There are probably all sorts of deep and dark reasons as to why I am a confirmed non-breeder, reasons that probably only myself and paleo psychiatrist, Dr Emily Deans, would understand. In all of my relationships, I have made this fact apparent from the get-go… no if’s, but’s, or maybe’s. It is a deal-breaker.
This stance has obviously made contraception an absolute must. But here is the rub… Despite it being me that is absolute about not landing my soldiers on anyone’s ovum, invariably I have still deployed those soldiers in the direction of said ovum with the expectation placed on the woman to deploy some form of hormonally-mediated ovum cloaking device. In other words, “I don’t want kids, so you have to go on the pill”.
To be honest, whilst being aware of everything that goes along with long-term exposure to oral contraceptives, the OCP is relatively easy to come by in New Zealand (and many women are on it by default anyway), and it proves to be the lazy way around the contraception issue. See this recent post by Mark Sisson on the OCP – include the comments section in your read if you want a bit more insight into this issue and how Paleo/Primal women feel about their contraception options. I’m not covering that side of things here.
So what are male options for contraception? Condoms? Okay – I generally don’t have an issue with them, though I’m not overly fussed. Abstinence? Fuck that. Withdrawal? See abstinence. Consume more soy and beer? I’ve worked too hard to not get moobs thus far in my life. So if I am going to permanently exit the gene pool, as I wish to do, there seemed only one option. Snip.
New Zealand has one of the highest vasectomy rates in the world, so there is likely only two-degrees of freedom when it comes to knowing someone who has had one. For my part, to be fair, there has been a lot of talk about it… A lot of “yeah, I’d get one”, but not a lot of action on that front. Until last year when it became an option I started taking more seriously. The catalyst? Paleo.
Now don’t get me wrong, I’m not claiming that having a crochet hook stuffed through the side of your scrotum and having the strands of spaghetti cut is “paleo”. But being in a relationship where both people are living a paleo life, and one of those people is struggling to gain traction with her health because she is taking synthetic hormones, spurred me to take a serious look at vasectomy as an option.
All the usual stuff that a guy might be concerned about. Erectile function. Testosterone levels. Future disease risk. Though I’d argue that if the first two checked out, most guys wouldn’t be overly concerned about the third.
My biggest mistake in my research early on was to go reading through forums… There were some horror stories. But I had to remind myself how self-selecting these forums can be. It is highly unlikely that a guy, having not had any issues with his vasectomy, would go hunt out a forum and add his glowing report. And after emailing a paleo doctor in Sydney, I was told that many such forums are the haunt of religious groups trying to spook men. I can’t vouch for the accuracy of that statement, but it is something to keep in mind when reading online contraception forums.
I am happy to get this procedure – after too many years as a student getting poked and prodded, stabbed, biopsied, and electrocuted, I don’t have an issue with needles, blood, etc (in my screening interview, I was offered a pre-med [declined] and was told I am welcome to bring a book to read during the procedure [WTF?] – perhaps a copy of Penthouse?… That way we’ll know if the wrong wire has been cut.). I am also satisfied that there isn’t any robust evidence that a vasectomy would impact on testosterone levels – after all, blood supply to the testes is not compromised (unless an earthquake hits at about the time the doctor goes in through the maintenance hatch), still allowing testosterone to be produced and off-loaded into the blood supply as per normal.
My main hesitation stemmed from comments made by two relatively high-profile paleo gurus, independently of each other, regarding vasectomy and the triggering of autoimmune conditions. Their concern regarding vasectomy is that it might act as a trigger for systemic autoimmune issues. When we spend so much of our time selling a paleo-templated lifestyle as a means to prevent or even treat autoimmune disease, does it then make little sense to set about potentially provoking such disease just so as to avoid having to say “sorry“?
I did some digging of my own on this autoimmunity issue and came up with this paper…
Immune-related disease before and after vasectomy: an epidemiological database study
Vasectomy can be followed by an autoimmune-antibody response. We aimed to determine whether men with immune-related diseases were more or less likely than others to have a vasectomy and then to determine whether vasectomy is associated with the subsequent development of immune-related diseases.
Despite the title containing the dreaded E-word, this was quite a good study…
Early interests in the long-term safety of vasectomy were concerned with possible immune-related sequelae. Sperm antigen develop at puberty, long after the immune system has distinguished ‘self’ from ‘not self’, and sperm antigen tend to be sequestered from the immune system behind a functional blood–testis barrier. At vasectomy, sperm antigens are released into the bloodstream and can provoke an intense antisperm autoantibody response.Although it is probably of no pathological significance, this was a postulated biological basis for the concern about immune-related sequelae of vasectomy.
So the concern stems from spilling sperm over into the bloodstream post-vasectomy and whether by exposing the immune system to such a prolonged stimulus we prime the immune system for autoimmunity.
The same research group that was looking at autoimmunity here had previously assessed the safety of vasectomy with regard to cancer and cardiovascular disease…
In a recent study on the long-term safety of vasectomy, we found no evidence for a long-term alteration of risk of cancer, myocardial infarction, other ischaemic heart disease or stroke in men who had undergone a vasectomy...
We decided to use the same method to study the occurrence, after vasectomy, of diseases, such as asthma, diabetes, rheumatoid arthritis, myxoedema and inflammatory bowel disease, in which immune-mediated mechanisms play an aetiological role.
The researchers here, using measures of hospitalisation for immune-related diseases, aimed to determine whether men with such diseases were more or less likely to get a vasectomy, and secondly, whether there is an increased risk for developing these diseases after vasectomy. The authors compared the rates of occurrence of immune-related diseases in men who underwent vasectomy with men in a reference group who had been admitted to hospital with other relatively minor medical or surgical conditions.
In the first analysis, we did a case–control study, comparing men who had undergone vasectomy with the reference group, identifying those in each group who had been admitted to hospital with each immune-related condition before admission for vasectomy or reference condition. In the second analysis, we did a cohort study, comparing the vasectomy group with the reference group, identifying those in each group who had been admitted to hospital for the immune-related conditions after the vasectomy or reference condition.
We confined the analysis to men who underwent vasectomy between the ages of 20 and 59. The immune-related conditions sought were ankylosing spondylitis, asthma in people aged ,55 years, coeliac disease, Crohn’s disease, ulcerative colitis, diabetes mellitus…, Hashimoto’s thyroiditis, idiopathic thrombocytopenic purpura, multiple sclerosis, myasthenia gravis, myxoedema, pernicious anaemia, primary biliary cirrhosis, psoriasis, and thyrotoxicosis.
The total data group included 23 988 men in the vasectomy group and 146 040 in the reference group. The mean period of follow-up after vasectomy was 12.8 years (13.2 years for the reference group).
Disease Prior to Vasectomy
Based on the results presented, there is the suggestion that men who underwent vasectomy were selectively ‘healthy’ (in terms of most of the immune-related diseases analysed) compared to the reference group. Only Crohn’s disease, multiple sclerosis and rheumatoid arthritis rates weren’t lower, but even these were similar between the two groups. But who cares? I know what I have now – I won’t to know what I’m at risk of after…
Disease After Vasectomy
Immune-related diseases that were low before vasectomy were similarly low in the cohort study of admission rates for disease after vasectomy…
…This suggests that vasectomy did not influence the risk of these diseases.
Whilst there was also no association with vasectomy and testicular atrophy (phew!), there was, as you would expect, an elevated risk of orchitis/epididymitis. Given the nature of the immune response to sperm now entering systemic circulation, it stands to reason that localised inflammation would occur.
Analysis of time intervals post-vasectomy also showed there was no evidence for increasing risk with increasing time post-surgery…
There was no evidence for any increase in risk, with increasing time intervals from vasectomy, for asthma, diabetes or multiple sclerosis, considering time intervals of 1–4, 5–9, 10–14 and >15 years after vasectomy.
With regard to orchitis, the risk was highest within the first year of vasectomy, and was elevated out to the 4-year mark (though significance was borderline). Risk drops below that of non-vasectomised men at 10-14 years post-vasectomy. There was also no evidence of an increase in risk of any other diseases with increasing time intervals.
The study design was reasonably strong, although like all studies it was not without its limitations. The original recording of vasectomy and any subsequent disease in the data set were two independent events, with the records only linked subsequently. Thus an element of bias in data collection was removed. The records of vasectomy were obtained from a hospital setting versus a walk-in clinic, such as the Family Planning Clinic that I am going through. Could this be a source of bias?
If patients’ clinical characteristics influenced the decision to admit, men with chronic diseases, such as those studied by us, would have been more likely than others to have been admitted. In other words, if biases related to the decision to admit patients were present, disease rates would have been relatively high rather than low at the time of operation in the vasectomy population, but they were not.
What of the observation that men who chose vasectomy were generally healthier than the rest of the population?
The simplest explanation for our findings about admission for disease before vasectomy is that, in this English population, men with some chronic diseases, such as asthma, diabetes or thyrotoxicosis, were a little less likely than others to choose vasectomy as a method of contraception.
We were unable to identify any literature on the contraceptive methods preferred in England by partners of men with chronic diseases. It seems reasonable to speculate, however, that they may differ from the general population; for example, fertility may be reduced in some men with thyrotoxicosis and some clinicians may prefer not to operate on people with diabetes because of the risk of wound-associated infection.
The authors looked at the major autoimmune diseases and readily admit that their analysis would miss any milder diseases that might be increased by vasectomy. But they also suggest (especially given such a long time frame for follow-up), that it is unlikely that a causal relationship between vasectomy and mild disease only would exist.
Was the follow-up long enough?
Sotolongo (1982) reported that the highest levels of spermrelated auto-antibody titres are typically found about a year after vasectomy. However, he also commented on the evidence that, in some subjects, antibody titres may either remain at the same level or increase over a period of 5–12 years postoperatively. For asthma, diabetes, multiple sclerosis, rheumatoid arthritis and orchitis/epididymitis—conditions with sufficient cases for us to compare time intervals in detail after vasectomy it is reassuring that there is no evidence of increasing rate ratios with increasing time from vasectomy.
The one significantly raised risk after vasectomy was that for orchitis/epididymitis. Unfortunately, we cannot distinguish the two and have no access to clinical and pathological sample data. The association was strongest in the short-term, and the most likely explanation is that the elevation of risk is for post operative granulomatous lesions. Assuming that the excess cases of orchitis/epididymitis in our vasectomy group are all attributable to vasectomy, this gives an attributable risk of 0.1 cases per 100 operations (30.5 in 23 988 men).
The simplest explanation for our findings about admission for other diseases after vasectomy is that vasectomy does not increase the risk of these diseases.
Although this is only one study, it is reasonably well designed and with good numbers. Based on this study, the fear that vasectomy may trigger autoimmune disease seems unfounded. However, some of the diseases looked at had very wide 95% confidence intervals. Type-1 diabetes, multiple sclerosis, and rheumatoid arthritis. To me, these wide intervals suggest that there might be something else other than the vasectomy itself at play, and this brings us to looking at the wider population and how well we can compare one guy with the next.
I can think of a handful of guys I know who have had vasectomies, who probably haven’t got the best diet and lifestyle, who have the typical Kiwi male patio over the playpen, and who are likely carrying a slightly higher risk for autoimmune disease, low testosterone levels, erectile dysfunction, and so on. All risks that I would argue have nothing to do with the vasectomy. Is the risk the same between your typical middle-aged bloke drinking beer, eating pizza, and watching rugby, and one who eats an optimal human diet, engages in regular physical activity, maintains a healthy body composition, values their sleep, and so on? Is this a similar situation to saying vegetarians are optimally healthy because everyone else is even less healthy than they are? Is there a risk of poor-health being associated with vasectomy just because the majority of the guys getting one are on the pathway to poor health anyway?
There is a small risk – without a doubt. But weighing up the risk-benefit ratio, I think the odds are stacked in my favour. I believe that following the lifestyle I am will buy me some additional risk-reduction capacity perhaps not afforded to those living a little more conventionally. I might have to make some tweaks to my lifestyle, perhaps having to eat a more autoimmune protocol paleo diet and watching that I don’t compound a lot of factors together. We will see.
My reason for this post is to put vasectomy on the table as a viable option for those individuals who might consider it suitable to their situation but have perhaps been put off by some of the discussions that have taken place to date in the paleo world. I certainly welcome comments and experiences from any readers who have had a vasectomy and lead a paleo lifestyle. It would be great to hear your stories.
UPDATE: I had my vasectomy this morning. Very painless procedure – didn’t even have any stinging from the local anaesthetic being applied. The procedure itself probably lasted 25-30 minutes. There is now a dull ache as the local wears off – more of a blue balls sensation (which will more the colour of them over the coming days, I’m sure). I’ll stick to doctors orders and take it relatively easy for the next few days (buggered if I’m spending the day on the couch though). Overall, very easy – easier than going to the dentist. Certainly if you were thinking of getting a vasectomy, I wouldn’t be put off by fear of the procedure itself. I had mine done by the New Zealand Family Planning Association – cost: $310 at time of writing.
FURTHER UPDATE: I am coming up to one year post-vasectomy. I went through a Family Planning Clinic in Christchurch, NZ. They perform something like hundreds of these procedures per year in this one clinic (only one day per week). Out of 5 males working in our office, only one is now “intact”. Some of the guys had theirs done well over a decade ago. None report having had any problems. I spent a decade training guys at one of the largest gyms in Christchurch, many of whom also had a vasectomy. None that I know of had any issues. I have spoken to a well-known paleo GP in Australia previously about vasectomies when I first started researching them, mentioning the number of online reports of vasectomy horror stories. He made two valid points; 1. People who are happy with how things went generally don’t feel they have to go on the internet and let the world know. Those who for whatever reason aren’t, generally do – skewing the “data” 2. He seemed to think that their was a lot of artificial reporting of vasectomy/contraception horror/fail stories, put there by various religious groups in an effort to discourage people from the practice. I don’t know if this is true, but it wouldn’t surprise me in the least.
I had only minor bruising for a day or two after. I did dose up large on fish oil capsules post-procedure, and I took analgesia that night as a (needless) preventative strategy. But I needed no pain relief at any point after that.
Everything “worked as it should” when tested.
All of my swimmers were gone by the first test.
I have had two episodes of vague discomfort on my left side (almost like a blue balls feeling) – both well-spaced and both gone within a few hours. No patterns to them that I can see though possibly related to sexual activity at the time (??)
I have had a vague sensation that something is “disconnected” down there. This lasted from the time of the procedure through to the last couple of months. This has had no effect on function, and from my reading may be related to a disruption in acetylcholine transmission along the vas deferens. It definitely felt more like a sensory issue than anything else. Interestingly, that disconnected feeling has disappeared. And no – I haven’t had the wires spontaneously reconnect!
I read many studies prior to getting the procedure done. I would not have had it done had there been any convincing and robust evidence regarding lowered testosterone status. What strikes me, however, is that most men seem to be of a certain age when getting one done (late 30′s to 40′s). And when you look around at the general population (the ones who would be studied), what do you think their testosterone levels are like?? How are they eating, sleeping, exercising? How do you separate that background noise out from what might be occurring post-vasectomy?
Overall – no problems, no regrets, and more importantly no kids. Oh, and a whole lot of fun. ;)