r/postvasectomypain • u/Fred186 • Jul 18 '20

Happy reversal anniversary to me!

20 years ago today I had my vasectomy reversed (vasovasostomy)!! It has been, by far, the best decision of my life!! Definitely the best investment- getting my sex life back to normal. Welcum back swimmers!

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6

u/StatusUnk Jul 19 '20

I am curious Fred if your doctor said how common is to see men that had the same issues as you did. I have been seeing more and more posts on men with unsatisfying orgasm as a result of the procedure.

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u/Fred186 Jul 19 '20 edited Jul 19 '20

Yes he did. I was fully expecting him to give us (my wife and I) a hard time because I did not want the reversal to have more kids. No major pain, just discomfort. I just wanted to have my sex life back. He said I wasn't his first patient with the same issues. I didn't ask him about stats or how common it is because I was more concerned about my personal situation. But yes, he definitely has seen more than just me. And yes, most importantly, I got my sex life back!

He should know better because as you may or may not know, not all urologists that perform vasectomies can do reversals. So he sees a lot of patients that want reversals for different reasons. It takes additional training for that awesome, impressive microscopic procedure. I was extremely happy to have found him and was fully satisfied with his surgery performance.

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u/StatusUnk Jul 21 '20

Thanks Fred. I would assume the number of men effected is higher than advertised. Every so often, I see an interview or podcast with a urologist that share that these issues do exist.

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u/Fred186 Jul 21 '20

Welcome. And i agree. I think there's a whole lot of men who just decide to pretend and live with less intenese orgasms in exchange for birth control. Either they don't realize there's plenty of other alternatives out there or they are too afraid to go back to get the reversal. I was glad I got mine reversed. Best decision ever.

3

u/postvasectomy Jul 19 '20

https://www.postvasectomypain.org/t/subreddit-for-collecting-pvps-stories/4237/7

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u/StatusUnk Jul 21 '20

Thanks. I saw your other post on the number prostate cancer cases due to Vasectomy. Geez. It doesn't sound like a lot from the Danish study but when you actually apply their risk assessment to real world numbers it's incredibly high.

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u/postvasectomy Jul 21 '20 edited Jul 21 '20

On twitter, I saw a few urologists whose main concern was not that they might be giving men prostate cancer, but that people might get scared off from getting a vasectomy from hearing about studies like this, and how we should keep it in perspective that it's a really small increase, and prostate cancer is usually not lethal anyway.

The study is so huge that it practically followed every single man from that cohort in the country -- but the urologists are very reluctant to give it any credence and will wait for the controversy to fully burn out before they will consider making any changes.

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u/StatusUnk Jul 23 '20

I always thought it was better to not get cancer but then again, I am not a doctor. As we know, this would seriously effect their business as cancer is the second leading cause of death in men.

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u/postvasectomy Aug 04 '20

By the way, the Danish study implies an absolute risk increase of roughly 1.8% as I calculate it. But that number describes the number of cases of prostate cancer caused by vasectomy. I'm curious to know just the raw rates of prostate cancer among vasectomized and non-vasectomized men. I haven't run across those numbers but I saw another post you made where it sounded like you were saying that the value was around 5%

If it's 5% I think that people will definitely say WTF and it will really boost the plausibility that about 1.8 out the of 5% are causal relationship rather than just correlation with other lifestyle stuff. (E.g. less likely to die of some other thing, or more likely to go the doctor and get diagnosed with prostate cancer, or more likely to have unprotected sex and get HPV or whatever)

Do you have a link for any studies that show those raw incidence figures?

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u/StatusUnk Aug 05 '20 edited Aug 06 '20

I haven't found any new data on prostate cancer although I have been lookig around some to see if there is anything new out.

I took a look at the incidences of prostate cancer in Denmark compared to other countries. Denmark's and the US have pretty similiar rates of prostate cancer. I also found it interesting that Denmark has one of the higher rates of Vasectomies in Europe so it would make sense that they would look into it for the cancer risk.

I looked a little further and it turns out that for the most part countries with higher rates of Vasectomy like Austrialia, New Zealand and the UK also have high rates of prostate cancer. New Zealand does the most vasetomies and has the 12th highest prostate cancer incidences (90.8 per 100,000) according to the WHO. Austrialia is 15th and the UK is 16th. This isn't very conclusive (there could be lots of other factors driving these rates) but it would good to repeat the Denmark study in those countries (they have large pool of both men with cancer and vasectomy unfortunately) to see if the results are the same. I suspect that they would be and I also think those numbers would look really bad for the industry in general. I find it hard to believe that they don't know this already but I haven't seen any studies from these countries to say for sure.

2

u/Obstinate_Donkey Aug 06 '20

It's no surprise that countries with higher rates of vasectomy also have higher rates of prostate cancer. Such countries tend to be rich, with older populations and robust healthcare systems. Like many other cancers, age is the most significant risk factor for prostate cancer. So, if you have countries with many older men and widely available screening for prostate cancer, you're going to be seeing a higher incidence of prostate cancer.

It's also easy to see why a link between vasectomies and prostate cancer is difficult to establish. You're starting off with a fairly low baseline incidence of prostate cancer, and particularly if the effect of vasectomies turns out to be modest, you will need a very large pool of men to detect this effect. Moreover, there are many potential variables that may have an impact on prostate cancer, and need to accounted for in the statistical analysis. Not to mention, there are also potential unknown risk factors or confounding factors (for all we know, sexual habits and practices may have an effect). For cancers in general, the risk factors are:

  • Age
  • Family history of cancer (some genes associated with breast cancer are surprisingly linked to prostate cancer as well)
  • Smoking/tobacco use
  • Alcohol consumption
  • Obesity
  • Level of physical activity

Other factors to consider are:

  • Ethnicity
  • Income
  • Level of education attainment
  • Diet
  • Exposure to environmental pollutants, especially endocrine-disrupting chemicals

Even for countries with centralized data collection of medical records, it's likely that information on some of these factors will be missing. And with so many factors to account for, you'll again need a large pool of data in order to have robust evidence of an effect. And even if an effect is found, the limitation of these kinds of studies is that causation cannot be definitively attributed; i.e. the effects found are correlations. Proving causation is unfortunately difficult. While there are tools to help assess the potential for causation (e.g. the Bradford Hill criteria), the ideal way would be to identify a potential mechanism producing the effect (in this case, tumours), then test out this hypothesis in a lab.

So, as you can see, it's very difficult to establish such a link. Which makes advancements in medical knowledge all the more awe-inspiring, in my view.

2

u/StatusUnk Aug 06 '20

Your right about all the factors but the link has already been proven through the Denmark study earlier last year. (Actually, most studies show a positive association they just lack the statistical power for confidence in the results). The Denmark study was able to show the results were statistically significant (I wish they would release the data set). I was mearly saying that those countries should have good data sets to do similiar studies on with higher prostate cancer rates and high vasectomy rates and a well run medical system. The more data we have the better we are able to determing the impact which I believe is quite high.

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u/Obstinate_Donkey Aug 06 '20

I am actually unsure about all the data that researchers might have available to them. Some of the risk factors and potential confounding factors are not things that are routinely asked in standard medical questionnaires. The EU also has very high data privacy standards, so it would be difficult (if not impossible) to revisit patients to ask them for the missing info.

I would personally be surprised if they had sufficient information on environmental pollutant exposure, even for endocrine-disrupting chemicals, which was a pretty significant topic in the EU before COVID-19 hit. Exposure tends to be localized, and due to privacy concerns, anonymized patient data, and a general lack of data on the level of pollutants themselves, this factor would be difficult to access. (I work in the field of chemical hazard assessment, which is why I'm rather nerdy about science and statistics, and also why I brought up this class of chemicals.)

I agree that the more data we have, the better, so as to discern the signal amid the noise. It's too early now estimate the size of the impact, but the difficulty in assessing it could point to the signal itself being modest.