consultation changed my mind
NotForMe
and the doctor convinced me not to have the vasectomy.
The doctor is Dr. Stewart McCallum, a urologist at Stanford Hospital, who
"has extensive experience in performing complex vasectomy reconstructions,
sperm retrieval techniques and microsurgical varicocelectomies."
(according to the website [1]). He normally performs closed-ended NSV
vasectomies.
I'm 31, childfree, and not in a relationship. I've been convinced for the
past six years that I do not want to ever have children. I decided a
couple of months ago to go ahead with a vasectomy and I've been
researching it on the net. I've had some experience with misinformed
doctors in the past so I went in today with the attitude that I've got to
be informed as possible before I see the doctor, that doctors are tools,
and that it's important to know how to use them effectively to get what I
want. Here's what happened:
I saw my primary care physician a couple of months ago and asked for the
referral. She raised her eyebrow at my request to have a vasectomy, given
my childfree status, and asked me some basic questions to determine how
serious I was. It wasn't too hard to convince her.
Today I met first with the doctor's assistant who gave me some basic
procedural information. He said he wishes he'd thought twice about having
kids. Pressing for clarification, I said, "It's a lot of work to raise
kids," and he said, "Yeah, especially as a single parent." Good. I felt
it wouldn't be hard to convince these people that I'm serious.
Next I saw a doctor-in-training (this is at Stanford Hospital, which is
part of a medical school). She asked me more about my history and pressed
me further about my reasons for wanting the vasectomy. I laid out all my
reasons (there are enough people in this world already, if I have to raise
a kid in the future I'll adopt, etc.) but felt some resistance--it was
much harder to convince her. Still I thought no problem, I need only
convince the doctor himself. The interactions are going pretty fast (as
they usually do at Stanford), and I was worried that I might not have
enough time with the doctor to answer my checklist of questions.
When the doctor came to talk to me, two more students where in the room
(including the resident I spoke with before). He was relaxed and spent A
LOT of time talking with me. It's a blur in my head right now but I'll
try to capture most of what I can remember. He said right away, "So what
brought you to this decision?" I started down my list of reasons, but he
kept repeating "What brought you to this decision?" I felt like he was
really trying to connect with me. Fine, I laid out my most serious
reason, which I hadn't brought up before this point (my big gun, as it
were). He wasn't convinced.
He started talking about his duty as a doctor to do no harm, and how he
always avoided performing surgery on healthy people. He then went into
great detail about the risks of PVP syndrome (I was thinking, this is
great! I read on this newsgroup how many doctors just seem to skip or
gloss over this). He said the incidence is less than 3%, but then he
really emphasized, when you get it, YOU DON'T CARE ABOUT THE STATISTICS
(I'm emphasizing this with caps to reflect his emphasis). The intern then
repeated the same thing. She said, when you get it, you get it 100%. She
said there is no standard effective treatment for PVP. The doctor said
when they treat a patient with PVP they aim for 60% pain reduction as
their goal. The intern piped up with "enough pain reduction so the
patient can return to work."
The doctor said think about it, these are your testicles. He said he has
had problems with his back, but he can find a comfortable position to sit
in to avoid the pain. He said how are you going to avoid pain in your
testicles? They're swinging all over the place; there's no way to get
them into a comfortable position. He said "What are you going to do, tape
them to your thigh or your abdomen?"
Throughout this both of them had a sympathetic tone in their voices and a
cooperative attitude. They weren't trying to scare me; they were
educating me.
The doctor said that not any of his vasectomy patients have had PVP yet
(knock on wood), but the statistics predict it will happen some day. He
said he has had many patients come to him with PVP that had vasectomies
elsewhere. He said that when patients don't respond to pain, they often
remove parts (such as the epididymis), and sometimes it's so bad the
patients have the entire testicle removed!
He said patients will sometimes have pain every time they ejaculate, and
they often lose interest in sex, for simple Pavlovian reasons. They
associate sex with pain.
I asked about the open-ended procedure as a way to minimize the risk of
PVP. Both the resident and the doctor were familiar with it and responded
that it increases the chance of failure. At any point in the future, they
said, the vas could reconnect enough to make the man fertile again. The
doctor also discussed how sperm getting dumped in the body can trigger an
autoimmune reaction and cause inflammation.
The doctor spent equal time on how many times he's seen patients who were
adamant that they never want kids and then later came back for a reversal.
He's done a lot of reversals. He said they're really to be avoided:
they're expensive, things don't always get put back exactly the way they
were, and they're not always effective. He asked me whether I had a happy
childhood, whether I wanted to talk to someone about any issues I might be
anxious about. I said no thank you, and was amazed at how sincere he was
and not patronizing. This guy really didn't fit my cynical expectations
about doctors being too rushed to care about the patient.
I don't go down without a fight so I spent some time sparring with him
about how committed I am to never having kids. He responded to everyone
of my points, then dropped the bomb: He was electing not to perform the
surgery on me! I was surprised, and thought he was testing my conviction
again. I told him I respected his decision but that I would find another
doctor because I was determined. He took me seriously and talked some
more.
Eventually he won me over. I kept thinking, "Damn, this guy's articulate,
and caring, and he's covered every point I've read on the Internet about
this." What I couldn't get from the Internet was the perspective of
someone who has a ton of professional experience with vasectomy, which
this guy does.
I finally said, "OK, tell me specifically why aren't you electing to do
the surgery on me. Is it because you think I might change my mind later
or because of the risk of PVP?" He said it was mostly the former but
partly the latter as well.
He even encouraged me to look at newer forms of sterilization, such as
hormone therapy. I asked him for more information and he said "The
Internet's a great resource for that, start with Google." I love this
guy!
All in all I feel really lucky that this doctor took so much of his time
to share his considered opinion with me and to take me very seriously. I'm
still adamant that I don't want to have kids, but think having kids is
fine for other people. After today I now think vasectomy isn't for me
(I'm not willing to take the risk of PVP), but it may be fine for other
people. Certainly this doctor thinks it's okay for people in other
situations, because he performs them all the time.
[1] A web page describing Dr. McCallum is here:
http://www-med.stanford.edu/school/Urology/McCallum.html
I'm grateful for having had the opportunity to read other people's stories
and hope my story is helpful for someone else.
NotForMe
David
all avenues were covered, including the opportunity to discuss childhood. I
guess this *could* have come accross as offensive to some, but clearly you
felt he was being a good practitioner.
How about having this story on the group website "Vasectomy stories" page?
I'm sure others would like to read it!
David
www.vasectomy-information.com
"NotForMe" <fa...@example.com> wrote in message
news:pan.2003.07.23....@example.com...
trifold
> to share his considered opinion with me and to take me very seriously. I'm
> still adamant that I don't want to have kids, but think having kids is
> fine for other people. After today I now think vasectomy isn't for me
> (I'm not willing to take the risk of PVP), but it may be fine for other
> people. Certainly this doctor thinks it's okay for people in other
> situations, because he performs them all the time.
>
> [1] A web page describing Dr. McCallum is here:
> http://www-med.stanford.edu/school/Urology/McCallum.html
>
> I'm grateful for having had the opportunity to read other people's stories
> and hope my story is helpful for someone else.
>
> NotForMe
All in all, this consultation sounds like a model, covering risks of
medical complications as well as the possibilities of post vasectomy
regret re: being sterile. I wonder how the 3% pvp risk your doctor
quotes compares with risks of complications from other birth control,
including the pill for women or tubal ligation? It's interesting what
he said about looking into the "male pill" (e.g. hormonal bc for men).
We keep hearing that the male pill is just around the corner--and
that it won't carry risks of reduced libido etc. But we've been
hearing this for awhile! One lesson I guess is that a decision for
vasectomy (maybe like any decision?) should be based on lots of
information, and on careful consideration of various "sliding scales"
of risk-benefit that adjust according to particular circumstances:
eg. you are a young, single guy who is pretty sure he wants to be
sterile but who, statistically speaking, might change his mind (and
who probably be using condoms as his primary bc anyway); vasectomy
carries some risk of complication; there are new male bc methods on
the horizon that are not permanent and that *might* not carry the same
risks of complication; you have no reason not to wait (that is, you
are not now involved in a monogamous relationship that has ruled out
children, in which the female partner is placed at risk by hormonal or
other bc, etc.).
Congratulations on a great consult and on the careful thought you have
put into this (and for having the courage to change your mind about
something!). I hope you will agree to post your story to the website!
Giraud
I have a gut feeling that the doctor you spoke with (although I believe he
was probably very sincere) is the type who has a problem with someone
declaring he doesn't want kids.
Yes, it may be statistically true that many men your age change their
minds, but I suspect this doctor simply does not believe in doing
vasectomies on childfree men. It may be that he does not believe in the
idea of being childfree. There are lots of people who are "religious"
about the fact that everyone should have kids.
One reason I wonder about his motives is that he made that comment about
not wanting to "do surgery on healthy people." What's up with that?? I
mean, isn't every vasectomy he does that way? It can't be a reason, or he
wouldn't do any.
Also, he emphasis on the PVP, and then saying it was the more minor reason
he denied you makes me think he pumped up the PVP issue in order to
convince you not to do it. I wonder if he speaks so strongly of PVP to
people who've had kids.
On my consultation, the doc DID warn of PVP (just to give another data
point of a doctor who does not try to hide this), and he was frank about.
But even though I am childfree (38 and married, however), he didn't push
the issue. I simply said we did not want children, and he asked no more
questions about that.
You must do what you feel comfortable with, of course. If you are still
wondering about your choice, I'd suggest going for a consultation with
another doctor to get a different point of view.
Giraud
Giraud
> The doctor spent equal time on how many times he's seen patients who were
> adamant that they never want kids and then later came back for a reversal.
> He's done a lot of reversals. He said they're really to be avoided:
> they're expensive, things don't always get put back exactly the way they
> were, and they're not always effective. He asked me whether I had a happy
> childhood, whether I wanted to talk to someone about any issues I might be
> anxious about. I said no thank you, and was amazed at how sincere he was
> and not patronizing. This guy really didn't fit my cynical expectations
> about doctors being too rushed to care about the patient.
Just something else I thought of while reading this: did you get the
feeling that he assumed your choice not to have children could mean you
have childhood issues or other issues to work out? This doctor may be of
the opinion that someone who would consider not having kids is troubled.
It may be that he does not understand the perspective. If, however, he
struck a chord with you, which it sounds like, you probably should spend
some more time being introspective about your thoughts on it. Best wishes
with your decision and further steps, whatever they may be!
Giraud
NotForMe
> I guess this *could* have come accross as offensive to some, but clearly
> you felt he was being a good practitioner.
Yes, he really was being tactful.
> How about having this story on the group website "Vasectomy stories"
> page? I'm sure others would like to read it!
Yes, that's a good idea. I edited it later for clarity after I was
feeling more calm. I'll send the edited version to the webmaster of
Vasectomy-Information.com.
On Wed, 23 Jul 2003 08:12:37 -0700, trifold wrote:
> I wonder how the 3% pvp risk your doctor quotes compares with risks of
> complications from other birth control, including the pill for women or
> tubal ligation?
Good point. During my consultation I brought up this point, which is that
the whole thing is really a guessing exercise in risk management. For
example, what's the risk of PVP vs. the risk of an unwanted pregnancy vs.
the risk of me changing my mind later? All difficult to measure,
unfortunately. The one certainty is that no path is risk free. In
response, he did point out that (relatively speaking) it's hard for humans
to get pregnant (I don't remember the actual figure he quoted). I think
he was trying to make me feel better about the odds of an accidental
pregnancy while using a condom.
> (and who probably be using condoms as his primary bc anyway)
Yes, but I do anyway. I wanted assurance for when condoms fail. I've
already turned down intercourse more times than I've wanted because the
women wouldn't commit to abortion if the condoms failed.
> Congratulations on a great consult and on the careful thought you have
> put into this (and for having the courage to change your mind about
> something!).
Thank you! I'm thrilled to have gotten what I consider to be such great
medical care, but naturally I'm also disappointed at not being sterile. :(
On Wed, 23 Jul 2003 12:14:37 -0700, Giraud wrote:
> I have a gut feeling that the doctor you spoke with (although I believe
> he was probably very sincere) is the type who has a problem with someone
> declaring he doesn't want kids.
Thoughts below.
> One reason I wonder about his motives is that he made that comment about
> not wanting to "do surgery on healthy people." What's up with that?? I
> mean, isn't every vasectomy he does that way? It can't be a reason, or
> he wouldn't do any.
That was his first line so I think it was a way of introducing the
conversation, i.e., before we begin to negotiate justification let's
acknowledge that this is already something which is generally to be
avoided.
I may be giving him more credit for this than he deserves but that's how
I interpreted the statement and I agree. I believe surgery is always to
be avoided unless necessary because it's still fairly primitive (in
general, not vasectomy specifically) and usually carries side effects.
> Also, he emphasis on the PVP, and then saying it was the more minor
> reason he denied you makes me think he pumped up the PVP issue in order
> to convince you not to do it. I wonder if he speaks so strongly of PVP
> to people who've had kids.
I've given a lot of thought to what this doctor's biases may be. Having
looked at the web page describing his expertise, it appears he is an
expert in two areas: a) fixing vasectomy when things go wrong or someone
wants a reversal ("complex vasectomy reconstructions") and b) unusual
methods for retrieving sperm for men who are having difficulty getting it
("sperm retrieval techniques and microsurgical varicocelectomies"). He's
also got credentials up the wazoo and is a professor of urology at a
prestigious university (Stanford). So I'm thinking this is the go-to-guy
when things go badly (so he must see a lot of PVP) and when guys are
desperate to have kids but can't get the sperm out (so he sees a lot of
people wanting kids or changing their minds about kids).
So with these biases it would be tempting to dismiss him as anti-vasectomy
for a single, childfree person such as myself, or at least very
conservative. However, I did NOT dismiss him because biases or no, he
still covered all the groundwork in the consultation. The things he said
and the points he made were objectively valid. He may have chosen to make
them because of his biases but regardless I felt the points were sound and
relevant.
> On my consultation, the doc DID warn of PVP (just to give another data
> point of a doctor who does not try to hide this), and he was frank
> about. But even though I am childfree (38 and married, however), he
> didn't push the issue. I simply said we did not want children, and he
> asked no more questions about that.
Giraud, recognize that your situation was different than mine because
you're married. Both the doctor and the resident shared stories with me
about men who didn't think they're ever want children until they married
women they fell in love with. The resident added, "and it's not just the
woman who pushes for it [the desire for children] at that point, it often
comes from both of them." So because I've never been married, I haven't
been exposed to that risk yet and that worried both of them. I explained
that I've lived with a girlfriend for two years but apparently that wasn't
sufficient.
> Just something else I thought of while reading this: did you get the
> feeling that he assumed your choice not to have children could mean you
> have childhood issues or other issues to work out? This doctor may be
> of the opinion that someone who would consider not having kids is
> troubled. It may be that he does not understand the perspective. If,
> however, he struck a chord with you, which it sounds like, you probably
> should spend some more time being introspective about your thoughts on
> it. Best wishes with your decision and further steps, whatever they may
> be!
I realized after the consultation that I was nervous and that, from my
memory of his face, I think he was watching for that and it was a factor
in his decision. The irony is that I wasn't nervous about getting a
vasectomy. I was nervous because my reasons for not having kids are part
of a belief system that clashes with that of people who do want kids. I
always get nervous when I'm in a discussion in which my belief system
might clash because I don't want to impose it on anyone and I don't want
to make anyone else feel threatened. This could have happened with the
doctor--he's got two kids. I was able to avoid it entirely with the
assistant and the resident, but the doctor wanted a solid answer so I gave
him one, and I explained how experiences in my family shaped my beliefs.
It was this which caused him to ask about my childhood. I think he
suspected I might have had a bad childhood and that I was in danger of
over-generalizing about the odds of my potential kids having bad lives
too.
So I didn't want to say to him and the two women in the room, "Look, I
want a vasectomy because I want to have tons of casual sex with women I
don't care about" and "I never want to have kids for reasons which might
imply to you that I think you shouldn't have kids either". I was pretty
sure neither idea would go over well so I was nervous about keeping the
conversation away from them.
Of course, I realize I shot myself in the foot by being nervous because if
I were in his position, I'd probably decline to perform a nonreversable
operation on someone if he couldn't discuss the idea of it calmly,
implying that he might have unresolved issues regarding the decision.
However, none of that invalidates the excellent objective points he made
about the risk of PVP so though I wish I could redo my "performance"
during the consultation I'm still convinced by what he said.
NotForMe
trifold
> about the risk of PVP so though I wish I could redo my "performance"
> during the consultation I'm still convinced by what he said.
>
> NotForMe
But, as you say, he does vasectomise some guys. I wonder if in his
heart of hearts he sees the 3% risk applying to his patients, or only
to patients of doctors who are less skilled than himself, or who get
the wrong procedure. I mean, does he really think it is just a matter
of blind (bad) luck? BTW, did you guys talk at all about various
procedures?
NotForMe
> But, as you say, he does vasectomise some guys. I wonder if in his
> heart of hearts he sees the 3% risk applying to his patients, or only to
> patients of doctors who are less skilled than himself, or who get the
> wrong procedure. I mean, does he really think it is just a matter of
> blind (bad) luck? BTW, did you guys talk at all about various
> procedures?
He said he's never had a case of PVP with a patient of his own, but that
he expects at some point in the future he will (because of the
statistics). He also said that the cause of PVP is still unknown.
He performs the closed-ended NSV and I asked about the open-ended as a
way of reducing the risk of PVP. He was familiar with it but brought up
the typical objections: risk of refertilization and autoimmune response
to sperm in the body, possibly causing inflammation.
NotForMe
trifold
> way of reducing the risk of PVP. He was familiar with it but brought up
> the typical objections: risk of refertilization and autoimmune response
> to sperm in the body, possibly causing inflammation.
I never have understood this autoimmune response concern, as I think
I've seen statistics that show some 70% of men develop anti-sperm
antibodies even after traditional vasectomy.
David
> I never have understood this autoimmune response concern, as I think
> I've seen statistics that show some 70% of men develop anti-sperm
> antibodies even after traditional vasectomy.
The only real context I've seen it used is where it's grossly
misrepresented. The usual interpretation is "Hey - non vasectomised guys
don't get antibodies. Have a vasectomy and you get antibodies". This
interpretation is of course irresponsible nonsense.
This is misrepresentation because:-
1. According to one of the studies on the website, pre-puberty 90% of men
AND WOMEN have asa's. Post-puberty the level sinks to 60% and remains there
for life. This is non-vasectomised men we are talking about here.
2. Vasectomy does increase the incidence (70% seems to be an agreed figure)
BUT the only known effect of this increased incidence is that it might make
getting your partner pregnant post reversal more of a lottery. Yes, men
should be warned of this, and it's a very good argument to enforce the idea
that sterility should be considered as permanent.
3. On a quick search of Medline I found nearly 800 studies with the term
antisperm antibody. A very small percentage related to surgery (torsion
testicle, hydrocele repair, hernia, vasectomy etc) but the vast majority of
studies were in the area of infertility/inability to concieve.
David
www.vasectomy-information.com
trifold
These are good points. Also, to say that 70% of men post vasectomy
have ASA doesn't mean that that these guys all developed ASA after
their snips. Some certainly had ASA before.
David
> These are good points. Also, to say that 70% of men post vasectomy
> have ASA doesn't mean that that these guys all developed ASA after
> their snips. Some certainly had ASA before.
Some??? Rather more than "some" sunshine!
David
www.vasectomy-information.com
trifold
Ummmm. . .yes. Now that I think about it, maybe 60%?
trifold
David
"trifold" <trif...@netscape.net> wrote in message
news:f6289b53.03073...@posting.google.com...
immunofluorescence. This has been (as far as I can make out) the standard
method of measuring if they are detectable or not for some years. No doubt
somebody has devised something more sensitive that can "detect" the presence
of asa's in 100% of the population by now!
David
www.vasectomy-information.com