Dear Dr. G,

I am a man in my forties and have two grown-up teenage children.

My wife and I both decided that we have completed our family and will consider male sterilisation.

As my wife had such a tough time with oral contraceptive pills, where she gained a lot of weight and had uncontrolled blood pressure, I offered to be the “sacrificial lamb” for the vasectomy.

I went to a urologist, who explained the procedure and consequences after the operation. He discussed the long and short-term problems after the vasectomy, including the low risk of infection, complications and even the chances of reversibility.

Indeed, the procedure went well as the operation, performed under local anaesthetic, took 20 minutes with minimal suffering.

It has been five months since the snip, and I have given the samples to prove that I no longer ejaculate any sperms. Although I am essentially symptom free after the operation, I somehow have this feeling of emptiness that I cannot explain.

I went to the urologist, who said it is all in my mind.

I would like to put Dr. G on the spot to ask about the sense of emptiness after vasectomy. Why do I have a sac full of sperms but a sense of emptiness?

What is the cause of this feeling and how long will it last?

Please help,
Empty Edward

Vasectomy is a surgical intervention for the sole purpose of permanent contraception. The sterilisation procedure involves the male vas deference segmentally excised, sealed and ligated to prevent the “coming-out” of sperms to the outside world through intercourse.

Due to the simplicity of the procedure, with short post-operative recovery, vasectomy is increasingly gaining popularity. Many men are pleasant surprised after a short recovery in the clinic, immediately resuming light daily activities. In fact, this minimally invasive intervention can also allow men to resume typical sexual behaviour, with minimal discomfort within a week of operation.

Although female sterilisation is still the predominant form of permanent contraception for couples, vasectomy is increasingly acceptable for men. According to the psychological analysis, the concept of “shared responsibility” is gaining momentum; with many men considering vasectomy an act of “minor heroism” shouldering the burden of contraception.

In addition to the initial consideration of minor post-operative complications, men contemplating vasectomy should also take into account the long-term outcome that might affect them physically and emotionally.

A 2012 study consolidating post-operative data on vasectomy revealed a low immediate complication rate of 2.5%. The common short-term complications include infection, bruising and slight bleeding. Although the long-term association of vasectomy with post-vasectomy pain syndrome (PVPS) is well documented to be 0.9%, the psychological impact of the sterilisation is less well reported.

Researchers published the data of well over 90% of men satisfied with the decision to have a vasectomy, while 7% of men regret their decision. For men in relationships, regret was less common when both couples in the relationship agreed on the decision.

One study highlighted the emotion of sadness, void and emptiness, when the decision of “baby-making” days had just ended. One study described “post-vasectomy grief”, when men closing the baby-making chapter of their lives will encounter sadness and nostalgia. Men may move through potential stages of emotional roller coaster of denial, bargaining and depression, before coming to terms of the acceptance phase.

For a small minority of men, there is even a prolonged sense of emptiness, despite two sacs full of obstructed sperms.

The American essayist and leader of mytho-poetic men’s movement, Robert Bly, well-known for his book “A Book About Men”, once said: “The beginning of love is a horror of emptiness.”

For men with apprehension in shouldering the “heroism” of responsibility in contraception, and being “arm-twisted” into the snip can inevitably lead to the horror of emptiness. While most men after vasectomy would celebrate the end of condom usage and fear of unwanted pregnancy, a minority of men grief the decision to shut down the baby-making factory.

Dr. G would advise men doubting their decision months or years after the snip to focus on the joy of rubber-free love making, without the loathe of diaper changing sleepless nights.

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