Getting a Vasectomy
by J. Daniel Janzen

Skip the euphemisms. If you prefer cute titles like "The Unkindest Cut" or "Gelding the Lilly," you're reading the wrong review; surgical male sterilization is not for the faint of heart.

For middle-class, middle-aged white men, a vasectomy is as commonplace a rite of passage as getting married or siring children, if somewhat less fun. Like the other two, it also symbolizes a new level of maturity, the putting away of childish things (in this case, squeamishness over having some guy mess with your balls) and the acceptance that with adulthood come new responsibilities.

The thought process runs something like this: "We've had all the kids we plan to; the alternative, asking her to continue taking artificial hormones through menopause, seems kind of selfish, after all. She willingly delivered one or more large-headed children through her vagina. It's my turn to step up to the plate. How bad could it possibly be?" (Those who consider this a rhetorical question will discover their error soon enough).

The premise is simple enough. Impregnation happens when sperm travels through a pair of tubes from the testicles to the penis and hence, now carried in a viscous fluid, into a woman who loves Daddy very much. By severing each of these tubes, called a vas deferens (plural: vas deferentia), the sperm is prevented from carrying out its mission, sexual congress is decoupled from reproduction and the Pope cries in his muesli. Another victory for science and reason over nature.

Accurate statistics on the frequency of vasectomy among US men are hard to come by, but the procedure seems routine enough; everyone knows a few guys who've had it done, and anyone old enough to consider it remembers the episode of "All in the Family" when Gloria told the meathead to get one. Some men even have two, with a reversal of the supposedly irreversible procedure (complete with your signature on the informed consent form) in between. In terms of severity of experience, it seems like it would rate somewhere between a tattoo and an appendectomy (laparoscopic): not that big a deal, in the greater scheme of things.

And many men report just such an experience. You sit on a bag of frozen peas and play EA Sports Tiger Woods for a weekend, and you're as good as new. But the reassuring though cringe-inducing anecdotes of a few buddies should not take the place of firsthand research. The Interweb contains vast quantities of vasectomy lore: pros, cons, different ways of getting it done, horror stories. Those who fail to look into the third area run a substantially increased risk of ending up in the fourth.

Broadly speaking, there are two ways for this to go.

Scenario 1. The well-informed manhood sacrificiant opts for the "no-scalpel vasectomy," once he has been reassured that this does not refer to a baseball bat to the nuts, and selects a provider (or remover, as the case may be) who offers it based on the carefully considered recommendation of a trusted friend.

On the appointed day, he is welcomed into a comfortable suburban clinic, where he drops his drawers while remaining otherwise clothed and relaxes in a purpose-built reclining chair. Having shaved beforehand as instructed, he is numbed with a local anesthetic (some doctors even offer "no-needle anesthesia.") The urologist uses special sharp-nosed forceps to puncture the scrotum and lift the first vas deferens out through this opening; the patient feels a pinch followed by a passing wave of slight nausea. The tube is cut and the ends deftly cauterized, a wisp of smoke carrying the news aloft. The process is then repeated on the other side.

(Note: some doctors prefer to leave the ends nearer the testicles open rather than closing them. Called an "open vasectomy," this approach has been said to reduce the risk of post vasectomy pain as well as complications such as congestive epididymitis, which can occur when sperm cells, finding their designated exit blocked, riot.)

In most cases, no stitches are required. After a sigh of relief, the patient straps on his jock (recommended for the first day or so, followed by a week of tighty whities) and is given snacks similar to those that follow a blood donation. Post-operative instructions are simple to follow: no heavy lifting for a few days, ice and Advil as needed. A feeling of moderate soreness and faint queasiness lingers for a day or two, described by some as "like having been kicked in the nuts yesterday."

A month or so later, or as long as it takes to notch roughly 15 ejaculations (during which time he is still assumed to be fertile), the patient returns for a fertility study. This consists of producing a specimen in the tastefully decorated, pornography-equipped restroom of the comfortable suburban clinic to verify that no stragglers remain in the system. A negative result clinches the deal.

Scenario 2. Too nervous or squeamish to bone up beforehand, the patient places himself entirely at the mercy of his primary care doctor, who refers him arbitrarily to a urologist at her affiliated hospital. On the appointed day, he is checked into said hospital, given a threadbare gown and a pair of polyester socks and told to strip. This is followed by a seemingly eternal wait in a pre-operative ward chair alongside various other lucky contestants awaiting anything from gall bladder removal to open heart surgery. A steady stream of nurses, medical students and aides bring forms to be signed, IVs to be attempted, questionnaires to be administered.

At long last the doctor arrives. The patient is walked to the operating room and strapped to the table, arms spread. A curtain is erected at chest level, beyond which a cool breeze intensifies a growing sense of vulnerability shading into terror. There are no fewer than four people in the room, though only the nurse at the head of the table can be seen. The merest suggestion of contact with the nether regions triggers uncontrollable flinching. Visions of "Brazil," "Casino Royale" and Abu Ghraib flash through the patient's mind, and a prickly sweat breaks out in the small of his back.

This abstract distress is quickly subsumed in actual pain as the first cut is made, a half-inch vertical scalpel incision spanning the juncture of shaft and scrotum. For reasons never fully explained, anesthesia is only now administered, via hypodermic needle, and to negligible effect at that. That sickening male-specific sensation that isn't pain but is much worse than pain engulfs the testicles and spreads into the abdomen. Cycles of sharp pain, dull ache and sickening sensation follow and amplify each other as the vas is sought out, wrenched free, cut and tied at each end with sharp tugs that radiate throughout the body cavity.

The patient's prolific swearing and cries of agony fall on deaf ears and the restraints bite his arms and chest as he arches futilely, wracked with animal fury. All sense of time and place are lost, and it seems like hours later when the evilest words of all echo through the nightmare: "Okay, now the left one."

The first dressing fails to hold, and the incision must be stitched a second time.

When it's over, the patient is wheeled trembling to a berth in post-op and given a tray of hospital food. After an hour of enforced rest, he limps to the urology ward in a far distant corner of the grim city hospital for a final chat with the oddly cheerful doctor. A prescription for "something stronger" is grudgingly given. The cab ride home passes in a daze.

Sequestered in bed, an ice pack slowly melting through his sweatpants, the patient spends the rest of the day in a fog of pain, nausea and memories too vivid to escape even for a moment. Unlike the patient in Scenario 1, this guy feels as if he's being kicked in the nuts right this minute, and continues to feel so through the next morning, by which time blood has stained both his athletic supporter and the surrounding tighty formerly whities. Even a short walk to the bathroom brings a resurgence of distress, and it will be days before he can bring himself to inspect the scene of the crime. The nights are a cruel joke; hours are passed in search of a comfortable position, and any sleep that does arrive is invariably interrupted by the searing pain of a nocturnal erection pulling at the wound.

Recovery is agonizingly slow. It takes weeks for the ache to subside, and even then lingering pinpricks persist from severed nerve endings. Just when the worst seems to be over, sudden unilateral swelling announces the late onset of epididymitis, necessitating two weeks of antibiotics and a concurrent extension of the tighty whities. Preparing for the fertility study is the last thing on the patient's mind, but when the day finally arrives, he must produce his specimen in a hall bathroom on the urology ward just a few feet and a shabby door from assorted groaning geriatrics of both genders.

Fifteen years or so later, dementia sets in, the result of an immunological reaction to sperm leaked into the bloodstream during the procedure.

Whichever scenario a given man's experience more closely resembles, the ultimate outcome is the same: no longer will his pursuit of carnal gratification pose the risk of one child too many or college expenses for the bastard issue of a blackmailing mistress. Secondary benefits include neutralizing childbirth as the wife's trump card and gaining valuable leverage in the negotiation of intimate matters. On balance, it is clearly the sensible, enlightened thing to do. In the long run, any short-term discomfort and inconvenience seem like a small price to pay for the termination of one's ability to create life.

E-mail J. Daniel Janzen at dan at clownyard dot com.