Choosing An Open Or Closed Vasectomy in Beverly Hills

Reproduction is all about pipes and valves, isn’t it? (Courtesy: Sam Loyd, Unsplash)

“Why aren’t open vasectomies more popular?” It was a good question and reflected the research he had done on the matter. Sometimes, it’s the simplest, most basic questions that get you thinking the hardest.

What’s the Difference: Open & Closed Vasectomy

What most of us do are called closed” vasectomies: Each of the two sperm conducting tubes in the scrotum is first divided and then blocked on each end by one means or another. That way the flow of sperm is interrupted, which is the goal of sterilization. And neither side “leaks” anything, because both sides are corked off. An “open” vasectomy is where only one side of the cut vas deferens is blocked, and the other side is left open. Importantly, the side coming from the testicle, laden with sperm, is left open and the abdominal end of the tube is blocked. In this way, the sperm spills into the scrotum and cannot (easily) get back into the vas deferens.

Although the “open and “closed” vasectomy camps have been sparring for 40 years, there is still no outright winner. According to our national society guidelines, either approach is acceptable for everyday use. So why aren’t open vasectomies popular?

A Historical Objective Look at Open & Closed Vasectomies

From my review of the literature, it appears that open vasectomies are associated with a slightly higher failure rate but also a slightly lower chronic pain rate. In other words, it may fail more often as a contraceptive, but it feels better doing it. The difference in failure rate may be due to the fact that while closed vasectomy shuts both doors — entrance and exit — to sperm passage, open vasectomy leaves one door open. And sperm are very motivated to find ways to get out!

The reason closed vasectomy causes more pain is probably because this technique is more likely to lead to a pressure buildup behind the blockage, which can cause bothersome epididymitis or congestion near the testis. But open vasectomies are not without pain: inflammatory granulomas in the scrotum occur with open vasectomies as spilled sperm are exposed to the body in unnatural ways, revving up the immune system which sees them as “foreign.” More granulomas but less epididymitis. Pick your poison.

The problem with the literature from which all of this stems, though, is that it’s old. Now, old is OK except that the rigor of the research is weak and the follow-up is lousy. For example, the majority of studies relied on patients to self-report their symptoms, which is unacceptable by today’s standards.

As we all know, many men suffer in silence, for whatever reason. If they came into the office with an issue, then the provider knew about it. If they did not, then no one knew about it. You really have to interview or survey men to get honest answers.

A Vasectomist’s Up-To-Date View

I did quite a bit of research as a testicular immunologist in medical school and this colors how I think about vasectomies even today. First off, all open vasectomies will eventually close. It’s what the body does with leaks. It just takes longer with an open vasectomy. Secondly, sperm are created in the body at puberty, having never been seen before and are “foreign” to the immune system. To me, this means that the potential inflammation, pain and scarring is more likely when sperm spill out of their natural habitat. It makes more sense to keep them where they normally live within the vas deferens and to not wake up the sleeping giant that is the immune system. Lastly, my patients just don’t have the same pain rates that are reported in the literature, which gives me pause when I think about changing what I do. And believe me, I am all about change if it’s for the better.