NO-SCALPEL VASECTOMY - EngenderHealth

Appendix E: Long-Term Effects Participant Handbook
1984; Petitti et al., 1982; Rimm et al., 1983; and Walker et al., 1981). However, antisperm antibodies
may play a role in decreased fertility after vasectomy reversal, although conflicting results have been
reported. Some studies have shown decreased pregnancy rates due to antisperm antibodies and others
have not (Huang et al., 1997; Meinertz et al., 1990; Newton, 1998; Thomas, 1981).
Prostate Cancer
Since the mid-1980s, more than a dozen epidemiological studies of the risk of prostate cancer after
vasectomy have been reported in the literature. Results have been difficult to interpret because of
conflicting study findings, the lack of a convincing biological mechanism for an association between
vasectomy and prostate cancer, and generally weak associations when they have been found. Also,
the potential for bias in some studies was high and likely led to an overestimation of any effect
(Bernal-Delgado et al., 1998).
Based on the results of the research published to date, there is little evidence for a causal association
between vasectomy and prostate cancer (Peterson & Howards, 1998). A panel of experts gathered by
the U.S. National Institutes of Health in 1993 concluded that no change in the current practice of
vasectomy was necessary nor should vasectomy reversal be done as a measure to prevent prostate
cancer (Healy, 1993). Studies published after the expert panel report support these conclusions
(Bernal-Delgado et al., 1998; Peterson & Howards, 1998; Stanford et al., 1999; Lynge, 2002; and
Lesko et al., 1999). Results from a population-based survey in New Zealand confirmed that vasectomy
does not increase the risk of prostate cancer, even after 25 years or more (Cox et al., 2002).
Testicular Cancer
Some studies have linked vasectomy with an increase in risk of testicular cancer. However, with one
exception (Cale et al., 1990), In the studies conducted between the 1970s and early 1990s, the
increased risk of testicular cancer was not statistically significant (Goldacre et al., 1978; Swerdlow et
al., 1987; Strader et al., 1988; and Thornhill et al., 1988). These studies included only small numbers
of vasectomized men with testicular cancer and were subject to confounding and/or misclassification
bias. Giovannucci and coworkers (1992) found no cases of testicular cancer among nearly 15,000
vasectomized men. Two additional studies, which included the largest numbers of cases of testicular
cancer among vasectomized men, found no increased risk (Moller et al., 1994; and Rosenberg et al.,
1994). Taken together, results of these epidemiologic studies provide convincing evidence that vasectomy
is not associated with an increased risk of testicular cancer.
Postvasectomy Pain Syndrome
A small percentage of vasectomized men have reported chronic pain in the testis following vasectomy.
While up to one-third to one-half of men have reported occasional testicular discomfort following
vasectomy, only a small percentage of all vasectomized men (no more than 2–3%) said the pain
had negatively impacted their life or that they regretted having had the vasectomy because of chronic
pain (Choe & Kirkemo, 1996; Ehn & Liljestrand, 1995; Manikandan et al., 2004; McMahon et al.,
1992). Conservative therapies (such as nonsteroidal antiinflammatory drugs, sitz baths, antibiotics, or
146 NSV Curriculum EngenderHealth