Episode Transcript
You and your partner now have three kids. And for the whole of your relationship, you've been responsible for the family planning part of family planning. And now, you and your honey decide that your family is full. You guys have all the kids you've wanted. Is it his turn? This is Dr. 来自犹他健康大学妇产科的Kirtly Jones说, 这是《大发娱乐》杂志上“女性健康的七个领域”的输精管结扎.
Cultural Attitudes Towards Vasectomy
在任何异性恋关系中，女性在很大程度上都有可逆避孕的责任. 他们是否认真对待这一责任，并计划好他们所有的孩子, or they had a number of kids by chance, what you do when you're done having kids? 大约23%的美国夫妇依靠一种永久性的避孕方式，比如 tubal ligation or vasectomy. That's about one in four.
Now, attitudes about vasectomy vary dramatically around the world. In the U.S., 1 in 5 guys over 35 has had a vasectomy. 受教育程度高，收入高的男性更有可能选择输精管结扎术. 西海岸的男性比东海岸的男性更有可能进行输精管切除术, and both are more likely to use vasectomy than men in the South. 西班牙裔男性和非裔美国男性选择输精管切除术的可能性较小.
In countries such as Canada, in countries in Scandinavia, about 1 out of 3 men over 35 have had a vasectomy. That's a lot of guys. 输精管结扎使用率高、性别平等程度高的其他高收入国家, that's an important thing. Where there's gender equity, 包括澳大利亚在内，越来越多的男性开始承担起避孕的责任, the Czech Republic, New Zealand, Spain, South Korea, Switzerland, and the UK. In some cultures, Africa in general, vasectomy is extremely rare.
Why Couples Should Choose Vasectomy over Tubal Litigation
首先，这两种方法都非常安全，与手术相关的并发症很少. However, tubal ligation requires either regional anesthesia, 比如硬膜外麻醉或者脊髓麻醉如果妇女在孩子出生后马上做输卵管手术, 或者需要全身麻醉如果是在婴儿出生后通过腹腔镜手术. A vasectomy is done under local anesthesia, which is much less risky.
Women have to have their abdomen entered to have their tubes tied. For men, the vas is right under the skin of their scrotum. So it's much easier. For men, 它的切口非常小，甚至不需要缝合，通常只需要15分钟. The time to recovery is faster with a vasectomy than a tubal, a couple of days for men versus a week or two for women.
Now, 尽管男性在输精管切除术后阴囊可能会有一些疼痛和瘀伤, long-term pain occurs in less than 1 in 100 men. Contrary to many men's fears, a vasectomy doesn't lower testosterone levels, and there's no change in sexual desire. 事实上，2015年斯坦福大学的一项研究发现，伴侣做了输精管切除术的女性 were 46% more likely to have sex 与没有做过手术的女性相比，每周至少做一次. 这是一个复杂的数字，其中可能包含很多有趣的统计数据. But at least it doesn't make you stop doing what you want to do. 这两种方法都非常有效，每年的怀孕率低于100对夫妇中的1对. 一项研究表明，输精管切除术后的怀孕率低至2000分之一.
Now, there are some rules. 你不能指望输精管结扎术来避孕，除非你对精子进行了评估，表明没有更多的精子出来. 这可能需要几个月和20次射精来清除管道中的所有精子. Some men may have cleared the sperm in a shorter period of time. 但重要的是射精时一定要检查，确认没有更多的精子.
Cost of Vasectomy
现在，费用是不同的，但这两种方法通常都在保险范围内. Under the Affordable Care Act, 一些州实际上已经将输精管结扎术纳入避孕的免费部分. If you had to pay out of pocket, vasectomy could cost $700 to $1,200. 如果在分娩时没有做输卵管结扎手术，费用可能高达5000美元.
到目前为止，这都是关于有长期忠诚关系的夫妻. But vasectomy has been increasing in young men who've never had children. 这是唯一一种避孕方法，它赋予男性选择生育的私人权力. 越来越多的年轻男性要求做输精管切除术，因为他们非常确定自己永远不想要孩子. 在过去，医生不愿意对没有生育过的男性进行输精管切除术. 在很多地方，医生的这种行为随着病人自主的角色而改变, the right of a person to make decisions about their own bodies, 医疗保健越来越多地影响了他们对绝育的态度.
Family Planning after Vasectomy
如果你爱上了一个做过输精管结扎手术的男人而你一直想要孩子会怎么样? 这是坦诚地讨论对长期关系的希望和期望的时候. Perhaps the guy never wanted kids until he met you. 输精管切除术后恢复生育能力的方法包括 vas reversal, which is successful about 50% of the time, 这取决于外科医生把这个叫做输精管的小管子重新连接起来的技术. 这也取决于输精管结扎手术的时间和男性的年龄.
对于输精管逆转术无法恢复生育能力的男性来说， in vitro fertilization to retrieve sperm from their testes can be very successful. 如果你的男人过去做过输精管结扎手术，但他仍然坚定地不想要孩子, that's a more complicated discussion.
所以如果你和你的病人决定要做输精管切除术，在哪里可以做? 一些计划生育诊所有输精管结扎服务，一些家庭医生也会做输精管结扎. It's a short office procedure. Most urologists do vasectomies. Only urologists do vasectomy reversal, 你应该选择那些做过更复杂手术的医生作为他们常规手术的一部分.
If for some reason your guy chooses to have a back-up, 有些男人选择冷冻精子，以防他们出于某种原因改变主意, change in circumstances such as change in partners or loss of a child. 大多数做体外受精的生育中心都可以冷冻和储存精子. 如果一对夫妇在输精管切除术后决定要孩子，那么试管受精是一个选择. However, you and your partner make your decisions, we offer all of these services at the University of Utah Health, and your family choices are important to us.