QUESTIONS (with links) from Radio Interview
What is a vasectomy?
Do men still ejaculate after sex?
What else is in the fluid, then, if not the sperm?
Do you find that many men are shy about coming to see a doctor about this issue?
What’s the difference between vasectomy for men and tubal ligation for women?
How much discomfort is there with vasectomy and what is recovery like?
How do we make a decision about this if we’re in our late 30s?
How do you talk to other family members about benefits of procedure?
What is the vasectomy reversal procedure?
What are the odds of getting a vasectomy successfully reversed?
Can a patient get an infection during vasectomy surgery?
What happens to sperm after vasectomy procedure?
After a vasectomy, when can I stop wearing protection?
Do you have to shave the area for surgery?
What is a no-scalpel vasectomy?
How does the recovery time for tubal ligation differ from vasectomy?
Do men suffer any hormonal effects?
How would you find a doctor in your area?
What is the recovery process like?
What are the cost differences between the traditional, the no-scalpel and the laser?
How do we convince our husbands that this is the best way?
Do urologists perform the surgery?
Is this an out-patient procedure?
Do you typically want them to come back and how long after the procedure?
INTERVIEW
M Cole: On my show today I have Dr. Ted Benderev, and he is a board certified urologist from Orange County California, and he is the founder of Vasectomy.com. Welcome to the show Dr. Benderev, how are you?
Dr. Benderev: I’m doing fine, thank you. It’s nice to be here.
M Cole: Thank you for being with us today. We are talking about vasectomies today and this is a really interesting topic. And I think people don’t understand it and when they hear the word, they automatically cover up their privates. Right?
Dr. Benderev: Yes, well it’s pretty natural, defensive reflex when men hear that word. But it turns out that it’s actually the number one surgical procedure done in men. There have been over 500,000 of them done just in the United States alone, each year.
M Cole: Really! And why don’t you start by telling us, what is a vasectomy?
Dr. Benderev: A vasectomy is an interruption of the flow of sperm from the testicles to the outside. And it’s done at a structure called the vas deferens. It’s a little tiny tube that runs from the testicles within the scrotum through the body and then enters the urinary system to deliver the sperm to the outside. It is actually the most muscular tube in the body when you look at the ratio of the inner lumen, the opening inside, to the wall because it’s so important and propels the sperm along. But it’s very small - its not much larger than a small string or a cord. A person can feel it, when examining that area. And there’s one on each side of each testicle.
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M Cole: So, if you are cutting the vas deferens and this is carrying the sperm, do men still ejaculate after sex?
Dr. Benderev: They do, because actually most of the fluid is made by the prostate gland and the seminal vesicle. So the sperm only makes up only a very small amount of the ejaculate. This is a question often asked by men because they wonder if they will still be able to “do it”. It should not affect sexual function. They can still climax. And the fluid is virtually the same, you cannot tell the difference.
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M Cole: What else is in the fluid, then, if not the sperm? I mean we just assume that’s what it is.
Dr. Benderev: The sperm makes up only less 10% of the fluid. Most of the fluid is nutrient for the sperm. And it is also a special medium to actually make sure that the sperm can continue to function once they are in the vagina.
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M Cole: So if a man is interested in having one of these. First of all, this is probably something that he and his wife have more than likely thought about, discussed. I mean, do you find that most men don’t even want to come see you in the first place?
Dr. Benderev: Well, this is again emotionally charged. Men look at it differently. Through the years, in talking with couples, you’ll find there are couples where men actually volunteer to do it, they look at it like their wives have made a big effort in delivering the child and that it’s the least that they could do. There are other men that try to avoid the topic and put it off. It’s interesting when you look at that statistics for vasectomy in the United States compared to other countries. The alternative procedure in women is called a tubal ligation, which is a much bigger procedure than a vasectomy. It usually requires 2/3 vasectomy and 1/3 tubal ligation. If you look at a country like New Zealand, it’s 80% vasectomy. So we still have a ways to go here with education. Women sometimes need a little help in convincing their husbands to do this. It’s particularly easier now, because the procedure has become dramatically easier for men. So hopefully with shows like this we can empower women to be able to talk to their husbands.
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M Cole: And help them to make this informed decision. And the thing is, you know, women have always been more apt to go to the doctor for things, and so I think we’d be more willing to say I’ll go for the tubal ligation. Because you know, quite honestly to my listeners and to you Dr. Benderev, I’ve been considering all these options myself, I’m 43 years old. I’m afraid, what if, and we’ll talk about the reversal thing later, but what if one of us does this and God forbid something happens and you want to have more babies? It’s such a large decision to make and, women, it would just seem, we’re the ones that will say, okay fine. But for us it’s a matter of going into the hospital for day right?
Dr. Benderev: Right. Well tubal ligation is usually an outpatient procedure but it is a big deal and estimates of its morbidity include 15 to 30 women who die a year from the procedure. I am not aware of anyone to have died from a vasectomy. So that’s another argument in favor of vasectomy. There’s also the socioeconomic side of this. If we were to adopt the Canadian pattern of 2/3 vasectomy, the savings in the U.S. would be somewhere between two and three billion dollars a year.
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M Cole: Wow! Now that’s huge, Dr. Benderev, I have a question. They’re coming in. This one is from Mike in New York, “Ouch it just sounds painful. How much discomfort will one feel and how long is recovery time after a vasectomy? My wife thinks I should get snipped.” That’s the word that a lot of people hear isn’t it – snipped.
Dr. Benderev: Yes. Well Mike’s concern is shared by just about every man. Men, they’re job is to protect that area. So to go to some stranger who is going to be working between their legs with sharp instruments is not an attractive concept. So it’s very natural that there’s a concern like that, but it’s dramatically different than it was before hand. The techniques now allow the vasectomy to be done through a tiny opening. You’re talking about an opening that is about a third of an inch. And there’s been a new development over the last four or so years where we now can deliver the anesthetic without a needle.
M Cole: Are you talking about the traditional vasectomy when you talk about the third of an inch opening?
Dr. Benderev: The traditional vasectomy was done through two separate incisions: one on each side of the scrotum for each testicle. And were quite a bit more involved because you had to deliver the tissues to the surface and there was tugging and there was pulling and sometimes it was difficult to anaesthetize. And so every man has heard the stories of somebody who had a procedure that was painful. Now it’s really different. We have special instruments that allow it to be done through a very tiny opening. So a big thing is the delivery of the anesthetic – the needle going into this area and the burning that can come from this anesthetic. I can tell you when I do vasectomies, I don’t call them painless because I want to avoid creating expectations, but I’ve had many patients tell me that they’re painless. So we call them virtually painless. We’re talking during the procedure and it usually takes less then ten minutes. Patients so frequently say, “This is so much easier than I thought it was going to be”. They’re relieved, dramatically relieved at that end.
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M Cole: Welcome back to the show. My name is Melanie Cole and you’re listening to Health Radio. We’re talking with Dr. Theodore Benderev from www.vasectomy.com and the questions, Dr. Benderev are coming in, in fast numbers. I’m going to ask them in sort of the order that we’re talking and listeners, I will definitely get to your questions as I can. This one comes from Jennifer, “My husband and I have three children, we’re in our late 30’s, we’ve considered a vasectomy, and do you have any advice?”
Dr. Benderev: It’s a relatively simple procedure but there are a lot of questions that come up, regarding how the procedure is done, how to prepare for it, what happens afterwards and what could happen. At this point I should put a plug in for the website. – www.vasectomy.com. It’s very helpful. We’ve spent many years putting it together with information from different physicians and it’s very simple to find. I think the only challenge there is to know how to spell it. There’s information there about both vasectomies and vasectomy reversals. So there’s information there on how to find physicians that actually do different types of vasectomy and vasectomy reversals in different locations around the country.
M Cole: Ok so now Jennifer’s question was basically “My husband and I have three children, we’re in our late 30’s, we’ve considered a vasectomy, do you have any advice?”
Dr. Benderev: Well the advice is that if they are done having children, then vasectomy is usually the primary alternative for surgical or permanent sterilization. That’s what they need to be clear about - that they do not want to have any more children. While one can reverse vasectomy (generally highly successful when reversed early after the vasectomy), the couple really needs to think about their future wishes. What I would generally recommend is, if they have questions, to just make an appointment for a consultation with a physician and to speak with them. You know, bring their questions and then go away and think about it and make a decision when the time is right.
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M Cole: Now, that’s very good advice and I have another one from Janice here in Chicago. “What do I tell my husband’s parents? They’re really upset with us for wanting a vasectomy.”
Dr. Benderev: Well, you’d have to find out the reason why. Maybe the parents would like their son or daughter to have more children. So that’s obviously a matter of communication between the families to find out and to work through that. But when the time comes, vasectomy is generally the best way to achieve permanent sterilization. But the family should be sure. They need to be comfortable. I can give you a little information about vasectomy reversal. About 5% of people who have a vasectomy will choose to reverse vasectomy at some point down the road. Generally it’s when somebody is remarried or heaven forbid, there is a loss of a child. If it is chosen to be done relatively soon, for example within the first three years, in almost all cases you can get sperm to come across that area where the connection is made.
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M Cole: So what is the vasectomy reversal procedure? Is it just a reconnection of this closed off vas deferens?
Dr. Benderev: That’s right but it’s a much bigger deal than the actual vasectomy itself. The vasectomy reversal does require an anesthetic; it requires a larger incision and it generally requires a high powered microscope. Sutures that are the size of a hair are used to bring the ends together. Even though you can bring it together and get the sperm to come across, you’ll find that only ¾ of the patients or less can actually conceive afterwards because there are other changes that occur from the blockage of the sperm over time.
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M Cole: Okay, I have a question that fits right along with this. “I’m remarried now and wish that I didn’t get a vasectomy several years ago. How can I get it undone and what are the odds that I’ll be able to make a baby after the reversal?” So when people say to you, “Dr. what are the odds?” What do you say to them?
Dr. Benderev: Well there are calculations and there have been studies with groups of larger than a thousand patients and found that the period time is very important. That’s one of the things that they’ll find on www.vasectomy.com. For example, if they go on the vasectomy reversal side of the site, the statistics are there and they can look for their own particular case, how many years it’s been since the vasectomy.
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M Cole: And that is kind of a way that they can tell. Now another question from Jack who says that “I’m really concerned that if I have a vasectomy, can it become infected” And this is a good question I think with all the fear of staph infections, what’s the rate of staph infections with this procedure? And he’s actually asking this about the new procedure but we haven’t actually gotten into the no-scalpel procedure yet. So, with the traditional, what don’t you tell us.
Dr. Benderev: With the newer no-scalpel vasectomy, there is less manipulation of tissue with less chance of injury to tissue and, thereby, less opportunity for bacteria to settle in that area. So the risk with the no-scalpel technique, which is done with the smaller instruments with a smaller opening, is significantly lower than the traditional technique. And it is really very low. Fortunately the scrotum is an area that has very good blood flow. It’s like the scalp – the head – you know if you have a cut in that area, it bleeds a lot but that also means that it can recover very quickly from any bacteria that are there. So it’s extremely rare to have to re-operate on the scrotum after a vasectomy. But there are infections that do occur. Fortunately they are very infrequent and it takes time to recover. They’re treated with antibiotics. So there is a chance of complications, but it is low.
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M Cole: What happens to the sperm Dr. Benderev?
Dr. Benderev: Well there’s a blockage, of course, and so the sperm back up. There’s a structure between the vas deferens and the testicle called the epididymis and that’s where the sperm normally mature. After a vasectomy, the sperm collect in there and there’s an equilibrium that takes place. Over time with that back pressure there’s a reduction in the number of sperm and the sperm begin to dissolve. But, frequently, you can go back there 10 to 15 years later and find live sperm.
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M Cole: Wow! That’s just amazing and how long does it take for the vasectomy to work.
How long does it take to start to have effect after the procedure?
Dr. Benderev: Well, you know of course the blockage is immediate but there’s sperm that are stored in different areas down river from the vasectomy site.
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M Cole: Yeah, there could still be a few errant swimmers, right?
Dr. Benderev: Oh, absolutely and it only takes one (laughs). So generally, people will wait at least 6 weeks, generally three months before a semen check for sperm. And there need to be at least 20 ejaculations afterwards to clear out the system and still you need to check. This is an issue that I have with many patients that don’t come back for the semen check. You’d think that people would want to make sure that there’s no sperm in there. Patients should make sure that they come back and have at least one assessment again just to make sure that there’s no sperm there.
M Cole: So you recommend to people that, after the procedure they still protect themselves for at least 20 times or something?
Dr. Benderev: Well, they should protect themselves until they get the green light from their physician.
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M Cole: Okay, quick question before we take our break here, do you have to shave the area for surgery?
Dr. Benderev: At least clip the hairs that are in the area, or else they get in the way. But just the area on the front of the scrotum.
M Cole: And do you do that, or do you have them do that at home.
Dr. Benderev: It’s up to each individual physician. My patients usually do it the morning of, before they come in.
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M Cole: We’re back with Dr. Ted Benderev and that’s what we’re talking about today. Vasectomies: the most done procedure on men in this country – something I did not know, and you can go to www.vasectomy.com. We’re asking him a lot of questions. So, Dr. Benderev, why don’t you tell us, what is a no-scalpel vasectomy? I have three questions on it right here and so we can kind of answer everyone’s question at the same time. What is the no-scalpel vasectomy – is this the laser treatment we hear about all the time or are those two different things?
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Dr. Benderev: No, it is not the laser treatment.
M Cole: Oh okay, so we want to ask about both of those. First, tell us about the no-scalpel vasectomy.
Dr. Benderev: The no-scalpel came the United States about in the mid-1980’s. The procedure came from China, from Dr. Li there who found that he could do a vasectomy much simpler with less risks and complications. He was able to minimize bleeding at the site by using these little tiny instruments that could actually bring the vas deferens to the surface with a smaller hole of the scrotum. It actually caught on here in this country there was support from a foundation for doctors around the country. Approximately 50% of doctors in this country use the no-scalpel technique and another 50% use the traditional technique. Here’s something really important to understand – as long as a doctor does vasectomies on a regular basis, which most urologists do and a number of family practitioners do; whatever technique they use can work very well and patients usually should have minimal to no pain during the procedure. That’s really key – there needs to be enough anesthetic that’s delivered and when people complain about that I wonder about what’s going on in their situation. So, urologists and family practitioners, whatever technique they’ve been trained to do, can do it very well and most patients do very well with it. The no-scalpel technique helps perhaps to promote the procedure because when one hears there’s no-scalpel used - rather just a small little opening by separating the tissue – that sounds more attractive to men because it’s less invasive.
You know, sometimes people will talk to friends, whom they know have had a vasectomy, to get information on who does the procedure that they want. There are certain other places where you can find information, if you’re interested, on different vasectomies – for instance, the website www.vasectomy.com has information on the procedures and doctors who perform them. As far as the laser vasectomy, there I have to come out very strongly against that concept of using a laser.
M Cole: Really?
Dr. Benderev: Yes, laser for a vasectomy is hogwash. The challenge in doing a vasectomy is not cutting the vas. Cutting the vas is actually nearly bloodless. You don’t need a laser for that. You can do it with scissors or you can do it with cautery. How you cut the vas doesn’t contribute to any pain. It doesn’t take away pain by using special instruments to cut the vas. The challenge in doing a vasectomy is actually getting to the vas and gently pushing away the surrounding tissues that are associated with the vas. The laser has nothing to do with that. I can tell you because I’ve been studying lasers since the early 1980’s with some of the earliest uses of lasers in Urology. My opinion is that the laser remains a promotional opportunity, because people like the idea of lasers. Personally, I would consider very carefully before I would have a laser vasectomy.
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M Cole: That’s good advice. We have a caller, a woman from Illinois. You’re on with Dr. Benderev, do you want to ask him a question?
Caller: I do, but you were just talking about the laser treatment and let’s say you have a couple and they’re in a quandary over who was going to be fixed, the male or the woman, and the man in this case is thinking more about the laser treatment just because he’s heard it’s less invasive and from what you just said, it sounds like that’s not necessarily true. But what would you recommend if a couple is having a hard time deciding who is going to be fixed as far as recovery time and side effects and all of that?
Dr. Benderev: There is a role for tubal ligation, for example if a woman is having a cesarean section, then a tubal ligation is a good way to go because everything is open and you can easily get to the tubes. Outside of that, unless the male has some sort of medical problem, that would keep him from having a vasectomy, there’s no reason to have a tubal ligation instead of a vasectomy. The vasectomy, hands down, is a less invasive procedure with quicker recovery and is much easier for the individual than a tubal ligation.
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Caller: This may sound like a naïve question, but do men suffer any hormonal after effects?
M Cole: I think that’s a great question.
Dr. Benderev: That’s a good question because men and their partners are concerned about any changes in the man’s sexual function after vasectomy. Studies have been done and there are no significant hormonal changes and there is no effect on sexual function. In fact it’s been called a “bedroom bonus.” Things get better. Women, many times, are very grateful that their husbands have done this for them.
M Cole: So, you’re saying that things can get better in the bedroom. Wow, that’s great. Lee, did you have any other questions.
Caller: No, that’s great thank you.
M Cole: Thanks for being on. Okay, so Dr. Benderev, things can get better. I can see that. And that’s probably a big issue because for some of us, and me even personally right now, it’s a nervous thing. Because you don’t want to get pregnant, and so there’s always that little bit of nerve that keeps some of the pleasure from happening. You’re just afraid that condoms and that sort of thing – and nobody wants to take the birth control pill very much anymore, especially at my age, so, you know, what do you do? Short of abstinence!
Dr. Benderev: Right, exactly, and on top of everything else, with all the stress of kids and work, one additional factor can impact intimacy. It requires people to be a little bit more proactive, when they are concerned about that additional child who could come along. That not infrequently happens, when people plan to have maybe two children and a third child comes along before a decision is made. It’s better talked about before hand. And it’s really just so much easier than it was before that it should be an easier decision.
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M Cole: And, you know, a lot of the questions that have been coming in have been about that laser, so it’s interesting that you are not recommending it, and you are the founder of vasectomy.com so you really know your business. How would somebody find a doctor to do this in their area?
Dr. Benderev: Asking friends or a physician in the community. But you know it is the age of the Internet. Most people who choose to have vasectomies are in that stage of their lives where they don’t have a urologist. So, they want to get information and they want to get that appointment. So, going to the web is a good place to find that and on vasectomy.com there are some 1700 physicians who have expressed interest in doing vasectomies. It’s easily searchable and there’s information, biography information about the physicians, information about their offices, there’s a form where you can make appointments. All kinds of different things are on there – we’ve tried to give the public what they’ve told us they want.
M Cole: And you gave one really good piece of advice I’d like to reiterate. You know whenever you are considering any kind of procedure or surgery; you want the guy who has done 10,000 of them, instead of the guy who has done four of them, right? So you want to make sure that the guy you are picking for your “no scalpel” procedure, or the guy you are picking to do your traditional vasectomy has done a lot of them and that he is very comfortable doing them and his success rate can be measured, right?
Dr. Benderev: Success rates from vasectomies should be extremely high. There is only about one in one thousand vasectomies that actually reverses itself. So fortunately, as long as the semen is negative after the procedure for sperm, the success rate is very, very high. But you’re absolutely right, the number of vasectomies can associate with the outcome and it’s not an unreasonable question to ask the physician when you go in on a consultation, how much does he emphasize vasectomy, how important a part of his practice is that. When they call to make an appointment, they can ask that of the office staff as well.
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M Cole: Now we haven’t asked you too much about recovery and what you’re supposed to do after the procedure. Why don’t you tell people how much time they have to take off of work, or what is the recovery situation for the traditional vasectomy.
Dr. Benderev: It varies according to the physician. I can tell you for myself I tell patients that, for about a week afterwards, they should just lay low and don’t do any strenuous exercise or activity. But they do go back to work. If they have it done on a Friday, they go back to work on a Monday. And they just take it easy mostly over the weekend. They will apply an ice pack generally for the first day. And then, generally, there’s very little soreness afterwards.
M Cole: Okay so they apply the ice pack, they take it easy a little bit and how soon can they resume sexual activity?
Dr. Benderev: The sexual activity, I say, along with the other activity, about one week. But there are other physicians who will tell you, and who do the same procedure, but are comfortable telling their patients to resume activity even earlier than that. I just tend to be more conservative because you don’t want to have a complication down there because it just delays your recovery and return to normal activity.
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M Cole: Now I have lots of questions about the cost. Let’s talk about the cost differences between the two types of procedures and if you would, the laser. What are the cost differences between the traditional, the no-scalpel and the laser?
Dr. Benderev: Well, fortunately, vasectomies are frequently covered by insurance. So you just need to check with your insurance plan. On a cash basis it varies generally according to the cost of living and the area. For example New York City would be more expensive than the outskirts of Phoenix. It can vary anywhere between five hundred dollars up to two thousand dollars, but generally closer to the five hundred dollar range. And there’s a consultation before hand. There really isn’t a cost difference between the traditional vasectomy and the no-scalpel vasectomy in the community. In fact we’ve even added the no-needle anesthetic technique and have not increased the price for that. It’s mostly about the experience of the physician – do they have a particular interest in this. The laser is not necessary, so any additional cost is likely not warranted.
M Cole: Now, why would insurance pay for this? Is it considered a choice procedure?
Dr. Benderev: The question is whether it’s a covered service, and we usually don’t write anything up if the person calls their insurance company and if they’re insured, they’ll tell them that they’re covered for that particular service. A lot of times the doctor’s offices can also call the company to find out if vasectomy is a covered procedure. I don’t know how they decide in the insurance company board room which procedures are going to be covered and which are not. But you can imagine that if somebody has a vasectomy they’re not going to have any more children, so the cost to the insurance company is going to be less, than having one or more deliveries afterward.
M Cole: I mean, it seems odd to me considering that elective procedures are so scrutinized. And that breast reduction is not necessarily always covered, unless you claim all these back problems and that sort of thing. And yet, vasectomy might be considered an elective procedure but covered. I just have to wonder if it’s because it’s men. I mean, you know, I’m not trying to go there, but I’m going there a little because there is something to that isn’t there?
Dr. Benderev: To be honest I’ve not seen a difference in coverage between vasectomy and tubal ligation, but there might be something there. This has been around for a long time, it was actually really popular in the early seventies, but then went a little bit out of favor, and then when the no-scalpel technique came about in the late 80’s, it has become more popular and we expect the numbers to increase. My goal is to provide the education that may get us toward that Canadian pattern. Everybody benefits from that – you know, women benefit, we as a society benefit because there’s less health care costs and more money for new technology. Maybe men wouldn’t be in favor of that early on, but after the procedure most men will tell you, it’s really very easy to do.
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M Cole: How can we as women, convince our husbands that this is the way to go rather than us?
Dr. Benderev: Well, there’s different ways of doing it. I’ve seen anything from women just talking to their husbands to actually calling and making the appointment. They will say to their husbands, “Let’s go in and talk to the doctor.” For the husbands with a lot of anxiety, there can be some medicine to help them relax.
M Cole: It’s just a process, but I’m certain that there are women out there whose husbands are absolutely adamant that they will not do this. “Nobody comes near me with a scalpel or otherwise, even with a needle, or no needle, or anything – nobody’s coming near me.”
Dr. Benderev: Well I’m not suggesting that the women should hold back or that they should do a tit for a tat kind of thing. I wouldn’t say that, but it is a relationship, and the men need to consider what the right choice of permanent contraception is – especially when they find out that a vasectomy is really not a big deal. I’ve had so many patients who, at the end of the procedure - after only seven or eight minutes, say, “You’re done, already!” Such a big deal had been made before hand about the vasectomy that, at the end, they’re saying, “I can’t believe this. I should have had done it earlier”.
M Cole: Well I would imagine you’d hear that a lot. And I just think that in the case of a complete refusal by the man to do something like this, you know we’re allowed to do the tit for tat sort of thing and say, “well you know honey, if you don’t go in and talk to this doctor, then you ain’t gettin’ any!” Because we have to have certain amo! We don’t have much but that’s some of it. Now, Dr. Benderev I do have another question. I heard about a valve that they put in the tube to block the flow of sperm, and then they can turn it back on, and it was made of gold.
Dr. Benderev: People have been studying technology like that for a long time because it would end some of the challenges. But no one has been able to come up with a simple reversible technique.
M Cole: But why have we heard that this is a reversible procedure, I know you said at the beginning, right at the outset, that you should consider a vasectomy to be a permanent situation. But there have been cases of reversal. You said it’s a more complicated procedure. What’s involved – reconnecting, and then hopefully some sperm will start to regenerate?
Dr. Benderev: Correct. Vasectomy reversals are frequently preformed. When you’re talking about a procedure that’s performed 500,000 times a year and 5% of those are reversed, that’s a significant number of reversals. And there are many people who have had very successful results from it. But because not everybody’s vasectomy can be reversed and you could be that unlucky person who can’t be reversed, then you should consider a vasectomy an irreversible procedure. But even if the reversal is not effective, there are artificial reproductive technologies where sperm can actually be taken directly from the testicle or that structure I talked about earlier, the epididymis, to be used for insemination.
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M Cole: Well I guess that would probably make sense. And is it a urologist that does the reversal?
Dr. Benderev: That’s correct. One would use a urologist to perform a reverse vasectomy.
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M Cole: And is that an in-office procedure as well?
Dr. Benderev: No, that’s actually done in an outpatient surgery center, although there are some rare offices that do do that, where they sort of integrate that into their office practice.
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M Cole: Wow, well it’s such an interesting topic and I guess there are so many angles and questions that people have about what to do with this. So once someone has made the decision and they come into your office and they do the vasectomy, do you typically want them to come back and how long after the procedure?
Dr. Benderev: In general they just come back with the specimen in six to 12 months. If it looks okay we will let them know that they are fine and they’re welcome to bring another specimen anytime they want. They can then just go ahead and enjoy the rest of their lives.
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M Cole: Wow. When you say it’s a permanent procedure, that’s what scares me and I imagine that’s what scares men. As a worrier, I think, God forbid, something happens to your family and you want to have more babies.
Dr. Benderev: Oh, there is another option by the way. We talked a little bit about the statistics for vasectomy reversal and they are quite reasonable. For example, within three years of having a vasectomy, there is a 97% chance of being able to reconnect the ends of the vas to get sperm to cross over. But we talked about as you go further along, it drops off. So, as an alternative, there are men who actually go and put sperm into a sperm bank to be used at a later date. Now, again, that’s not 100% effective either, but it’s another additional safety measure for them.
M Cole: I would think that that is a great idea, just like banking your eggs if you have to go on Tamoxifen or something like that. Also to bank your sperm to say, “You know what? If we need to, we can just go and get sperm that is still ours.” It’s probably expensive but it’s a really great idea.
Dr. Benderev: For a couple who really want to have permanent sterilization, but the loss of a child is the only thing that’s a concern for them and they’ve worked out everything else, I think a sperm bank is a viable option.
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M Cole: Well, I would think that that probably is. Now, tell us a little bit about vasectomy.com. How did you come up with this idea and how did you get other doctors to jump in on it?
Dr. Benderev: Well, about 11 years ago we started www.vasectomy.com from the idea that the Internet would be a great medium to find information first and then potentially find physicians afterward. So we were the first to build this vasectomy and reversal portal. We’re number one on most of the search engines and there are about ¾ of a million people who come to the site every year. And as a result, physicians who have a special interest in performing vasectomies and reversals find that this is a good way for them to be found by those people who are looking to have these procedures. So it’s a natural fit.
M Cole: How’d you get other doctors to jump in on it with you? I mean, did you go to doctors around the country and say, “Would you like to be listed in Vasectomy.com as a doctor who is interested in performing this procedure?”
Dr. Benderev: That is a way that physicians are contacted. But we also have physicians contacting us. We’ve been around long enough now that we’re a known entity among urologists and so it’s sort of a natural extension for them.
M Cole: Because as I’m looking at the website right now, I don’t know how it knows that I’m from Illinois, but I see that when I put in that I’m from Illinois, it came up with all these doctors – maybe from my zip code or something?
Dr. Benderev: We have a special way that it can read exactly where people are coming from so that we can give them exactly the information that they want for their area. So the doctors that show up will be from your particular area.
M Cole: Yeah, it’s really wild that it does that. How Big Brother of you. (laughter) But really, it just shows the doctors from my area. It has all these Illinois doctors and I didn’t do anything or put in anything, so that’s pretty interesting that you were able to do that. So people can go on there, they can find a doctor and they can look at the questions. Is there a place on there to ask questions and will you respond?
Dr. Benderev: Well, we usually don’t take medical questions. We refer them to a physician for that first consultation. But there are about 100 pages of information there and the way that it’s layered you can start at the top and you can go as deep as you want. So you can search out different aspects of the vasectomy and vasectomy reversal procedures.
M Cole: Well, Dr. Benderev, thank you so much. You’ve been on with me before and I know you’re going to be on with me again soon. So thanks so much for doing the show and we certainly enjoyed it.
Dr. Benderev: You’re quite welcome and it was my pleasure.
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Recorded November, 2007. Edited for clarity May, 2008.
