Vasectomy - how we got here!

History of Vasectomy

Vasectomy is today a fairly common method of male sterilization. That is because it is highly effective in preventing pregnancy. That is because if the sperm never make it to the semen, they can’t be ejaculated; and if they aren’t ejaculated from the body, they aren’t going to fertilize an egg.

Vasectomy can be performed through conventional surgical methods or the new and improved no scalpel vasectomy method. Either way, the procedure is a highly effective method of family planning but affords no protection from sexually transmitted diseases.

For such an unassuming procedure, it has quite a historic past.

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 vas deferens. Cooper performed several experimental surgeries on dogs.

Dr. Leon Gosselin published the results of his experiments on dogs in 1853. Dr. Gosselin practiced surgical ligation and resection on the vas deferens 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.

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 Preventing 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 behavior 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

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 vigor 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 vigor made one-sided vasectomy quite popular!

Anything You Can Do…I Can Undo Better

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 important, 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 sterilization 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.

Vasectomy Anatomy

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 has 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.

Reversible Vasectomy

Yes, you read this correctly!

The holy grail of vasectomies would be a reversible vasectomy. There has been over 20 years of research into reversible vasectomy and we’re still some years (at least) off this goal. This will in effect be a mini vasectomy. Instead of cutting the tubes, they are blocked with an RISUG gel or implant. A fully reversible form of male contraception would be immensely beneficial to men who are unsure whether they are ready for permanent contraception.