Everything You Need to Know About Vasectomies
“A lot of my patients think they’re actually going to be castrated,” exclaims Jasmine Patel, assistant clinical professor of obstetrics and gynecology at the University of California Irvine. “I really don’t know where such an idea comes from — I guess it’s hearsay, from talking to misinformed friends. Fear breeds fear. Perhaps that’s why men who talk to other men who have actually had a vasectomy are more likely to have one themselves. They have a truer idea of what vasectomies are about.”
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What Is a Vasectomy?
For those still puzzled, a vasectomy —- sometimes referred to as ‘the snip’ — is a minor surgical procedure that cuts out, ties or seals the tubes that carry a man’s sperm. It’s a super reliable form of contraception for any man who doesn’t want children or, more typically, has had enough. It doesn’t have the side-effects associated with chemical intervention — as with oral contraceptives taken by women, or the general anesthesia and invasive surgery required of the sterilization procedure for a woman. It doesn’t require the regular maintenance of an intrauterine device, again inevitably left to the woman. It also doesn’t require donning a condom and hoping it survives the trip. Nobody has to remember to do anything. It’s done. You’re ready to roll.
Why Are Men Reluctant to Have a Vasectomy?
Why is there such a reluctance among men — in stable, long-term relationships, who have children — to have a vasectomy? More than 500,000 men in the US have had a vasectomy, yet this represents only 5 percent of all married men of reproductive age. And that’s unusual. Go to Bhutan and the rate is around 40 percent. In New Zealand it’s 25 percent. Another report, from the UN, suggests that only 1 in 10 men in the US get a vasectomy, half the rate in Canada or the UK. In the US, female sterilization is twice that of vasectomy, despite the fact that the latter is just as effective and a whole lot simpler. So why the imbalance?
Patel argues that there is a wider societal issue in the burden of contraception still typically falling on women (and especially in long-term relationships). Men are often avoidant of doctors and medicine at the best of times, knocking actively pursuing surgery well down their list of priorities. And this avoidance in turn seems to reflect the fact that many men — unlike women, who have to come to terms with menstruation and pregnancy — just aren’t au fait with the workings of their own bodies, and their reproductive system in particular.
Petar Bajic, assistant professor of urology at the Case Western Reserve University and a urologist at the Center for Men’s Health at the Glickman Urological and Kidney Institute in Cleveland, Ohio, argues that there’s likely some evolutionary drive to protect our genitals. “It’s not just that some men have this notion of not wanting anything in their body altered — which is a double standard of course, if they make the same expectation of their partner,” he says. “It’s that the genitals are an area we really don’t like to be messed with.”
“Men don’t like the idea of having a sharp instrument there,” adds Patel. “But men in particular seem to have all these misconceptions about what a vasectomy entails.”
What Are Some Common Misconceptions Around Vasectomies?
What are the most common misconceptions? That, for instance, it affects your ability to get an erection or have an orgasm. Wrong. That it affects your libido and/or your testosterone levels. Wrong. Its effectiveness as a form of contraception isn’t that good anyway. With just a 1 in 2000 chance of failure, that too is wrong. That possible complications are many and serious — when they’re actually minor and very rare. That it’s an invasive, painful procedure requiring general anesthesia —- wrong, with less than 5 percent of operations requiring any more than local anesthesia — for which you’ll need weeks off work. Your volleyball team may be missing your skills for a couple of weeks, but you could be back at work the next day. “I remind patients to imagine just how much more painful giving birth is,” says Bajic, “and that usually sets them right.”
In the US, where health insurance is a consideration, insurers tend to be positively enthusiastic about covering vasectomy because, big picture, that’s cheaper than the potential cost of more children.
And, it seems, American men in particular are hampered by these misunderstandings, if by no means exclusively: the same reluctance to take on vasectomy as a means of contraception is found too in, for example, India. There only 7 percent of sterilization procedures in 2018 were vasectomies — a product perhaps of family planning still being widely perceived as woman’s work. Oh, and the fact that 6.2 million men were sterilized by force in India throughout the 1970s. In India, where health education is not as advanced as it is in the US, the misconceptions go further too — that vasectomies can alter a man’s gait, or his strength or his voice, or anything else he holds on to as characteristically male. All wrong.
The suggestion is that there is something cultural at play, broadly in the sense that the vasectomy is just not as much part of the contraception conversation as it needs to be — Patel suggests there’s a great need in the US for education, advocacy and an acceptance that men too have to play their part in contraception measures. But, it’s also cultural in the sense that, as Bajic has it, there’s more of a “need to feel macho that, thanks to the misconceptions, the idea of vasectomy works against. It’s as though vasectomy is akin to some form of neutering.”
“I think there’s a fearfulness that after a vasectomy they will no longer be ‘a man’, in some sense, and that they will be giving up their manhood,” agrees Patel, “when actually getting a vasectomy and making that kind of commitment is an expression of love.”
Of course, that’s what my wife told me as she ushered me into the operating theater. But, in all seriousness, what is having a vasectomy really like? Remarkably prosaic actually. Indeed, the most awkward aspect was having not just the surgeon do their thing, but the two theater assistants still milling around chatting about last night’s TV. I only had to be undressed from the waist down, received a local anesthetic and, aside from having one’s manhood somewhat man-handled, felt nothing untoward. The whole process, from undressing to re-dressing, took no more than 30 minutes. Driving yourself home after this surgery isn’t recommended, so my wife — and, precisely why I was there in the first place, my two toddler boys — were there to collect me. Frankly, the whole thing was disappointingly pedestrian. Any man inclined to taking to bed at the first sign of a sniffle will have little excuse to work with here.
How Long Is the Recovery Period After a Vasectomy?
Inevitably the next couple of days are tender ones, akin to the after-glow of having recently been kicked in the balls. But that fades soon enough and — while pain is a subjective experience — all that’s left then is the bruising, a little swelling and that tingle associated with the healing of a minor wound, enough to keep me from the gym for a few days but that’s about all, though some men report a spell of more ‘chronic’ scrotal pain. The stitches dissolved and no discernible scarring was evident. The desire to jump back into bed took a little time to power up — and not without a little anxiety — but there was, as, so to speak, no loss of function.
Not that you can do without other forms of contraception just yet — once healing is complete, the process has you submit a semen sample some three months later just to check that sperm content has been successfully curtailed. It’s worth the wait. The benefit to any couple’s sex life, I’d wager, is immeasurable. Neither of you has to think about protection ever again. That’s liberating. It’s sexy. Indeed, a vasectomy is the kindest cut.
Is a Vasectomy Permanent?
A vasectomy is designed to be permanent. That’s why the vast majority of men who have a vasectomy already have children, and are pretty sure about their and their partner’s desire not to have any more. However, Bajic explains that a vasectomy is technically reversible — around 6 percent of American men seek one — though the procedure is much more complicated and typically not covered by insurance and not guaranteed: you may go through a reversal and still not be able to have children. According to a 2020 study, only 33% of partners of younger men and 25% of older men later impregnated their partner.
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