• The burden of family planning, especially in rural areas, is often left to women, as men despise condoms and find vasectomies unAfrican
• However, many vasectomy patients can resume their typical sexual behaviour within a week, and do so with little or no discomfort
While women have many methods for preventing pregnancy, the options for men boil down to condoms, withdrawal (pulling out) or getting a vasectomy. The latter is rarely used by many men in Kenya. The question is: why?
Many men prefer the 'house of leather' (skin-to-skin) feeling that condoms normally prevent, while the withdrawal method is the least effective. But they are loath to settle for a vasectomy as a means of family planning.
In medical parlance, a vasectomy is a surgical procedure for male sterilisation or permanent contraception. During the procedure, the male vas deferens (tube which conveys sperm from the testicle) is cut and tied or sealed to prevent sperm from entering into the urethra. This thereby prevents fertilisation of a female through sexual intercourse.
Most men and women interviewed by the Star had a general idea of what a vasectomy is. The women were in agreement that more men should undergo the procedure, as family planning should not be left to one gender alone.
The men were split, with most saying they would not undergo the procedure. However, there were a few brave souls who said they would do it if all the conditions were right.
Laila said she believes the procedure is similar to when women's tubes are tied. She felt that more men should do a vasectomy as women suffer more, despite the many contraceptive methods available to them.
Steve was well-versed with what the procedure entailed but said he would never ever get a vasectomy under any circumstances. However, he didn't have a problem with any man procuring the operation.
Ana exuded a greater understanding of the procedure, speaking about both the reversible and irreversible types. She also said more men should do it as women have been bearing the family planning role far too much.
Pendo felt there is a stigma around vasectomies. "Many men are scared because they believe it will make them lose their sexual urge and ability, but that isn't true," she said.
She added that traditional African culture frowns on any attempt to cull a man's virility, and that it is embarrassing for a man to admit that he's had a vasectomy.
In African culture, a man is seen as a jogoo. So if you get the procedure done, people will wonder: How are you still able to get the job done?Henry, respondent
SHROUDED IN MYTHS
Henry said getting a vasectomy is a personal decision that could work out in the Western culture but is frowned on in Africa. "In African culture, a man is seen as a jogoo. So if you get the procedure done, people will wonder: How are you still able to get the job done?"
John, meanwhile, said some men believe getting a vasectomy is a punishment. He said they shouldn't see it that way as it is an effective family planning method.
Oliver was the rare man who felt that women should not be the only ones who have to bear the family planning burden. He said he would consider having one as it is effective, quick and has very few downsides.
Jill was the only woman who saw the procedure as a boon to men. "It should be done by men who don't want to get trapped by women with nefarious motives. But men in serious relationships should speak to their significant others before they undertake the procedure," she said.
So, what do medical experts have to say about the procedure?
Family Health Options Kenya's Dr Charles Ochieng, 45, said vasectomies are shrouded in myths. These deter men from opting for the family planning method, yet many desire to limit the number of children they sire.
The doctor, who has worked at Kakamega General Hospital and Kenyatta National Hospital, agreed with the viewpoint that most men from rural areas have a bad view of the procedure and prefer that their wives bear the contraceptive burden.
In his time working at Kakamega Hospital, the facility would conduct a maximum of two surgeries a year. It was not a popular procedure at hospitals outside Nairobi.
“There’s a lot of ignorance,” Dr Ochieng said. “Some think that after a vasectomy, a man grows big and becomes hypersomnolent — sleepy and lazy.
“The numbers are rising though not to the levels we want. A lot of people think it is castration, but it is not.”
Castration entails the removal or destruction of the testicles. The term is sometimes also used to refer to the removal of the ovaries in the female, otherwise known as an oophorectomy or, in animals, spaying.
The numbers are rising though not to the levels we want. A lot of people think it is castration, but it is not. It is a modern, safe and effective family planning method for men whose families are complete.Dr Charles Ochieng
HOW VASECTOMY IS DONE
There are several methods by which a surgeon could complete a vasectomy procedure, all of which occlude (seal) at least one side of each vas deferens.
To help reduce anxiety and increase patient comfort, men who have an aversion to needles may consider a "no-needle" application of anaesthesia, while the "no-scalpel" or "open-ended" techniques help to accelerate recovery times and increase the chance of healthy recovery.
Dr Ochieng’ said there is even a new advanced technique called the no-needle-no-scalpel, which does not interfere with testosterone production, nor does it kill one’s ability to orgasm.
The procedure blocks only five per cent of fluid being released, which essentially has sperms, while 95 per cent of seminal fluid will still pass through. Because the procedure is minimally invasive, many vasectomy patients find that they can resume their typical sexual behaviour within a week, and do so with little or no discomfort.
Due to the simplicity of the surgery, a vasectomy usually takes less than 30 minutes to complete. After a short recovery at the doctor's office (usually less than an hour), the patient is sent home to rest.
Because the procedure is minimally invasive, many vasectomy patients find that they can resume their typical sexual behaviour within a week, and do so with little or no discomfort.
“Vasectomy is a modern, safe and effective family planning method for men whose families are complete,” Dr Ochieng said.
The procedure is not encouraged for young, single, childless men, as their chances of biological parenthood are thereby more or less permanently reduced to almost zero.
Practitioners expect the men to have spoken to their partners well before they agree to undergo the procedure. For men who opt to get the operation done yet are under 30 years of age, he said, "We normally give them a month to think about it."
The cost of a vasectomy in Kenya differs. It ranges from Sh15,000 to Sh150,000. Dr Ochieng says they charge Sh15,000.
However, Dr Ochieng’ also partners with vasectomists from No Scalpel Vasectomy International to provide free sterilisation for low-income earners, and the men receive a Sh2,000 stipend.
Though rare, some men may have swelling, pain and infection afterwards. However, the pain is manageable. Three months after a vasectomy, a test is necessary to ascertain success.
The doctor said he had never met any man who had regretted having the procedure done on them. All the men who did it knew what they wanted, he said.
Dr Ochieng shared his experience with the procedure. "I myself had it 11 years ago at 34 years. I came from a polygamous family. My wife wasn't into doing it, she was a bit hesitant at first, but after we spoke about it, we agreed and I did it," he said.
And what was his reason for having it? He said money was a big factor and as such, he wanted to give the two children he had the best life he could offer.
The doctor was informed by his experiences abroad, noting that the procedure is very popular in the US and India. He added that in sub-Saharan Africa, it isn't common but things are changing as people get more information.
He also explained that the reason many men don't undergo the procedure is that most of them fear the pain, not knowing it is negligible. He said it is a very intelligent way to have family planning.
Dr Ochieng said the experience has been good for him and his wife. "The sexual experience is enjoyed more. It fosters a loving relationship. Now she is very happy," he said.
Edited by Tom Jalio