Vasectomy and Abnormal Psychology: Exploring the Dementia Link
Written by: LA Harte
One of my favorite courses in undergrad school was Abnormal Psychology. In Abnormal Psychology you don’t just learn about the different diseases and ailments that the mind can endure but you also learn about normal brain structure and function. Coupled with statistics and some basic understandings of medical terminology you can glean a bright picture of what is going on in the mind and have a basic understanding of mental illnesses that afflict the greater population.
What does vasectomy have to do with mental health, abnormal psychology, and Dementia? In the mid-2000’s a study was produced and published in Cognitive and Behavioral Neurology titled Vasectomy in Men With Primary Progressive Aphasia. Let me define Aphasia. Aphasia is a neurological condition classified by the ASHA (American Speech Language Hearing Association) as a language disorder that affects the afflicted individual’s ability to sufficiently communicate. This is caused by damage to parts of the brain that process language. There are different areas of the brain that control different functions. Your language processing core in the frontal left hemisphere is affected. Not only is the brain a large organ (the most important one in your entire body) with different regions that process and control different areas but it is also divided into two hemispheres the right and left.
Aphasia can be Global (both Broca’s and Wernicke’s), Logopenic Progressive Aphasia (LPA), Primary Progressive Aphasia (PPA), Broca’s Aphasia, or Wernicke’s Aphasia. Broca’s Area controls expressive speech and language while Wernicke’s controls comprehension of speech. PPA (the Aphasia that researchers linked to vasectomy) causes degeneration throughout the language processing areas of the brain on the left hemisphere and PPA doesn’t just happen overnight. PPA is gradual in its initial onset. Overtime the afflicted individual’s broader language network becomes afflicted when they have PPA. The University of California, San Francisco states, “PPA subtypes include progressive non-fluent aphasia (PNFA), semantic dementia (SD) and logopenic progressive aphasia (LPA). These syndromes result from a variety of underlying diseases, but most often frontotemporal lobar degeneration (FTLD) (both tau and TDP-43 subtypes) or Alzheimer’s disease,” (UCSF, 2012).
Why should we care about PPA? PPA is a more rare form of dementia and people who have PPA lose the ability to communicate and/or understand what is being said to them. They are continually losing their ability to read, their ability to write, their ability to understand, and their ability to speak. Further, there is no hope for improvement with our current technology and no one test is available to diagnose PPA. Because it is progressive patients won’t even know they have it until it is to a point where a patient seeks out help. Thankfully, some patients will retain other areas of the mind with PPA but these patients will exhibit frustration when their speech-language capabilities fail.
A study written by Jonathan Obert, MD along with Christian Davis Furman, MD in 2014 looked at a 70 year old male with PPA. Overtime this patient degenerated into full blown dementia and he died. PPA can be fatal leading to other co-morbid psychological problems. The study titled “A Case of Primary Progressive Aphasia Progressing to Severe Dementia and Death” describes,
The patient was diagnosed with dementia, likely a progression of PPA. A speech consult was obtained for his dysphagia and he was put on a pureed diet. Hospice was offered, but the family wanted to wait until the patient became worse. The patient started to develop hallucinations and risperidone was prescribed. The family wanted his goals of care to be comfort-focused, so hospice was consulted. All medications that were not for comfort were discontinued. The patient continued to decline and died with hospice support, (Obert & Furman, 2014).
The doctors also described more clinical manifestations they gleaned from research in their study,
PPA is associated with atrophy of the central portion of the brain’s left hemisphere where the language center is housed. Scar tissue and abnormal proteins may also be present, and brain activity is often reduced. Research shows region-specific relationships, primarily in the left hemisphere, between atrophy and impairments in language performance. In patients with PPA, the perisylvian portions of the inferior frontal and temporoparietal regions (known as Broca’s and Wernicke’s areas), as well as surrounding regions of the frontal, parietal, and temporal cortex, display atrophy, EEG slowing, decreased blood flow, and decreased glucose use. All PPA subtypes have left hemisphere atrophy that involves components in the language network, (Obert & Furman, 2014).
PPA causes this atrophy in the brain and decreased blood flow and even more disturbing brain activity is often reduced in PPA patients. Further, those afflicted with PPA also undergo behavioral changes or co-morbid motor neuron disease or even corticobasal degeneration.
The link to vasectomy is present and clear. The Cognitive and Behavioral Neurology article discussed the prevalence of men with vasectomy and PPA. In the study two groups were used one group of 47 men were studied and these men had PPA. A secondary group of 57 men without dementia were studied. In the PPA group 40% of the men had undergone a vasectomy whereby only 16% of men in the non-PPA group had a vasectomy. This created what is known as a statistic significance factor of 0.02. This is known as the P value in statistics and this means that there is clinically significant evidence to prove that vasectomy links men to a higher risk of PPA. The study states, “Vasectomy may constitute one risk factor for PPA in men. Potential mechanisms mediating risk include vasectomy-induced immune responses to sperm, which shares antigenic epitopes with the brain,” (Weintraub, 2006). Prior to this study Weintraub once concluded vasectomy didn’t produce any Alzheimer’s or Dementia risk, however, the study was clear that there was a risk of increased PPA incidences if a patient had undergone a vasectomy.
This study allowed Weintraub to theorize further on PPA and why men with vasectomies have a higher risk prevalence for this rare disease. Marla Paul of Northwestern University wrote,
Weintraub theorizes a vasectomy may raise the risk of PPA (and possibly FTD) because the surgery breeches the protective barrier between the blood and the testes, called the blood-testis barrier. Certain organs – including the testes and the brain – exist in what is the equivalent of a gated community in the body. Tiny tubes within the testes (in which sperm are produced) are protected by a physical barrier of Sertoli cells. The tight connections between these cells prevent blood-borne infections and poisonous molecules from entering the semen.
After a vasectomy, however, the protective barrier is broken and semen mixes into the blood. The immune system recognizes the sperm as invading foreign agents and produces anti-sperm antibodies in 60 to 70 percent of men. Weintraub said these antibodies might cross the blood-brain-barrier and cause damage resulting in dementia. “There are other neurological models of disease which you can use as a parallel,” Weintraub said. Certain malignant tumors produce antibodies that reach the brain and cause an illness similar to encephalitis, she noted. (Paul, 2007).
To understand this more I want to break away for a moment and discuss the functions of how a vasectomy works. Firstly, the vas (long tubes connecting the man’s testes to the prostate) are cut. The vas functions as a tube that allows the man’s sperm to mix in with the ejaculate. The ejaculate fluid is produced by the seminal vesicle and the prostate nourishes the sperm with vital nutrients. These vas are sometimes clipped or cauterized (my husband’s were cauterized it is a more standard procedure of no-scalpel vasectomies). When this happens the sperm can no longer mix into the ejaculate fluid but is instead reabsorbed into the body. In women and men something called antisperm antibodies can develop overtime. In medical courses you learn all about the blood-brain barrier. There is also a placental barrier in pregnant women. The blood brain barrier is how something crosses from the blood and creates effects in the brain (as layman as I can put it). Drugs that produce effects in the mind cross the blood brain barrier; for example. Overtime the antisperm antibodies that the 60-70% of men with vasectomies produce result in damage that causes PPA and dementia. These antisperm antibodies might be responsible for why PPA is occurring in vasectomy populations. PPA can also affect women and Weintraub’s research also pointed out PPA is also a risk factor in women with antisperm antibodies present.
Sadly, antisperm antibodies can begin to be produced at any time after a vasectomy. The time between vasectomy and reversal does not matter in cases of long term infertility and antisperm antibodies. While the chances to reverse a vasectomy are greater the shorter the time between the vasectomy and reversal there are still those men who have had vasectomies and reversals in a short span of time and have found themselves producing high antisperm antibodies. These antisperm antibodies are responsible for rendering them essentially infertile with a higher risk of PPA. A study found that antisperm antibodies come in different types known as antigens in the acrosome and then antisperm antibodies to the sperm nucleus. Antisperm antibodies were rarely present in men prior to a vasectomy to the sperm nucleus but the antibodies steadily began to rise after a man had a vasectomy.
The study by KS Tung was published in Clinical Exp. Immunology in 1975. The study titled “Human sperm antigens and antisperm antibodies. Studies on Vasectomy Patients” notes; “The second group included antibodies to the sperm nucleus, the tail and to discrete antigens over the acrosome. They were found rarely (3%) in patients before vasectomy; increased in incidence to 25% at 2 months and 55% at 6-9 months after vasectomy,” (Tung, 1975). The time between vasectomy and reversal according to the renowned vasectomy reversal specialist Dr. Hickman is 6 months post vasectomy. Men cannot get a reversal until they are 6 months post-operative after the vasectomy meaning 55% of these men will be producing the antisperm antibodies that can induce PPA.
Vasectomies and sterilizations continue to be a prevailing form of birth control worldwide, however, the ethicalities of the practice of vasectomy should be reviewed due to overwhelming evidence of severe co-morbid factors that develop. Patients going into vasectomy clinics today are given no knowledge of the link between PPA and vasectomy. Most patients are told this is a low risk procedure with no side-effects. More information should be available for men and women about PPA and the vasectomy link before making their choice on sterilization. Further, more studies on PPA and vasectomy need to be performed so the science and medical community can better understand the link between vasectomy and PPA. However, vasectomy is still a leading cash cow in male fertility options and proponents are readily available to defend its practice and ongoing push to vasectomize men of lower socioeconomic status.
References (Non-APA Form for easier link clicking):
Obert & Furman, 2014. (http://www.consultant360.com/articles/case-primary-progressive-aphasia-progressing-severe-dementia-and-death). A Case of Primary Progressive Aphasia Progressing to Severe Dementia and Death
Marla Paul, 2007. (http://www.northwestern.edu/newscenter/stories/2007/02/vasectomy.html). Vasectomy May Put Men at Risk for Type of Dementia.
KS Tung, 1975 (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1538169/). Human sperm antigens and antisperm antibodies. Studies on Vasectomy Patients.
University of California San Francisco, 2012. (http://memory.ucsf.edu/ftd/overview/biology/language/multiple/aphasia). Frontotemporal Dementia.
Sandra Weintraub, 2006. (http://journals.lww.com/cogbehavneurol/Abstract/2006/12000/Vasectomy_in_Men_With_Primary_Progressive_Aphasia.4.aspx). Vasectomy in Men With Primary Progressive Aphasia.