You see it's going to pull the sperm cells from the Epididymis and move up the Spermatic Cord.
Today we're going to talk about birth control for men.
Now this procedure we're going to discuss is called The Vasectomy.
It makes it so sperm cells can't leave the male reproductive tract and therefore fertilize an egg.
But what happens to all the sperm cells that are produced after the procedure is done?
I think that's a reasonable question, especially if you watched our last
video on sperm production where we learned the testes produce millions of sperm cells per day.
So we're going to address that.
We'll talk about how the procedure is done,
discuss the pros and cons of this form of birth control, and if it can even be reversed.
So, to the cadavers!
The exact details of sperm production were discussed in one of our previous videos.
We will definitely provide a link to that video.
However, we're going to pull some highlights from that video that
are relevant to today's discussion.
So let's take a look at the right side of the cadaver,
specifically the right side of the groin here.
The first structure I want to highlight is the Spermatic Cord.
It's going up towards the abdomen or if we go downward that's going to take us to
the right Teste or Right Testicle. Now, inside of the Spermatic Cord
we've got blood vessels, like veins and arteries for blood supply to and from the Testes.
Also nerves for sensation and controlling muscular tissue.
There is also a really important tube that's going to transport sperm cells away from the Testes.
If I reflect this and pull the Teste out of the Scrotal Sac, you can see
we've still got the connective tissue surrounding the actual Teste.
If I turn it over, you can see we've reflected that tissue away, and here is the Right Teste.
Now on top of the Right Teste this is a structure here called the Epididymis.
Now "epi" means "upon",
"didymus" means "teste" — so a great name for a structure that's sitting on top of the Testes.
But if we were to go inside of this
Epididymis we'd see a highly coiled tube just coiled up in there.
If you were to straighten that out it would be 20 feet long.
Now what's going on inside of the Epididymis?
Well this is where sperm cells mature and where they actually are stored.
So with 20 feet of tubing there is plenty of storage space.
What happens when the sperm cells are pulled out of storage or in other words called upon?
Well in that case they're going to leave this structure called the Epididymis,
or our little storage facility here, and move into another tube called the Vas Deferens,
also known as the Ductus Deferens. Either name is appropriate
but this Vas Deferens is the important tube of our story.
It's about 18 inches long.
That's quite a remarkable length for a tube that's transporting sperm cells.
But, when we talk about the pathway that it has to travel it makes a little bit more sense.
You see, it's going to pull the sperm cells from the Epididymis, move up the Spermatic Cord,
and enter through a canal in the Abdominal Wall, to go back inside the Pelvic Cavity, wrap around
the back side of the Bladder, and enter into the Prostate Gland to eventually meet up with Urethra.
It's quite the length.
Now we can see functionally this tube is all about transporting those sperm cells
but inside this tube there's smooth muscle embedded in the walls and that helps to facilitate
the movement of the sperm cells along this pathway.
Now what activates the smooth muscle?
Well that typically happens during sexual arousal.
So when arousal occurs that sends some nerve impulses to the smooth muscle
to start contracting and propelling the sperm cells forward to eventually get down,
like we mentioned earlier, the Prostate, which contains the part of the Urethra.
Then there was this day in the past when someone thought,
“hmm, if I can stop the sperm cells from going from the Testes to the Prostatic part of the
Urethra we could have men deal with the birth control”... and then all the women were cheering
in the streets and the birth control pills, and the IUDs and the implants were tossed into the
fires as humanity celebrated the development of the procedure known as the Vasectomy.
That's not really how this all went down but, the point is
we got to stop the sperm cells from getting out.
To do that we're going to talk about snipping this tube.
Now there are two main approaches to a Vasectomy.
One is referred to as the Conventional Vasectomy,
and that is when they actually make a one centimeter incision into the Scrotal Tissue.
The other is referred to as a No-Scalpel Vasectomy, which is kind of self-explanatory.
In this case they use a puncturing tool to puncture through the Scrotal Tissue.
Now a lot of people will think, "well what's the main difference there?
You still got to go through the Scrotal Tissue!"
I agree.
The end game is still to isolate this Vas Deferens.
The no scalpel approach tends to be associated with less pain and fewer complications.
Both are pretty effective but if you have to pick the winner
the No-Scalpel approach is a little bit better.
But, once they isolate the Vas Deferens here they'll create a loop
and we actually remove a little piece of it.
They'll take on average out about 10 to 15 centimeters of that tube out.
Let me kind of show you that in a larger little object lesson here with a bigger tube.
So let's imagine this is the Scrotal Tissue — the pink glove there.
We've isolated the loop of the Vas Deferens, and I'm going to snip here, I'm going to snip there
because we're going to remove a few centimeters.
This is obviously not to scale but, we've got these two blunt ends here and before we
put the two blunt ends back in the Scrotal Sac we're going to
cauterize the inside of the tubes to block them off so no sperm cells
can leave the testicular side and go into the side that's going to eventually make it to the Urethra.
Now on top of that remember, let me show you this.
This connective tissue that surrounds the Testis and even the tubes — we've
removed a lot of it there — they'll take a little
piece of that like Fascial Tissue and they call it a Fascial Interposition
and put it over the end that essentially would go out through the rest of the body.
They'll stitch it down with some absorbable stitches and then you've got cauterized ends as
well as a blocked end with Fascial Tissue and that tends to make these even more effective.
So once that has been completed the person is either stitched or glued up.
If they used the conventional approach because they made the
incision they'll use sutures or stitches.
If they use the no scalpel approach usually glue is just enough to hold the Scrotal Skin together.
But, then we have to talk about aftercare and what to do after the procedure.
So men are often advised to wear supportive underwear for about 24
to 48 hours after the procedure to help minimize discomfort.
They can also use things like Tylenol and Ibuprofen
or even icing the area three to four times daily, again just to minimize discomfort.
However they are given very strict coital precautions, or in other words they are advised
to use other methods of contraception for about three months after the procedure and here is why.
Yes, we mentioned that the Epididymis stores the majority of the sperm cells
however, some of those sperm cells will make it into the Vas Deferens
and can be stored in there for extended period of time, up to three months.
So a clinician who did the surgery will often recommend to the patient that they do a seminal
analysis three months post procedure to analyze if there's any sperm that has been released.
Now, 80% of men typically have zero sperm cells, but if there is any they'll do a
follow-up seminal analysis to just see if they needed more time to clear the tubing.
Now there was an interesting study that came out that said, coital frequency of about three
times per week tended to clear the area of sperm cells more quickly than any other way.
So you could maybe think the more coital activity, or the more intercourse,
the faster you can clear all the residual sperm cells out of that Vas Deferens.
Seems pretty reasonable to me.
Now how effective is a Vasectomy?
It is the most effective way for male birth control and one of the
most (effective) overall types of contraceptive methods — up to 99+ %.
Nobody wants to say 100%, but pretty close.
Because there has been some rates of what they call Recanalization,
or in other words the tubes reattaching to each other.
But that's rare.
We're talking about .2% of cases and there's some disagreement and some variability based on the
type of procedure that was used. Did they cauterize?
Did they use that Fascial Interposition that we mentioned?
In this, all those could potentially influence the rate of Recanalization
or the tubes reattaching to each other.
So let's talk about the pros and cons.
Pro is, the cost isn’t that expensive,
ranging from anywhere from $300 to a $1000 in the United States.
If you calculate that over time that actually will end up being less expensive over the lifetime
or many many years of use of say like birth control pills or other contraceptive methods.
Another pro is that this does not affect blood supply to the Testes or nerve supply,
again, if these procedures are done correctly.
It also does not affect Testosterone, so there's no hormonal issues with this type of procedure.
What are the cons associated with this form of contraception?
One is the pain and discomfort after the surgical procedure.
However, that tends to be fairly short-lived and
most men get back to their routine relatively quickly.
The other is surgical complications like infections or Hematoma formation.
Fortunately people are getting pretty good at these and those complications are pretty minimal.
Now the last question we often get with Vasectomies is, can this be reversed or
in other words can we take this tube and reattach it even though we took a little piece of it out?
The answer is yes, but the success varies depending on the study.
I've seen studies that say
successful reversal from anywhere from 30 - 50%, all the way up to 50 -70%.
What tends to be agreed on is that the longer in between, from Vasectomy to procedure to try
to reverse it, the longer that time goes, the success rate tends to go down a little bit.
That is why when they talk to patients about
doing a Vasectomy they really want to make sure this is what you want to do.
If you do change your mind there still is some hope.
Finally the most common question we get is, what happens to all those sperm cells that
are being produced every second of every day even after a Vasectomy has taken place?
Are we worried about this?
Are we going to get a build up of swelling?
Do they have to be released?
The answer is no, because as sperm cells get older or age they start to degenerate.
Remember the sperm cells were stored in that structure called
the Epididymis that had that tube that we could stretch out or straighten out to 20
feet long on the inside of that tube there are some specialized cells lining it.
On the inside wall of the tube and those specialized cells
have these structures called Microvilli.
Microvilli are important because they increase the surface area
so that they can more effectively reabsorb degenerating sperm cells.
So as sperm cells are being produced each day they're also being reabsorbed each day.
Now this wouldn't just apply to a Vasectomy this would also apply to an individual that has gone
longer periods of time from intercourse or other activities that release sperm cells.
So I also have to apologize profusely to those who've used the excuse
that they need intercourse in order to release the sperm cells
because of some you know detrimental effects that, that might have if they're not released.
I'm sorry, that's just not true.
However I would argue this — there are plenty of other benefits to intercourse.
I don't know, like love, connection, acrobatic exercise, the list goes on and on.
As always, thanks for watching.
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Let us know what you think of different contraceptive methods
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and everyone must clothe themselves with Institute of Human Anatomy merchandise.
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So until next time, stay safe out there and we'll see in the next video.