Why men should embrace vasectomy

FAMILY PLANNING |

Saturday, November 14^th, was World Vasectomy Day, a celebration of men who are stepping up for their partners, their families, and their future. The family planning community united in appreciation of the men who underwent it and encourage others not to fear. Agnes Kyotalengerire takes us through what you need to know

The use of contraceptives has been one-sided - the female side, which has a wide range of family planning methods while men have only two options; condoms and vasectomy. Even then, the majority of the men have not embraced vasectomy.

According to Dr. Gonzaga Andabati, a gynaecologist working with Bethany Women and Family Hospital, vasectomy is one of the permanent methods of family planning where the man's tubes that carry sperm from the testis to the penis-semen (vas deferens) are cut and tied or sealed to prevent contraception.

Dr. Joseph Kafuuma of Women's Hospital International and Fertility Centre Bukoto, adds that vasectomy is good for men who have had their desired family size or a number of children and do not wish to have more. It is not similar to castration.

Dr. Mark Muyingo, a consultant gynaecologist working with Neo-genesis Fertility centre in Kampala, says it is a simple procedure that does not even require admission.

"We don't cut off the testes; it is a non-scalpel (meaning no knife)," explains Dr. Muyingo. "Medics use a special instrument to hold the tube, crush and separate it. Sometimes the incision (cutting) is done if the medics are finding it difficult in identifying the sperm tubes."

According to Docus Tuhirirwe; a nurse who is a specialist in administering contraceptives, vasectomy procedure lasts about 15 to 20 minutes. The cost ranges between sh50,000 to sh100,000 in private facilities.

The procedure involves counselling, basic examination, and written consent. The surgery requires local anaesthetic before the 20 minutes the procedure is done.

Okello's story

At 43, Robert Okello opted for vasectomy in 2017. After five children, four girls and one boy, Okello consulted health workers who explained more about the method and recommended it. He also researches it online. He later discussed the idea with his 36-year-old wife who welcomed the idea given the fact that condoms were causing an allergic reaction to her.

His biggest challenge was the cost. Mulago Hospital charges were sh200,000 to sh300,000, and Marie Stopes Uganda, sh100,000. Luckily, through friends, Okello learnt of the voucher system that Marie Stopes Uganda was giving other service providers at a subsidized fee of sh50,000 as a way of persuading men to embrace the method of birth control. He approached a health facility in Buddo for the surgery. It lasted about one hour and he was discharged on the same day.

It took him about two weeks to heal. He was advised to use a condom for three months and then do a sperm check at Marie Stopes Uganda.

Results showed the test was negative; implying there were no traces of sperm in the semen, hence the surgery was successful.

Okello says he is no longer worried about unwanted pregnancy. He encourages men to embrace vasectomy if they want to stop having children.

Low uptake

Dr. Justine Bukenya, a family planning expert at Makerere School of Public Health notes that the uptake for vasectomy is very low at about 1%. 

"If men undertook family planning services such as vasectomy, the rapid population growth would be reduced because men are decision-makers and also the breadwinners," she notes

Tuhirirwe, however, says men are gradually beginning to embrace vasectomy as a method of contraceptives. She estimates that at Marie Stopes they conduct about 1,000 vasectomy procedures in a month. The numbers include men of all ages who have had a desirable number of children.

Data compiled by Reproductive Health Uganda captured from various regions across the country on uptake of vasectomy shows that in 2018, a total of 18 men received vasectomy in the central region.

This number grew to 161 in 2019. For the Eastern region, 15 men got a vasectomy and increased to 46 in 2019.

The northern region recorded seven men in 2018 and in 2019, the number shot to 106.

In the western region, a total of 18 men received vasectomy services in 2018 and the number increased to 54 in 2019.

In 2019, the highest number of men who received vasectomy services were 96 from Katego district. This was followed by Arua district at 65, Apac and Mityana 35 each, associated clinics registered 32, while Hoima had 18 men, Tororo,16, Mbale and Iganga 13 each.

Bushenyi district had only eight men and Lira district, six. Luwero came last with two men.

Dr. Placid Mihayo, the former assistant commissioner in-charge of sexual reproductive health at the health ministry, said some men are reluctant to embrace vasectomy because they associate it with impotence. But also, the thought of not being able to have more children in the future scares men off.

There are also women who don't want their husbands to go for a vasectomy for fear that it can lead to impotence later in life.

Others fear it will lure their husbands into infidelity when they are not worried about fathering children outside marriage.

How effectiveness?

Dr. Andabati considers vasectomy as one of the most effective birth control methods.

"It is considered to be 99.9% effective in preventing pregnancy three months after the procedure is done," he explains and is quick to warn that vasectomy does not prevent the transmission of sexually transmitted diseases including HIV.

Tuhirirwe attributes the 0.1% risk of failure to errors during the surgery; if it was not done properly due to failure to identify the tubes or failure for the man to follow instructions such as using a barrier method or another form of contraceptives before three months.

According to Dr. Andabati, vasectomy is a permanent method of contraception, which makes the chances of reversal very minimal; almost not there.

"However, with the advancement in technology, there are some microsurgical techniques that are used to safely reverse the procedure. This, restores fertility in up to 60 to 70% of users provided the reversal is attempted with five years after the vasectomy surgery was done," Dr. Andabati says.

Dr. Kafuuma explains that reversal chances decline with time because the longer the scar takes, the more it becomes strong and permanent.

"It is a very tinny tube, so reversing it means you cut away part of the tubes that had formed scars and then you join the tubes together. So it requires a lot of skills and even after the joining is done, a tube where sperm can pass may fail to form, thus reducing the chances of reversal," Dr. Muyingo notes

Any side effects?

Dr. Bukenya explains that vasectomy does not cause any major side effects apart from slight pain and discomfort during the procedure.

Sometimes the site where the procedure was done may get an infection if good hygiene is not observed. However, the infection can be combated with medication, she notes.

On possible impotence, Dr. Andabati dismisses the fear.

"Vasectomy does not cause erectile dysfunction because it does not affect the production of the male hormones or the blood vessels responsible for erection," he says.

Instead, vasectomy enhances the psychological freedom for men who have had the procedure done on them because they are not worried about pregnancy. Consequently, this improves their sexual performance. The only down side with vasectomy is that it does not protect one against sexually transmitted infections with HIV inclusive.

Resuming sex

According to Dr. Andabati, one can engage in sexual intercourse after the pain at the site of operation subsides.

Tuhirirwe adds that clients who have undergone vasectomy are encouraged to take an extra week to heal (seven days) before they engage in sexual intercourse. However, this should be backed up with a preferred method of contraception such as condoms for three months to prevent pregnancy.

"This allows the sperm stored along the tubes (vas deferens) to drain or die off completely," he explains.

How to involve men

Professor Fredrick Makumbi of Makerere School of Public Health says the majority of men lack knowledge about vasectomy. As such, there is a need to have men who have received vasectomy services to encourage fellow men to embrace the family planning method.

Prof Makumbi blames the low uptake of vasectomy on the absence of programmes that encourage men to embrace the services. He urges implementing partners to design programmes promoting male involvement through a couple approach.

The health ministry has also positioned male champions who have undergone vasectomy traversing different regions of the country, encouraging and mobilizing fellow men to go for vasectomy.

Other testimonies

Dr. Peter Ddungu

At 43 years, I had had enough of the emergency moments which required the use of emergency pills. Besides that, I wanted to give my three children the best in life and that could not be achieved if I continued to have more children. I, therefore, decided to undergo a permanent family planning procedure -vasectomy.

This was on one Saturday morning of June 2010 at Marie Stopes Clinic just after the Mulago round- about for only sh30,000.

My wife is younger than me and, at that stage, I did not want to expose her to hormonal contraceptives. After years of using male condoms as a family planning method, which effectively helped to space our children, a permanent method like vasectomy seemed a better option. Our children are now aged 20, 17, and 14.

However, it is about choice and quality of life and not the number of children.

There were moments when we would not use condoms consistently. My wife would have to take emergency contraceptives the next day because we were not ready to have more children.

I had the opportunity to be trained in the provision of voluntary surgical contraception as a young medical officer while at Kagando hospital in the early 1990s. Throughout my medical career, I conducted several surgical contraception procedures on both men and women. It is such an experience that motivated me to have a vasectomy procedure done.

And, with a medical background, I knew all the myths and misconceptions.

I now enjoy the freedom of sexual intimacy with no limitations and without having to worry about an unintended or unplanned pregnancy.

I am grateful to my supportive wife who accompanied me to have the vasectomy procedure done. We put our faith in God that this was the right thing to do.

My wife was happy and relieved because sometimes, she would get allergic reactions to condoms. Additionally, she does not have to take emergency contraceptives anymore.