MyMedExpert Health Articles

Vasectomy does not affect production or release of testosterone, the male hormone responsible for a man’s sex drive, beard, deep voice, and other masculine traits. The operation also has no effect on sexuality. Erections, climaxes, and the amount of ejaculate remain the same.

Occasionally, a man may experience sexual difficulties after vasectomy, but these almost always have an emotional basis and can usually be alleviated with counseling. More often, men who have undergone the procedure, and their partners, find that sex is more spontaneous and enjoyable once they are freed from concerns about contraception and accidental pregnancy.

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Vasectomy is a simple operation designed to make a man sterile, or unable to father a child. It is used as a means of contraception in many parts of the world. A total of about 50 million men have had a vasectomy–a number that corresponds to roughly 5 percent of all married couples of reproductive age. In comparison, about 15 percent of couples rely on female sterilization for birth control.

Approximately half a million vasectomies are performed in the United States each year. About one out of six men over age 35 has been vasectomized, the prevalence increasing along with education and income. Among married couples in this country, only female sterilization and oral contraception are relied upon more often for family planning.

Vasectomy involves blocking the tubes through which sperm pass into the semen. Sperm are produced in a man’s testis and stored in an adjacent structure known as the epididymis. During sexual climax, the sperm move from the epididymis through a tube called the vas deferens and mix with other components of semen to form the ejaculate. All vasectomy techniques involve cutting or otherwise blocking both the left and right vas deferens, so the man’s ejaculate will no longer contain sperm, and he will not be able to make a woman pregnant.

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The chief advantage of vasectomy–its permanence–is also its chief disadvantage. The procedure itself is simple, but reversing it is difficult, expensive, and often unsuccessful. Researchers are studying new methods of blocking the vas that may produce less tissue damage and scarring and might thus permit more successful reversal. But these methods are all experimental, and their effectiveness has not yet been confirmed. It is possible to store semen in a sperm bank to preserve the possibility of producing a pregnancy at some future date. However, doing this is costly, and the sperm in stored semen do not always remain viable (able to cause pregnancy). For all of these reasons, doctors advise that vasectomy be undertaken only by men who are prepared to accept the fact that they will no longer be able to father a child. The decision should be considered along with other contraceptive options and discussed with a professional counselor. Men who are married or in a serious relationship should also discuss the issue with their partners. 

Although it is extremely effective for preventing pregnancy, vasectomy does not offer protection against AIDS or other sexually transmitted diseases. Consequently, it is important that vasectomized men continue to use condoms, preferably latex, which offer considerable protection against the spread of disease, in any sexual encounter that carries the risk of contracting or transmitting infection.

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Chlamydia is a curable sexually transmitted infection (STI). You can get chlamydial infection during vaginal, oral, or anal sexual contact with an infected partner. It can cause serious problems in men and women, such as penile discharge and infertility respectively, as well as infections in newborn babies of infected mothers.

Chlamydia is one of the most widespread bacterial STIs in the United States. The Centers for Disease Control and Prevention (CDC) estimates 2.8 million people are infected each year.

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Understanding the basic facts about STIs—the ways in which they are spread, their common symptoms, and how they can be treated—is the first step toward preventing them. Researchers supported by the National Institute of Allergy and Infectious Diseases are looking for better methods to diagnose, treat, and prevent STIs, including supporting research on vaccines and topical microbicides.

These are some key points about STIs in the United States.

1. STIs affect men and women of all backgrounds and economic levels. They are most prevalent among teenagers and young adults. Nearly half of all STIs occur in young people 15 to 24 years old. Some STIs disproportionately affect certain minority populations, such as gonorrhea that affects African Americans 18 times more than it does whites.
2. Most of the time, STIs cause no symptoms, particularly in women. When and if symptoms develop, they may be confused with those of other diseases not transmitted through sexual contact. Even when an STI causes no symptoms, however, a person who is infected may be able to pass the disease on to a sex partner. That is why many healthcare providers recommend periodic testing or screening for people who have more than one sex partner.
3. Health problems caused by STIs tend to be more severe and more frequent for women than for men.
   • Some STIs can spread into the womb (uterus) and fallopian tubes to cause pelvic inflammatory disease, which in turn is a major cause of both infertility and tubal (ectopic) pregnancy. Tubal pregnancy can be fatal.
   • STIs in women also may be associated with cervical cancer. One STI, human papillomavirus infection, may cause genital warts and may lead to cervical and other genital cancers.
   • STIs can be passed from a mother to her baby before, during, or immediately after birth. Some of these infections of the newborn can be cured easily, but others may cause life-long disabilities or death. Examples of these STIs are gonorrhea, chlamydia, herpes simplex, and HIV.

When diagnosed and treated early, many STIs can be treated effectively. Some infections have become resistant to the medicines used to treat them and now require newer types of treatments. Experts believe that having STIs, other than HIV infection, increases one’s risk for becoming infected with HIV.

Everyone who is sexually active should learn more about STIs and then make choices about how to minimize their risk of getting these diseases and spreading them to others. Knowledge of STIs, as well as honesty and openness with sex partners and healthcare providers, can be very important in reducing the incidence and complications of STIs

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According to the Centers for Disease Control and Prevention (CDC), bacterial vaginosis (BV) is the most common cause of vaginitis symptoms among women of childbearing age. It previously was called nonspecific vaginitis, or Gardnerella-associated vaginitis. Health experts are not sure what role sexual activity plays in developing BV

 Cause

BV is a sign of a change in the growth of vaginal bacteria. The resulting chemical imbalance occurs when different types of bacteria outnumber the normal “good,” or beneficial, ones. Instead of Lactobacillus (a type bacteria that normally lives in the vagina) being most common, increased numbers of bacteria such as Gardnerella vaginalis, Bacteroides, Mobiluncus, and Mycoplasma hominis inhabit the vaginas of women with BV.

 Transmission

Although health experts are not sure what role sexual activity plays in developing BV, a change in sexual partners or having multiple sexual partners may increase a woman’s chances of getting the infection. Using an IUD (intrauterine device) and douching also may increase her risk of getting BV.

 Symptoms

The main symptom of BV is an abnormal, foul-smelling vaginal discharge. Some women describe it as a fish-like odor that is most noticeable after having sex.

Other symptoms may include 

• Thin vaginal discharge, usually white or gray in color 
• Pain during urination 
• Itching around the vagina

Some women who have signs of BV, such as increased levels of certain harmful bacteria, have no symptoms. A health care provider who sees these signs during a physical examination can confirm the diagnosis by doing lab tests of vaginal fluid.

 Diagnosis

A health care provider can examine a sample of vaginal fluid under a microscope, either stained or in special lighting, to look for bacteria associated with BV. Then, they can diagnose BV based on 

• Absence of lactobacilli 
• Presence of numerous “clue cells” (cells from the vaginal lining that are coated with BV germs) 
• Fishy odor 
• Change from normal vaginal fluid

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Treatment

Because the course of Peyronie’s disease is different in each patient and because some patients experience improvement without treatment, medical experts suggest waiting 1 to 2 years or longer before attempting to correct it surgically. During that wait, patients often are willing to undergo treatments whose effectiveness has not been proven.

Experimental Treatments

Some researchers have given vitamin E orally to men with Peyronie’s disease in small-scale studies and have reported improvements. Yet, no controlled studies have established the effectiveness of vitamin E therapy. Similar inconclusive success has been attributed to oral application of para-aminobenzoate, a substance belonging to the family of B-complex molecules.

Researchers have injected chemical agents such as verapamil, collagenase, steroids, calcium channel blockers, and interferon alpha-2b directly into the plaques. These interventions are still considered unproven because studies included small numbers of patients and lacked adequate control groups. Steroids, such as cortisone, have produced unwanted side effects, such as the atrophy or death of healthy tissues. Another intervention involves iontophoresis, the use of a painless current of electricity to deliver verapamil or some other agent under the skin into the plaque.

Radiation therapy, in which high-energy rays are aimed at the plaque, has also been used. Like some of the chemical treatments, radiation appears to reduce pain, but it has no effect at all on the plaque itself and can cause unwelcome side effects. Although the variety of agents and methods used points to the lack of a proven treatment, new insights into the wound healing process may one day yield more effective therapies.

Surgery

Peyronie’s disease has been treated surgically with some success. The two most common surgical procedures are removal or expansion of the plaque followed by placement of a patch of skin or artificial material, and removal or pinching of tissue from the side of the penis opposite the plaque, which cancels out the bending effect. The first method can involve partial loss of erectile function, especially rigidity. The second method, known as the Nesbit procedure, causes a shortening of the erect penis.

Some men choose to receive an implanted device that increases rigidity of the penis. In some cases, an implant alone will straighten the penis adequately. In other cases, implantation is combined with a technique of incisions and grafting or plication (pinching or folding the skin) if the implant alone does not straighten the penis.

Most types of surgery produce positive results. But because complications can occur, and because many of the phenomena associated with Peyronie’s disease (for example, shortening of the penis) are not corrected by surgery, most doctors prefer to perform surgery only on the small number of men with curvature so severe that it prevents sexual intercourse.

Peyronie’s disease, a condition of uncertain cause, is characterized by a plaque, or hard lump, that forms on the penis. The plaque develops on the upper or lower side of the penis in layers containing erectile tissue. It begins as a localized inflammation and can develop into a hardened scar.

Cases of Peyronie’s disease range from mild to severe. Symptoms may develop slowly or appear overnight. In severe cases, the hardened plaque reduces flexibility, causing pain and forcing the penis to bend or arc during erection. In many cases, the pain decreases over time, but the bend in the penis may remain a problem, making sexual intercourse difficult. The sexual problems that result can disrupt a couple’s physical and emotional relationship and lead to lowered self-esteem in the man. In a small percentage of patients with the milder form of the disease, inflammation may resolve without causing significant pain or permanent bending.

The plaque itself is benign, or noncancerous. A plaque on the top of the shaft (most common) causes the penis to bend upward; a plaque on the underside causes it to bend downward. In some cases, the plaque develops on both top and bottom, leading to indentation and shortening of the penis. At times, pain, bending, and emotional distress prohibit sexual intercourse.

One study found Peyronie’s disease in 1 percent of men. Although the disease occurs mostly in middle age, younger and older men can develop it. About 30 percent of men with Peyronie’s disease develop fibrosis (hardened cells) in other elastic tissues of the body, such as on the hand or foot. A common example is a condition known as Dupuytren’s contracture of the hand. In some cases, men who are related by blood tend to develop Peyronie’s disease, which suggests that genetic factors might make a man vulnerable to the disease.

Men with Peyronie’s disease usually seek medical attention because of painful erections and difficulty with intercourse. Since the cause of the disease and its development are not well understood, doctors treat the disease empirically; that is, they prescribe and continue methods that seem to help. The goal of therapy is to keep the Peyronie’s patient sexually active. Providing education about the disease and its course often is all that is required. No strong evidence shows that any treatment other than surgery is effective. Experts usually recommend surgery only in long-term cases in which the disease is stabilized and the deformity prevents intercourse.

A French surgeon, François de la Peyronie, first described Peyronie’s disease in 1743. The problem was noted in print as early as 1687. Early writers classified it as a form of impotence, now called erectile dysfunction (ED). Peyronie’s disease can be associated with ED; however, experts now recognize ED as only one factor associated with the disease—a factor that is not always present.

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Most physicians suggest that treatments proceed from least to most invasive. For some men, making a few healthy lifestyle changes may solve the problem. Quitting smoking, losing excess weight, and increasing physical activity may help some men regain sexual function.

Cutting back on any drugs with harmful side effects is considered next. For example, drugs for high blood pressure work in different ways. If you think a particular drug is causing problems with erection, tell your doctor and ask whether you can try a different class of blood pressure medicine.

Psychotherapy and behavior modifications in selected patients are considered next if indicated, followed by oral or locally injected drugs, vacuum devices, and surgically implanted devices. In rare cases, surgery involving veins or arteries may be considered.

Psychotherapy

Experts often treat psychologically based ED using techniques that decrease the anxiety associated with intercourse. The patient’s partner can help with the techniques, which include gradual development of intimacy and stimulation. Such techniques also can help relieve anxiety when ED from physical causes is being treated.

Drug Therapy

Drugs for treating ED can be taken orally, injected directly into the penis, or inserted into the urethra at the tip of the penis. In March 1998, the Food and Drug Administration (FDA) approved Viagra, the first pill to treat ED. Since that time, vardenafil hydrochloride (Levitra) and tadalafil (Cialis) have also been approved. Additional oral medicines are being tested for safety and effectiveness.

Viagra, Levitra, and Cialis all belong to a class of drugs called phosphodiesterase (PDE) inhibitors. Taken an hour before sexual activity, these drugs work by enhancing the effects of nitric oxide, a chemical that relaxes smooth muscles in the penis during sexual stimulation and allows increased blood flow.

While oral medicines improve the response to sexual stimulation, they do not trigger an automatic erection as injections do. The recommended dose for Viagra is 50 mg, and the physician may adjust this dose to 100 mg or 25 mg, depending on the patient. The recommended dose for either Levitra or Cialis is 10 mg, and the physician may adjust this dose to 20 mg if 10 mg is insufficient. A lower dose of 5 mg is available for patients who take other medicines or have conditions that may decrease the body’s ability to use the drug. Levitra is also available in a 2.5 mg dose.

None of these PDE inhibitors should be used more than once a day. Men who take nitrate-based drugs such as nitroglycerin for heart problems should not use either drug because the combination can cause a sudden drop in blood pressure. Also, tell your doctor if you take any drugs called alpha-blockers, which are used to treat prostate enlargement or high blood pressure. Your doctor may need to adjust your ED prescription. Taking a PDE inhibitor and an alpha-blocker at the same time (within 4 hours) can cause a sudden drop in blood pressure.

Oral testosterone can reduce ED in some men with low levels of natural testosterone, but it is often ineffective and may cause liver damage. Patients also have claimed that other oral drugs—including yohimbine hydrochloride, dopamine and serotonin agonists, and trazodone—are effective, but the results of scientific studies to substantiate these claims have been inconsistent. Improvements observed following use of these drugs may be examples of the placebo effect, that is, a change that results simply from the patient’s believing that an improvement will occur.

Many men achieve stronger erections by injecting drugs into the penis, causing it to become engorged with blood. Drugs such as papaverine hydrochloride, phentolamine, and alprostadil (marketed as Caverject) widen blood vessels. These drugs may create unwanted side effects, however, including persistent erection (known as priapism) and scarring. Nitroglycerin, a muscle relaxant, can sometimes enhance erection when rubbed on the penis.

A system for inserting a pellet of alprostadil into the urethra is marketed as Muse. The system uses a prefilled applicator to deliver the pellet about an inch deep into the urethra. An erection will begin within 8 to 10 minutes and may last 30 to 60 minutes. The most common side effects are aching in the penis, testicles, and area between the penis and rectum; warmth or burning sensation in the urethra; redness from increased blood flow to the penis; and minor urethral bleeding or spotting.

Research on drugs for treating ED is expanding rapidly. Patients should ask their doctor about the latest advances.

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Patient History

Medical and sexual histories help define the degree and nature of ED. A medical history can disclose diseases that lead to ED, while a simple recounting of sexual activity might distinguish among problems with sexual desire, erection, ejaculation, or orgasm.

Using certain prescription or illegal drugs can suggest a chemical cause, since drug effects account for 25 percent of ED cases. Cutting back on or substituting certain medications can often alleviate the problem.

Physical Examination

A physical examination can give clues to systemic problems. For example, if the penis is not sensitive to touching, a problem in the nervous system may be the cause. Abnormal secondary sex characteristics, such as hair pattern or breast enlargement, can point to hormonal problems, which would mean that the endocrine system is involved. The examiner might discover a circulatory problem by observing decreased pulses in the wrist or ankles. And unusual characteristics of the penis itself could suggest the source of the problem—for example, a penis that bends or curves when erect could be the result of Peyronie’s disease.

Laboratory Tests

Several laboratory tests can help diagnose ED. Tests for systemic diseases include blood counts, urinalysis, lipid profile, and measurements of creatinine and liver enzymes. Measuring the amount of free testosterone in the blood can yield information about problems with the endocrine system and is indicated especially in patients with decreased sexual desire.

Other Tests

Monitoring erections that occur during sleep (nocturnal penile tumescence) can help rule out certain psychological causes of ED. Healthy men have involuntary erections during sleep. If nocturnal erections do not occur, then ED is likely to have a physical rather than psychological cause. Tests of nocturnal erections are not completely reliable, however. Scientists have not standardized such tests and have not determined when they should be applied for best results.

Psychosocial Examination

A psychosocial examination, using an interview and a questionnaire, reveals psychological factors. A man’s sexual partner may also be interviewed to determine expectations and perceptions during sexual intercourse.

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