Vasectomy…For My Wife
By Jonathan David A. Flavier, MD
Eight-years ago, when my wife and I first talked about vasectomy
VASECTOMY, at least the kind I had, is usually an eight-minute procedure but my wife and I needed around eight years before we could finally decide that I should have one. There were also eight considerations in our decision process.
At that time (eight years ago), we already had two children - a lovely and talkative girl in the first grade, and a loving and timid boy just going into preschool. Pauline Joy and Jose Carlo are the best reasons to have children, and two of the many reasons I am thankful that Patit and I married.
Patit and I met in college and had gone to medical school together. Soon after graduation, we both went to work in what is now called Apayao Province - in the municipality of Kabugao. Patit was the senior resident in the government hospital and later district chief (she became my boss both at home and at work). From the inspiration with rural community exposure and because of a promise I made when our UP Christian Youth Movement had gone to Kabugao - I returned to work as a rural health physician in the Municipal Health Office.
Before and after the two years we had worked in the mountain region of Cordillera, Patit and I had our two kittens. While Patit and I enjoyed most of her pregnancy, she did not have an easy time during the delivery of our children - both by caesarean section.
During the first time, our baby had gone into distress after only a few hours of labor so Patit had to be operated on. On my wife's second pregnancy, her obstetrician - the late Dr. Fe Dacanay - did not feel comfortable going on a trial of labor so Patit had to be cut up again. My wife had difficulty, this time, after her operation when she experienced abnormal bleeding from her womb. As physicians, we were fortunate that Patit's obstetrician and the husband-wife anesthesiologist-pediatrician team of Dr. Carlo Magno and Dr. Perla Santos Ocampo freed us from the burden of paying professional fees. Our children were "born free," but we were not free from the anxiety of risky delivery nor the cost of child care.
Eight years ago, while I had volunteered to have a vasectomy, Patit was more inclined to take on the responsibility for birth spacing and family planning. Like most women, my wife considered that she should have a ligation or try out the other non-permanent methods of contraception first.
The more serious considerations were less thoroughly discussed between us. While Patit and I had known each other for almost two decades, in a setting where a number of men had other partners, I could easily have been unfaithful. An unwanted pregnancy may have been perceived as a deterrent to my involvement with other women. In my case, working in rural development with government and later with the Philippine Rural Reconstruction Movement (PRRM) - I was often faced with the specter of children's diseases and child deaths. I had a fear of losing my own children and having no capacity to have more.
With two reasons to be content with the number of children we had, with two risky caesarean sections that we no longer wanted to face - we had some cause for me to have a vasectomy. But, with the cultural environment of imposing reproductive health burdens on women, the availability of other methods of family planning, non-trustworthy male behavior, and my distress with irreversible contraception combined with the uncertainty of child survival in our country - we also had four reasons why we were not yet ready for a vasectomy eight years ago.
My vasectomy eight months ago, eight years after we first considered it
Over those eight years, my wife and I tried a few other methods of family planning. While working in the Kabugao Main Health Center, Patit and I made use of the large supply of condoms and a few spermicides that were available for my patients. But with the discomfort from spermicides and after an expired condom broke (and we had our second child), my wife shifted to the pill. Oral contraceptive pills had the desirable side effect of regularizing the irregular menstrual cycle of Patit but it also gave her less desirable prominent veins on her legs. So until eight months ago, my wife and I practiced natural family planning (NFP) by keeping track of her cervical mucous changes. NFP was a wonderful way of encouraging communication and reproductive consciousness between my wife and I. For the eight years before we decided that I should have a vasectomy, NFP was an acceptable method for us. But there were also times when our relationship (or my urges) could not be controlled by NFP rules.
Because of irritation with condoms and spermicides, unwanted effects of the pill, and our occasional uncertainty with NFP fertility signs - Patit and I again considered vasectomy.
There are around three mechanisms for closing the tubes where the sperm passes from the testicle - the vas deferens. Traditionally, you could make a small incision on the scrotum to reach the tubes. The vas would be tied or cauterized, and cut. Most recently - the vas could be reached even without surgery and occluded by coagulation with ultrasound. I chose the method of voluntary surgical contraception called the No Scalpel Vasectomy (NSV). This was being promoted by the organization I worked with then - EngenderHealth, and a few other organizations like Johns Hopkins University - Population Communication Services (JHU-PCS), Management Sciences for Health (MSH), and of course, the Department of Health (DOH), USAID, and FriendlyCare.
NSV is a very safe, inexpensive, and simple procedure. It was first developed in China in 1974 and since then more than eight million men have had this type of vasectomy. The method is also popular in Thailand, where one physician has even performed no scalpel vasectomy on himself.
In the Philippines, vasectomy for men can be paid for by PhilHealth. FriendlyCare has even offered discounted services in some of its 10 clinics nationwide. MSH has worked with local government offices like Bago City, Negros Occidental, where the government officials have subsidized the cost of NSV. In most cases, NSV services are specially important when we do not have the facilities or qualified physicians who can provide female surgical contraception.
EngenderHealth and MSH have experienced setting up NSV services and building up the capacity of local physicians in areas that could not comply with the more stringent requirements for female ligation facilities. NSV has proven to be a lower cost and simpler alternative to hospital-based surgical contraception services. On an outreach basis, NSV can be provided even under the banana trees.
MY CASE OF VASECTOMY was performed on top of my office table. I had come into the office in the morning and my coworker - our NSV trainor Dr. Francis Floresca - performed the procedure with my wife assisting him in the privacy of my room. After the procedure, I came out of the office without my other coworkers knowing what had happened. In fact, with just a Band-Aid on my NSV puncture site - I was able to meet with advocates in Congress, the Secretary of Health and other participants in the Socioeconomic Summit; with no pain or discomfort during the entire day.
Eight months after my vasectomy
I have to complete the picture of my experience with NSV by pointing out that it was not without some disadvantages. Like most surgery around the human genital organs, I was supposed to clip off some of my pubic hair. When I was learning how to do the traditional type of vasectomy with a scalpel, we were instructed to shave off all the hair. With NSV you only had to use scissors to cut some of the hairs that would affect the puncture site. But because I shaved, when the hairs began to grow again, my wife and I felt like I had two small cactus balls between my legs!
It is also important to explain that, unlike some other family planning methods, vasectomy does not provide immediate contraceptive benefit. Since the passage of the sperm is cut only within the scrotum, the portion of the tubes within the body and going towards the penis still has viable sperm cells. It will take a few weeks and a number of ejaculations before the tubes no longer have the sperm. For me, two months after the NSV, the laboratory examination of my semen still showed one million sperm cells per milliliter. But this is no longer enough for normal fertilization because more than 10 million motile cells per milliliter is required. And by the fourth month after my NSV, the procedure was declared successful based on my last semen analysis - with zero motile sperm cells.
NSV will not automatically improve your married life nor will it immediately provide you with protection from unwanted pregnancies. My wife and I still had to continue following NFP rules for a few more months after the procedure. But after I no longer had any sperm cells in my semen, Patit and I could enjoy each other without the anxiety of risking another pregnancy for her. After vasectomy, there is no observable change in the quantity and quality of semen. This difference can only be detected by microscopic examination. My wife is reviewing this article so I can brag that our sex life has even improved after the procedure.
In closing, I have to explain why I am sharing this experience. I believe that it is important for men to be able to obtain information regarding this procedure. I found it difficult to get first hand experience and to talk to men who had gone through a vasectomy. There are a number of myths and misconceptions that have to be dispelled. Even more importantly, family planning and responsible parenthood have too long been a burden imposed on women mostly. I believe that more men should become partners in reproductive health.
To highlight this challenge, you can say that men are involved with sexual reproduction in only a few minutes (or even less) out of the nine months or so that it takes to have a baby. For family planning, there are only a few methods involving men out of the nine or so contraceptive methods we have available. Vasectomy is a very safe, inexpensive, and simple procedure that allows men to demonstrate contraceptive responsibility.
I am just above 5 feet tall, I cannot say that my NSV has made me taller. But it has made me feel better about myself. I can even tell my wife that vasectomy is one way of showing that I am concerned about her reproductive health. And I want to continue loving her and providing our children with a better quality of life.
[The man of (healthy) wit, Dr. Jondi Flavier, wrote this piece on the 28th of July 2002 and published by the Philippine Daily Inquirer in condensed form.]
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By Jonathan David A. Flavier, MD
Eight-years ago, when my wife and I first talked about vasectomy
VASECTOMY, at least the kind I had, is usually an eight-minute procedure but my wife and I needed around eight years before we could finally decide that I should have one. There were also eight considerations in our decision process.
At that time (eight years ago), we already had two children - a lovely and talkative girl in the first grade, and a loving and timid boy just going into preschool. Pauline Joy and Jose Carlo are the best reasons to have children, and two of the many reasons I am thankful that Patit and I married.
Patit and I met in college and had gone to medical school together. Soon after graduation, we both went to work in what is now called Apayao Province - in the municipality of Kabugao. Patit was the senior resident in the government hospital and later district chief (she became my boss both at home and at work). From the inspiration with rural community exposure and because of a promise I made when our UP Christian Youth Movement had gone to Kabugao - I returned to work as a rural health physician in the Municipal Health Office.
Before and after the two years we had worked in the mountain region of Cordillera, Patit and I had our two kittens. While Patit and I enjoyed most of her pregnancy, she did not have an easy time during the delivery of our children - both by caesarean section.
During the first time, our baby had gone into distress after only a few hours of labor so Patit had to be operated on. On my wife's second pregnancy, her obstetrician - the late Dr. Fe Dacanay - did not feel comfortable going on a trial of labor so Patit had to be cut up again. My wife had difficulty, this time, after her operation when she experienced abnormal bleeding from her womb. As physicians, we were fortunate that Patit's obstetrician and the husband-wife anesthesiologist-pediatrician team of Dr. Carlo Magno and Dr. Perla Santos Ocampo freed us from the burden of paying professional fees. Our children were "born free," but we were not free from the anxiety of risky delivery nor the cost of child care.
Eight years ago, while I had volunteered to have a vasectomy, Patit was more inclined to take on the responsibility for birth spacing and family planning. Like most women, my wife considered that she should have a ligation or try out the other non-permanent methods of contraception first.
The more serious considerations were less thoroughly discussed between us. While Patit and I had known each other for almost two decades, in a setting where a number of men had other partners, I could easily have been unfaithful. An unwanted pregnancy may have been perceived as a deterrent to my involvement with other women. In my case, working in rural development with government and later with the Philippine Rural Reconstruction Movement (PRRM) - I was often faced with the specter of children's diseases and child deaths. I had a fear of losing my own children and having no capacity to have more.
With two reasons to be content with the number of children we had, with two risky caesarean sections that we no longer wanted to face - we had some cause for me to have a vasectomy. But, with the cultural environment of imposing reproductive health burdens on women, the availability of other methods of family planning, non-trustworthy male behavior, and my distress with irreversible contraception combined with the uncertainty of child survival in our country - we also had four reasons why we were not yet ready for a vasectomy eight years ago.
My vasectomy eight months ago, eight years after we first considered it
Over those eight years, my wife and I tried a few other methods of family planning. While working in the Kabugao Main Health Center, Patit and I made use of the large supply of condoms and a few spermicides that were available for my patients. But with the discomfort from spermicides and after an expired condom broke (and we had our second child), my wife shifted to the pill. Oral contraceptive pills had the desirable side effect of regularizing the irregular menstrual cycle of Patit but it also gave her less desirable prominent veins on her legs. So until eight months ago, my wife and I practiced natural family planning (NFP) by keeping track of her cervical mucous changes. NFP was a wonderful way of encouraging communication and reproductive consciousness between my wife and I. For the eight years before we decided that I should have a vasectomy, NFP was an acceptable method for us. But there were also times when our relationship (or my urges) could not be controlled by NFP rules.
Because of irritation with condoms and spermicides, unwanted effects of the pill, and our occasional uncertainty with NFP fertility signs - Patit and I again considered vasectomy.
There are around three mechanisms for closing the tubes where the sperm passes from the testicle - the vas deferens. Traditionally, you could make a small incision on the scrotum to reach the tubes. The vas would be tied or cauterized, and cut. Most recently - the vas could be reached even without surgery and occluded by coagulation with ultrasound. I chose the method of voluntary surgical contraception called the No Scalpel Vasectomy (NSV). This was being promoted by the organization I worked with then - EngenderHealth, and a few other organizations like Johns Hopkins University - Population Communication Services (JHU-PCS), Management Sciences for Health (MSH), and of course, the Department of Health (DOH), USAID, and FriendlyCare.
NSV is a very safe, inexpensive, and simple procedure. It was first developed in China in 1974 and since then more than eight million men have had this type of vasectomy. The method is also popular in Thailand, where one physician has even performed no scalpel vasectomy on himself.
In the Philippines, vasectomy for men can be paid for by PhilHealth. FriendlyCare has even offered discounted services in some of its 10 clinics nationwide. MSH has worked with local government offices like Bago City, Negros Occidental, where the government officials have subsidized the cost of NSV. In most cases, NSV services are specially important when we do not have the facilities or qualified physicians who can provide female surgical contraception.
EngenderHealth and MSH have experienced setting up NSV services and building up the capacity of local physicians in areas that could not comply with the more stringent requirements for female ligation facilities. NSV has proven to be a lower cost and simpler alternative to hospital-based surgical contraception services. On an outreach basis, NSV can be provided even under the banana trees.
MY CASE OF VASECTOMY was performed on top of my office table. I had come into the office in the morning and my coworker - our NSV trainor Dr. Francis Floresca - performed the procedure with my wife assisting him in the privacy of my room. After the procedure, I came out of the office without my other coworkers knowing what had happened. In fact, with just a Band-Aid on my NSV puncture site - I was able to meet with advocates in Congress, the Secretary of Health and other participants in the Socioeconomic Summit; with no pain or discomfort during the entire day.
Eight months after my vasectomy
I have to complete the picture of my experience with NSV by pointing out that it was not without some disadvantages. Like most surgery around the human genital organs, I was supposed to clip off some of my pubic hair. When I was learning how to do the traditional type of vasectomy with a scalpel, we were instructed to shave off all the hair. With NSV you only had to use scissors to cut some of the hairs that would affect the puncture site. But because I shaved, when the hairs began to grow again, my wife and I felt like I had two small cactus balls between my legs!
It is also important to explain that, unlike some other family planning methods, vasectomy does not provide immediate contraceptive benefit. Since the passage of the sperm is cut only within the scrotum, the portion of the tubes within the body and going towards the penis still has viable sperm cells. It will take a few weeks and a number of ejaculations before the tubes no longer have the sperm. For me, two months after the NSV, the laboratory examination of my semen still showed one million sperm cells per milliliter. But this is no longer enough for normal fertilization because more than 10 million motile cells per milliliter is required. And by the fourth month after my NSV, the procedure was declared successful based on my last semen analysis - with zero motile sperm cells.
NSV will not automatically improve your married life nor will it immediately provide you with protection from unwanted pregnancies. My wife and I still had to continue following NFP rules for a few more months after the procedure. But after I no longer had any sperm cells in my semen, Patit and I could enjoy each other without the anxiety of risking another pregnancy for her. After vasectomy, there is no observable change in the quantity and quality of semen. This difference can only be detected by microscopic examination. My wife is reviewing this article so I can brag that our sex life has even improved after the procedure.
In closing, I have to explain why I am sharing this experience. I believe that it is important for men to be able to obtain information regarding this procedure. I found it difficult to get first hand experience and to talk to men who had gone through a vasectomy. There are a number of myths and misconceptions that have to be dispelled. Even more importantly, family planning and responsible parenthood have too long been a burden imposed on women mostly. I believe that more men should become partners in reproductive health.
To highlight this challenge, you can say that men are involved with sexual reproduction in only a few minutes (or even less) out of the nine months or so that it takes to have a baby. For family planning, there are only a few methods involving men out of the nine or so contraceptive methods we have available. Vasectomy is a very safe, inexpensive, and simple procedure that allows men to demonstrate contraceptive responsibility.
I am just above 5 feet tall, I cannot say that my NSV has made me taller. But it has made me feel better about myself. I can even tell my wife that vasectomy is one way of showing that I am concerned about her reproductive health. And I want to continue loving her and providing our children with a better quality of life.
[The man of (healthy) wit, Dr. Jondi Flavier, wrote this piece on the 28th of July 2002 and published by the Philippine Daily Inquirer in condensed form.]
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