Vasectomies less common in France

VASECTOMIES have only been legal in France since 1999 – before that the Code Napoléon saw the operation as a mutilation and it was banned – and even today some doctors seem less than willing to help their patients.

However, French men themselves have not been rushing to get the snip and, undoubtedly, many still see it as a mutilation. They have not been helped by health journals: as recently as 2007 an online offshoot of publisher Lavoisier was saying vasectomy was illegal and the article is still available online today.

Vasectomy is a minor surgical procedure, usually performed under local anaesthetic, which involves cutting the vas deferens or canaux déférents to stop sperm from getting into the semen. It has no effect on the patient's sex life after the first few months, but it avoids a major surgical procedure for the woman.

For about three months after the operation, men are advised to continue using birth control as they will need to ejaculate as many as 20 times to clear the vas deferens of sperm.

Until 1999, doctors faced between two and five years in prison for carrying out a vasectomy; discreet adverts appeared in magazines from the likes of the Marie Stopes clinic in London offering one.

A one-word change in the law was enough to make the difference: the word medicale was substituted for therapeutique in article 70 loi n°99-641 and the change meant operations could be carried out without them having a recognisable health benefit.

It opened the way for what an American study showed was the safest form of birth control; only about 15 out of 10,000 couples fall pregnant the first year after a vasectomy. It also opened the way for female sterilisations, but this is a more complicated operation.

Another American study, in 1999, showed that, compared with a vasectomy, the procedure to cut, seal or block the fallopian tubes, through which eggs travel from the ovaries to the womb, carries 20 times the risk of major complications, costs three times as much and has a death rate (even if rare) 12 times as high.

Now French law says that, if a patient asks a doctor about a vasectomy he has to be told of the various different procedures and the potential risks.

He will also get information on the opportunity to save sperm at a Centre d’Etude et de Conservation du Sperme (CECOS) in case he wants to have a family later.

The doctor must give the risks of the operation not being permanent – there is a 1-3% chance of the vas deferens joining up again – and also warn the patient to take birth control precautions until a
sperm test spermogramme shows he is clear.

Then the patient is sent for an obligatory four-month period to think it over and, if still determined, must sign a document saying he wants to proceed.

Many doctors say vasectomy is irreversible, but urologist Dr Georges-Antoine de Boccard in Geneva says they have nearly a 90% success rate in reversing the work after 15 years and a high rate of pregnancies.

As the sperm is only about 1% of the ejaculate, the male feels no difference as the cut in the vas deferens has no effect on ejaculation, sensations or virility.

There is also no hormonal change and ill-effects are confined to a little pain or bruising in the scrotum; surgeons advise patients to wear a jock-strap or similar for support.