having children, take full responsibility, and get the vasectomy, helps lessen the burden." 

"However vasectomy needs when a man has had some children if they don't have any child they shouldn't do it," she stated. 

What the future looks like 

The fertility rate in Uganda is among the highest in the world as on average every Ugandan woman has the ability to have 5 children, according to national statistics. 

Also, an estimated 1.6 million babies are born in the country annually yet Uganda remains among the poorest nations in the world despite reducing its poverty rate.  

Although the need is high for vasectomy to have a manageable family, the uptake is still low because of myth, disclosed Dr Ssentongo. 

"In the central region were I operate we get only about 20 men in a year coming for vasectomy 

In a month it's either one man or three maximum. Sometimes we get men who don't qualify," he disclosed. 

Dr Ssentongo however says with more knowledge the desire for vasectomy will rise.