It is difficult to find another surgical procedure as simple as vasectomy that has sparked so much medical and social controversies for more than a century. The history of this procedure is a combination of finding the most ideal technique and the best results but also filled with misconceptions, false beliefs and incorrect indications. Vasectomy has a long and interesting history. The term vasectomy means an excision of the vas deferens. In Latin, vas means vessel and deferre means to carry down. As a medical term, vasectomy is somewhat misapplied because only part of the vas deferens is excised during the procedure. Vas deferens as an anatomic structure was not a subject of significant clinical and research interest until the nineteenth century.
A short history of Vasectomy:
Vas deferens named by Berengarius of Carpi.
Oldest condoms found in Dudley Castle in England, made of fish and animal intestines. Believe to be used to prevent STDs.
Early account of the vas deferens listed in Sir Ashley Coopers “Observations on the Structure and Diseases of the Testes”.
Goodyear and Hancock begin mass producing rubber condoms
Advertising of birth control made illegal under the Comstock Law
Research shows that obstruction of the vas deferens had no effect on sperm production- the testes still produced sperm even when it was blocked!
Vasectomy suggested as castration alternative for treatment of prostatic hypertrophy
Ochsner published “Surgical Treatment of Habitual Criminals”, a precursor to the infamous eugenics movement.
Documented from this period was the curious case of a young man in Indiana who volunteered himself for castration due to “excessive masturbation”. Vasectomy was suggested instead. According to Sharp, the operation was a success: “The man’s mind and nervous system – especially the centres of self restraint are strengthened by re-absorption of sperm”. We know now that vasectomy has no physiological effect on masturbation habits.
Indiana introduces bill authorizing the compulsary sterilization of any “criminal, idiot, rapist, or imbecile in a state institution”. 29 other states passed similar bills shortly after. Eugenics was picking up in America and around the world.
Bouin and Ancel examined the effects on sex glands in animals, concluding that vasectomy in post-pubescent animals caused degeneration of germinal tissues in the testes.
The first vasectomy was performed for the purpose of “rejuvenation” by Steinach, based on an experiments on animals that led to the belief that vasectomies would lead to renewal and transformation. It is notable that Sigmund Freud and WB Yeats had vasectomies for this purpose.
Simmonds found that blocking of vas deferens did not lead to testicular degeneration or loss of germinal tissues. He found that the epididymis was enlarged by the all the sperm carried to it. Doctors conduct further research on the “rejuvenation” theory.
At this time many doctors believe that vasectomy could result in regrowth of hair, better color, better erections, and increased libido.
Sterilization laws are challenged in court in Virginia, but upheld. Many early sterilization laws were overturned, but since 1909, over 6000 people were sterilized against their will in the United States.
The Kaiser Wilhelm Institute for Anthropology, Human Genetics and Eugenics is established, experimenting in how to discriminate different races and ethnicities based on blood type and the shape of different body parts. Switzerland introduces the first eugenics law in Europe the year after.
The first German sterilization law is drafted by the Reich. A law was passed that required a certification of fitness to marry and those who did not pass were tried in “hereditary health courts”. Germany enforces sterilization under the certification of fitness law.
Rejuvenation procedures have largely fallen out of favor at this point.
World War Two ends and eugenics as a movement fades in popularity.
At this time vasectomy reversal is 40% effective.
Garrison and Gamble reported little to no change in sexual performance in a sample of 50 men, and those that did actually reported an increase in libido!
Walker states “It can be said with confidence that vasectomy has no adverse effects on the physical or mental welfare of the patient. Operative patients have now been watched for a period of 30 years and no delayed adverse effects have been noted”. The only exceptions were in cases of surgical errors.
A new single incision, single-stitch method of vasectomy is invented that resulted less trauma and less post-operative care.
First trials of oral contraceptive are successful by Pincus, Chang, and Rock.
Enovid, made my Searle, is the first registered female contraceptive in the United States.
Poffenberger reports, “Not only were men pleased with the result of the operation but they talked about its advantages freely and attempted, often with success, to convince others to have it done. In some cases, men came several hundred miles to have the operation. 85.6% of the men there was no medical problem stated as a reason for requesting vasectomy”. At this time, vasectomies were still rare for family planning purposes- they were usually used as treatment in a medical context.
The US Supreme Court makes a landmark ruling legalizing the use of birth control in Griswold v. Connecticut, leading to widespread acceptance of birth control in the US.
Kothari and Pardanani show that a reversible vasectomy-like procedure is possible using a synthetic thread to block the vas deferens.
“Vasectomania” is a term coined by D & H Wolfers. The paper provided commentary on the ethics of sterilization, stating “The free, unprompted, informed decision of a man to terminate his own fertility is the only legitimate reason for vasectomy.”
No-Scalpel vasectomy techniques are pioneered by Dr. Li Shunqiang in China. The vasectomy was minimally invasive with much lower complication rates, especially in parts of rural China that had limited facilities.
A man in Germany sues for a child born after a vasectomy. The case is dismissed as failure is certainly possible, as stated in the consent form.
A study by Wagenaar finds that vasectomy does not reduce incidence of epididymitis when used in prostatic surgery.
The 1978 Federal Sterilization Regulations are put into place to prevent eugenics. The purpose of this bill was to ensure that patients were fully informed of the ramifications and not coerced into being sterilized- however, its efficacy left something to be desired. Many Americans, especially those that are targets of sterilization, had below average literacy rates which resulted in the spread misinformation.
The first No-Scalpel vasectomy is performed in the United States by Dr. Mark Goldstein, who learned it in China. The procedure was spreading rapidly to the rest of the world.
FDA approves female contraceptive implant “Norplant”.
Vasectomy is made even simpler with No-Needle vasectomy techniques, using a “hypospray” jet injector to deliver anesthesia instead of syringes.