Pain, Diabetes And Dementia

Research Highlights Medical Risks of Vasectomies

BY CELESTE MCGOVERN

REGISTER CORRESPONDENT

August 12-18, 2007 Issue | Posted 8/7/07 at 12:10 PM

CHICAGO — Twice a year in Chicago, a group of men diagnosed with a type of dementia called primary progressive aphasia (PPA) meet to talk about their disease.

They discuss its huge impact on their speech and ability to understand, and share the struggle of facing incurable dependent disability. It is a somber support group meeting.

So it was unusual when a 43-year-old patient rushed into the room at one meeting and blurted out: “Okay, guys, how many of you have PPA?” Nine hands went up.

Then he asked, “How many of you have had a vasectomy?” Eight hands rose.

It raised Sandra Weintraub’s eyebrows, too. A professor of psychiatry and behavioral sciences and of neurology at Northwestern University’s Feinberg School of Medicine in Chicago, Weintraub had initially dismissed the support-group patient’s connection of his vasectomy to his dementia, but when he put the question to his support group she decided it was worth investigating.

Weintraub’s preliminary findings, reported earlier this year in Cognitive and Behavioral Neurology, are suggestive enough to warrant a larger national study.

And they add to a massive pool of research data, most of it completely unreported in the mainstream media, linking vasectomy to a lengthy list of diseases from atherosclerosis and auto-immune disease to chronic testicular pain and prostate cancer.

Weintraub and her team of researchers found that 40% of 47 men with primary progressive aphasia who were being treated at Northwestern’s Alzhheimer’s Disease Center had undergone a vasectomy, compared to just 16% of the 57 community volunteers with no cognitive difficulties.

“That’s a huge difference,” Weintraub said when the study was released in February. “It doesn’t mean having a vasectomy will give you this disease, but it may be a risk factor to increase your chance of getting it.”

As well, Weintraub found that men who had had a vasectomy had an earlier onset of the disease (58 years average) compared to those who hadn’t (62 years).

Primary progressive aphasia, also called Pick’s disease, is especially tragic because it tends to strike younger men and women — as young as their 40s. Initially it presents as confusion with language, stumbling over the right word for common objects, while leaving other complicated processing skills intact.

Eventually, it destroys the brain’s communication centers, leaving most patients unable to care for themselves.

Additionally, Weintraub’s preliminary study found that a similar form of dementia, frontotemporal dementia (FTD), affecting the brain’s personality more than language centers, also appears to have a vasectomy connection: Thirty-seven percent of 30 frontotemporal dementia patients had undergone vasectomy.

Like primary progressive aphasia, frontotemporal dementia can strike at a relatively young age. It is associated with bizarre out-of-character behaviors such as shoplifting and compulsive spending or gambling.

Weintraub stresses that her findings are only preliminary and she has no intention of “scaring men out of a major birth control alternative.”

But there is a base of medical knowledge to theorize why vasectomy could produce dementia in some. A biological barrier of tightly packed cells that prevent infections and other toxins from reaching the sperm protects sperm production in the testes. Vasectomy breeches this barrier, allowing sperm to flow into the blood.

In studies, about 60% to 70% of men who have had a vasectomy produce antibodies against their own sperm. Other neurological diseases provide models of how such an autoimmune reaction can then turn to assault the brain.

Though the Chicago study is small, some medical researchers believe it certainly warrants further investigation, especially because vasectomy is so common. One in six American men over age 35 have been sterilized and about an additional 500,000 undergo vasectomy each year.

It is the favorite contraceptive of population control efforts in the developing world, too.

Weintraub’s preliminary findings add to the list of suggested and established vasectomy complications in the medical literature — complications rarely discussed publicly, even with men prior to surgery.

Virtually every family planning or vasectomy clinic website describes it as a safe, minimally painful and effective birth control.

“Many men have it done on Friday and return to work on Monday,” one such website reads.

Few of the sites mention even the most well-documented vasectomy complications. Most obviously absent is mention of chronic testicular pain, also referred to as post-vasectomy pain syndrome.

Some studies have found it affects perhaps 30% of men who are sterilized, but a more conservative estimate of less than 5% is generally accepted.

Post-vasectomy pain syndrome was frequently dismissed as psychological, but now urologists explain that vasectomy, in cutting off the natural avenue for sperm (manufactured at 50,000 per hour), creates a tide of back pressure in the epididymis, the tightly coiled testicular apparatus that stores and transports sperm — and causes ruptures. The technical term is “epididymal blow-out.”

Virtually all men experience “epididymal blow-outs” at some point after a vasectomy — most are mild or unnoticed. But for some, nothing brings relief.

Male health Web forums are rife with their testimonies.

“I have to say this is the biggest mistake of my life so far,” wrote one post-vasectomy patient. “I am searching for some cure to the pain short of a bullet in the brain. I have seen six doctors so far and none has any idea what to do. I know many men get this condition and I am very puzzled as to why I never heard of it before I did this.”

Kevin Hauber, a mortgage broker from San Luis Obispo, Calif., had a vasectomy in 1999 and thus began an ordeal of testicular pain that would spike several times a day, leaving him doubled over. He has since undergone more than a dozen invasive procedures (none successful) and taken 227 different medications to deal with the pain.

The 46-year-old father of two has researched urology and immunology tracts, written a book and runs a webpage (dontfixit.org) dissuading men from vasectomy. The dementia connection does not surprise him.

But even more than ruptures and other obvious side-effects, Hauber worries about subtler and slower-developing consequences of chronic immune and inflammatory responses to vasectomy that are the basis of disease models for cancer, heart and neurodegenerative disease.

A study in the May 2007 journal Human Reproduction found no long-term elevation of immune-related disease — including asthma, diabetes and multiple sclerosis — among vasectomized men, but questions about vasectomy’s relation to auto-immune disease have repeatedly been raised.

“We certainly don’t desire these problems associated with vasectomy, but it would not be surprising to find that frustrating a major function of the body has grave consequences,” said John Brehany, executive director of the Catholic Medical Association.

Regardless of the physical consequences, Brehany added, the Catholic Church teaches that in its deliberate intention to render procreation impossible, vasectomy is intrinsically evil.

The Catechism of the Catholic Church teaches in paragraph No. 2399 that while regulation of births is an aspect of responsible parenthood, “Legitimate intentions on the part of the spouses do not justify recourse to morally unacceptable means (for example, direct sterilization or contraception).”

Vasectomy opponent Hauber, though not Catholic, has acquired a measure of respect for the Catholic perspective. His site refers people to a natural family planning website, as an alternative to sterilization.

“I can think of no other bodily function we would suggest should be blocked off. For doctors to suggest we could plug our tear ducts, or obstruct our digestive system, without serious repercussions would be ludicrous,” Hauber said. “But there is a very cavalier attitude to cutting the flow of reproductive cells.”

Added Hauber, “There is a sanctity to our bodies and we should respect it.”

Celeste McGovern is based in

Innerleithen, Scotland.

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