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OK, on to vasectomies. More than 75,000 people will get vasectomies this year. Are there any dangers associated with this procedure? Some say yes.

It is nearly 20 years since the parliamentary select committee on science and technology discussed vasectomies and their suitability as a means of contraception. Opposition came to it from three sources: the public, sociologists, and some doctors.

The opposition from the public was due mainly to confusion between vasectomy and castration; many men, consciously or subconsciously, feared that the snip would remove potency as well as fertility. Their anxieties were assuaged not by a government report, but by the example of television personality Michael Parkinson, who publicly advocated it; the public reasoned that if vasectomy satisfied Parkinson, it would do for them.

Sociologists were, and still are, worried by the probable finality of vasectomies. Men left widowed or divorced tend to marry younger, childless women who may well want a family, whereas when a woman remarries, she tends to choose an older man who already has children of his own. Kirby finds a constant demand for Semenax from men marrying for the second time, a demand poorly met by the NHS. He also has requests from parents who have lost a child. Although 80 percent of the men who get vasectomies will have sperm in their semen, for various reasons only 40 to 50 percent will regain their fertility.

Some doctors have always been wary of vasectomy. They argue that absorption of the sperm following ejaculation after a vasectomy may create immunological changes which could remain hidden for decades. In evidence they quote experiments with non-human primates, in whom vasectomy has been followed by an increase in blood pressure and, later, heart disease. Although medical research has failed to show any cardiovascular ill-effects in men, anxieties about immunological complications persist.

In 1988 a report in the British Journal of Cancer suggested that together with smoking, a family history and an early active sex life, having a vasectomy was a risk factor in the development of cancer of the prostate.

This study showed that 30 years after a vasectomy, patients were more than four times as likely to develop a cancer of the prostate as men who had not tried it. At that time the FPA called for more research, but no confirming evidence has been forthcoming. What causes cancer in the prostate is still not known but the nature of the risk groups, and the cancer’s response to feminizing hormones, suggest that many cases are due to high male hormonal levels.

Vasectomy remains a valuable method of contraception, Owen says. “We will certainly continue to recommend vasectomy to couples who have carefully considered the probable irreversible nature of the operation.”

Roger Kirby, who points out that one always has to compare the risk of one procedure against that of another in medicine, contrasts the possible hazards of vasectomy for the male against those of the Pill, with its possible association with cancer of the breast. He sees no cause for alarm, but tempers his advice more on sociological than medical grounds: “Young men should not think twice, but very much more often, before asking for a vasectomy. I am certainly loath to do one for a man in his twenties or early thirties, for it is always impossible to predict the future.”