The History & Future Of Vasectomy

Who knows what was going through the minds of early 20th century Vasectomists. Things started off well with research on dogs and guinea pigs, concluding in the fact that the vas deferens carries sperm from the testicles to the urethra.

Yet contraception was furthest from the minds of the early human pioneers who thought that the procedure may reduce masturbation, treat criminality, and improve quality of life.  We now know that vasectomy is simply stops a man from fathering children.

And of course, guys who are getting a little worked up about having to get the procedure can thank their lucky stars they weren’t born 100 years ago!

Things were a little different then, with no local anaesthesia and of course, there was no such thing as the No-Scalpel method.

Vasectomists now avoid any use of the phrase ‘male sterilisation’ – confirmed by a study published in 2021 that confirms that men will run a mile from ‘sterilization’ – a term described as “sinister,” “bleak,” and “barbaric.”

For such an unassuming procedure, vasectomy has quite an interesting past.

History of Vasectomy

Early Vasectomy Studies

In 1830 Sir Astley Paston Cooper, the accomplished surgeon and anatomist, published Observations on the Structure and Diseases of the Testis. This was the first time much medical attention was paid to the tube that carries sperm- The Vas Deferens. Cooper performed several experimental surgeries on dogs to investigate the anatomy further.

Dr. Leon Gosselin published the results of his experiments on dogs in 1853. Dr. Gosselin practised ‘surgical ligation and resection on the vas deferens’ – in other words, vasectomy – and noted that anywhere from 4 to 6 months after the surgery there was ‘normal spermatogenesis’ (sperm production). In other words, the procedure had no effect on the production of sperm, just the distribution of it. Like Cooper before him, Gosselin noticed no change in the testicles after the procedure. So far, so good.

However, Vasectomy takes a turn in an unexpected direction. The first vasectomy done for non-medical reasons was performed in the United States by Harry Sharp in 1899. The subject was a nineteen-year-old inmate at a reform school in Indiana. According to Sharp, the young man complained of “excessive masturbation.” As a result of the operation, Sharp reported that the boy “became more of a sunny disposition, brighter of intellect and ceased to masturbate.” Sharp would go on to become a major player in the US eugenics movement.

In 1923, Dr. Robert Oslund submitted his dissertation on vasectomy of rats and guinea pigs. At the start of his research he was confused as to why previous researchers reported conflicting results on the changes in the testicles after the procedure was performed. After performing the procedure himself over 200 times, he determined that the previous conflicting reports as to testicular degeneration were due to variances in how the procedure was performed and confusion between the results of vasectomy and cryptorchidism (testicles that have not properly descended). His paper might look like a boring study on the surface, but he proved that when properly performed, vasectomy did not have negative health results. It added fuel to the eugenics fire sweeping the planet.

Eugenics and Vasectomy

Eugenics was a misguided belief that the human race could be improved upon by eliminating the undesirable elements from the gene pool. It was based on the concepts that the propensity to be a criminal was genetic and that mental illness was hereditary. To stop crime and mental illness, criminals and the mentally ill should be sterilized to prevent them from making more criminals or mentally ill people. It seems crazy today, but at the time it was considered science.

The Eugenics movement began in the US in earnest when Albert Oschner published his work “Surgical Treatment of Habitual Criminals” in 1899. He advocated for a procedure that would sterilize males in a method that “will in itself not be a punishment to the criminal, or interfere with his enjoyment of life should he reform and become a useful member of society”.  Vasectomy fit this description.

Harry Sharp’s Vasectomy as a Means of prevention procreation in defectives urged laws “to render every male sterile who passes its portals, whether it be almshouse, insane asylum, institute of the feeble-minded, reformatory or prison” In 1910, the Russian government sent representatives to observe Sharpe perform the sterilization technique on an inmate.

From 1909 to 1924 over 6,000 people were sterilized without their consent. Reasons ranged from epilepsy to criminal behaviour with insanity tossed in for good measure.

In Europe, the Eugenics Education Foundation was established in London in1907. Many distinguished people were counted in their ranks. However, they faced fierce opposition from the Labour Party and the Catholic Church. No legislation was ever passed in Great Britain.

The rest of Europe was not so lucky. Switzerland passed the first eugenics law in 1928 and their program continued against Gypsies until 1972. In July of 1933, the Germans passed a law that required certification of fitness to marry. This certificate was issued by the local health office. If you were not able to get a certificate to marry, not only could you not marry, but you were considered a candidate for sterilization and had to appear in a “hereditary health court”. The Eugenics movement continued until the end of World War II and it is estimated that 320,000 were sterilized without consent.

Vasectomy to Improve Quality of Life

Vasectomy was performed in 1923 as an attempt to treat for oral squamous cell carcinoma. Guess what? The patient was none other than the famous psychologist Sigmund Freud.

Eugen Steinach was an Austrian endocrinologist who thought he had found the secret Fountain of Youth. He performed a procedure termed the “Steinach vasoligature”. It was really just a unilateral vasectomy (one-sided vasectomy). He claimed the procedure would cause the testicles to stop producing sperm and start producing more hormones (testosterone) and as a result the patient would be “reinvigorated”. Claims of reduced fatigue, increased sexual drive, and vigour made it quite popular. Don’t laugh. Famous men of the time such as William Yeats and Sigmund Freud underwent the procedure. Steinach made a full length film of his procedure for fellow physicians. The demand for the procedure spread like wildfire around the globe. The procedure was debunked in 1935 when the hormone testosterone was isolated. Poor Eugen Steinach was deemed a quack, and died in exile in Zurich in 1944. Quite a fall for a man nominated for a Nobel Prize 6 times.

Claims of reduced fatigue, increased sexual drive, and vigour made one-sided vasectomy quite popular!

Vasectomy Reversal

In 1938, E.D. Twyman and C.S Nelson performed the first Vasectomy Anastomosis (vasectomy reversal) on a man that had become depressed after his vasectomy. The reversal was performed four years after his first voluntary operation. It was deemed a success as the patient went on to father children. In 1945, C.S. Cameron reported in the Journal of the American Medical Association on a successful reversal operation performed five years after the initial procedure. Medicine was proving that the procedure could be reversed in some cases.

Vasectomy and Sexual Satisfaction

In 1950, researchers P.L. Garrison and C. J. Gamble publish their findings on the fellows that had undergone the vasectomy procedure. They performed a follow up with men that had the procedure performed between 1941 and 1949. These men all had voluntary vasectomies.   They discovered that the men lost an average of less than 1 day from work. More importantly, they discovered that the men reported almost no change in sexual satisfaction. Five men reported a decrease in desire, but this was offset by the 9 men that reported an increase in sexual appetite. While 4 men said they had sex less frequently, 8 men reported a greater frequency. The most important finding was that 47 out of 50 said they would “do it again” when asked about their satisfaction with the procedure. This sets the stage for the expansion of vasectomy as an accepted means of birth control.

Vasectomy and Birth Control

You can’t look at vasectomy as a means of birth control unless you understand a bit about how birth control has evolved. Scraps of the first condoms made from fish and animal intestines date back to 1640 and were found in the foundations of Dudley Castle near Birmingham, England. Contraceptives didn’t advance much for a very long time.

In 1956 the first clinical trials of a female oral contraceptive are underway. By 1960 Enovid becomes the first female contraceptive for sale in the U.S. Australia becomes the second nation to allow the sale of female oral contraceptives in 1961. However, it wasn’t until 1965 that laws barring birth control and contraceptives were finally struck down by the courts.

One year later, in 1966 The Lancet announces the “Simon Population Trust” to promote sterilization in Britain and to counter the misinformation that sterilization was illegal.

By 1971 vasectomy had become an accepted method of birth control, preferable to female sterilisation as it presented less risk and shorter recovery time. In Kerala India a state sponsored program performed almost 63,000 procedures in one month. In Gujurat India 222,000 vasectomies are performed in a two month period. By 1973 the number of vasectomies in India topped 7 million.

Advances in Vasectomy Procedure

In 1974, the No-Scalpel method of vasectomy was developed by Dr. Li Shunqiang of the Chongqing Family Planning Research Institute, Sichuan province, China. Vasectomy was not popular with Chinese men. Necessity was certainly the mother of invention in this instance. Dr. Shunqiang was looking for a way to perform the procedure that would be more readily acceptable to men and that could be easily performed in rural areas that have very limited medical procedures. He would go on to teach the procedure to visiting doctors and it would gain world-wide acceptance. By 1985, the first No-Scalpel Vasectomy is performed in the US by a doctor who travelled to China to study the procedure, and by 1989, the procedure had spread to Australia.

Future of Vasectomy

No Needle Anaesthesia

The first ‘No Needle’ device was developed in 2005. A study of 465 volunteers found satisfaction rates were very high. The device is not currently approved for use in Australia.

Reversible Vasectomy

Yes, you read this correctly!

The holy grail of vasectomy is a truly reversible vasectomy.

A fully reversible vasectomy would be immensely beneficial to men who are unsure whether they are ready for permanent contraception.

The most promising concept is to block the tubes with a gel or implant that can be removed at a later date. The procedure itself would still look like like a Vasectomy.

The most promising research appears to be coming from the use of a Reversible Inhibition of Sperm under Guidance (RISUG) gel which may be flushed out at a later date. An Indian study on RISUG was published in late 2019. The procedure ‘failed’ in 6 out of 139 men (4%) that were given the RISUG gel, compared to a failure rate of under 1% for a ‘normal’ Vasectomy. We need bigger and longer term studies to check for failure and for reversibility in humans.

A trial of the injectable gel on 25 men starts in Melbourne in 2023.

The prospect of a ‘reversible vasectomy’ is truly tantalising. However, we are likely to be some years away from potential approval by medical regulators – if it gets that far. Watch this space.

The ‘male pill’

There is no doubt that a ‘male pill’ would also be a welcome addition to male contraception.

The ‘male pill’ sounds easy but the challenges to developing a safe and effective male contraceptive pill are daunting because the pill would need to be:

  • reversible
  • free of side effects.
  • safe

The combined oral contraceptive pill in women does rarely have serious side effects. However, the purpose of taking the pill is to prevent pregnancy. Therefore, pregnancy is the ‘comparison group.’  Pregnancy is more risky than taking the pill which justifies its use.

On the other hand, the male contraceptive pill would need to be even safer because healthy males are the comparison group. You, therefore, have to prove that a male contraceptive pill is as safe to take as a simple multivitamin tablet. The development of a male pill that switches off sperm production without causing rare but serious adverse effects is a tall order indeed.

Furthermore, will men may consider side effects such as mood changes and acne to be somehow emasculating?

The prospect of a male pill is very much overdue but we are still many years off the final product. The timeline between the discovery of a promising new molecule to the availability of the pharmaceutical product for clinical use can easily take 10 years.