Vasectomy: An Easy But Neglected Form of Birth Control

Anna Clark

While it is a routine operation—nearly 500,000 are performed in the United States every year—the myths about vasectomies fester.

You will lose
your sex drive. Your genitals will swell. You will suffer excruciating pain.
You won’t be able to get an erection or ejaculate. You won’t be a man anymore.

While it is a routine
operation—nearly 500,000 are performed in the United States every year—the
myths about vasectomies fester.

In fact, the
outpatient procedure is a simple form of birth control for men, intended to be
permanent, in which the health care provider closes or blocks the tubes that
carry sperm. This prevents sperm from leaving the body or causing pregnancy; the
body instead absorbs it. Used as birth control, vasectomies are nearly 100
percent effective.

Of course,
vasectomies are not for everyone. Particularly, they must be weighed against a
person or couple’s desire to have children in the future —considering such dire
circumstances that may intervene in one’s life, such as death or divorce. While
vasectomies can sometimes be reversed, the procedure is intended to be
permanent; reversals do not always work. Doctors warn against depending upon it
for any future change of heart.

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Jason, a
38-year-old man from Turlock, California who had a vasectomy and asked that his
last name not be used, said that vasectomies seem to be shrouded in mystery for
most men.

They don’t
understand that it is virtually painless,” Jason said. “It is extremely safe. Also,
most men are extremely protective and shy about male organs, outside of being
in a sexual situation. To think that some doctor will be cutting them open and
doing stuff turns off a lot of men to the idea.”

Julius,
a 49-year-old from Winston-Salem, North Carolina, noticed a similar sort of
thinking.

“Men
always seem to cringe when vasectomies are discussed, like it would really hurt,”
Julius said. “I was in so little pain that I did have intercourse the evening
of the procedure, and there was no pain involved. I had the procedure on a
Friday, and was easily back to my desk job on Monday.”

Still,
the mystery about vasectomies persists—and it is most prevalent outside the
United States. About 43 million men around the world have undergone voluntary
sterilization—compared to 180 women who have chosen sterilization, despite the
fact that vasectomies are far simpler, safer, and more affordable than tubal
litigation. A vasectomy costs anywhere from $350 to $1,000; female
sterilization costs nearly six times as much. (Medicaid covers sterilization
for both men and women.)

“Vasectomy is
extremely rare in all but a few industrialized countries and China,” according
to “In Their Own Right,” a 2003 report from the Guttmacher Institute on the
reproductive and sexual health of men. It further reports that most men in their
forties and early fifties do not want more children. Vasectomies are most prevalent in
North America, parts of Western Europe, and China; it is nearly nonexistent in
much of Africa, Latin America and Eastern Europe.

And yet, cued by
a tight economic outlook around the world, many people are considering
permanent birth control. Besides wanting to prevent against unexpected
pregnancies, men in precarious jobs often want to have the procedure while they
still have health insurance that covers it.

Doctors have
seen a sharp increase in the number of people inquiring about the procedure,
according to U.S. News and World Report.
An article from last March cites Dr. Marc Goldstein of Cornell Institute for
Reproductive Medicine in New York City, who estimates that he has provided
about 48 percent more vasectomy consultations than he had one year ago. CNN
reports
that the Cleveland Clinic in Ohio has seen a 50 percent jump in the
number of vasectomies that it is performing since the nadir of the recession in
Fall 2008.

There is, then,
an opportunity to dispel the myth and mystery around vasectomies as couples and
individuals begin to ask questions they might not have asked before.

While
vasectomies are becoming more common, the procedure comes in context of a
complicated history. Sterilization has been abusively applied to non-voluntary
individuals, particularly people of color. While women have been the primary
targets of this abuse, men too have suffered coerced vasectomies.

In India in the
1970s, reports of compulsory sterilization at “vasectomy camps” began to gain
notoriety around the world. Men were coerced with substantial monetary and
other incentives for having a vasectomy as part of India’s attempt to lower its
national birth rate. Government officials participated in many vasectomy camps,
lending it a troubling authority, according to the comprehensive book The Global Family Planning Revolution.
Indeed, to “persuade” men to have a vasectomy, one state withdrew public
rations for families with more than three children; another state legally
required sterilization after three children. In still another state, married
teachers with children had to be sterilized or they would lose a month’s pay.

The traumatic
legacy of this, paired with fears that the procedure inhibits virility, has
caused the unpopularity of vasectomies in that nation. A Times of India report in 2004 indicates that of the 34,000 men who
come to Delhi hospitals and clinics for advice about contraception, only 2,000
of them choose vasectomies.

Alongside the
lingering suspicion of sterilization as a tool of abuse, vasectomies also emerge
in context of the relative dearth of male birth control options. Historically,
the burden of family planning has fallen on women.

Matt Johnson
wrote in AlterNet about how his
decision to have a vasectomy was in part influenced by a desire to take responsibility
for his contraception:


All
the other common birth control methods (besides condoms and vasectomy) have one
aspect in common: They place the onus on women. Not only does our society
expect women to deal with the logistics of birth control, but these methods
also have severe physiological drawbacks, from roller-coaster hormonal changes
to intensifying menstruation cycles to weight and skin changes. Although these
methods have come a long way in a few decades, they still burden women and
their bodies. Is it any coincidence that in a male-dominated society, the
medical establishment has thus far focused on birth control methods that leave
the burden solely on women?

Having decided that I want to take an active role in birth control, a vasectomy
is fair, easy, and it confronts my privilege on this issue.

This socially conscious approach to
vasectomies also takes an environmental turn. Thomjon Borges of Somerset,
Massachusetts, said that he has “No regrets whatsoever” about having a
vasectomy. He added that, “the chance to contribute to slowing the population
growth was a plus.”

 



News Politics

NARAL President Tells Her Abortion Story at the Democratic National Convention

Ally Boguhn

Though reproductive rights and health have been discussed by both Democratic Party presidential nominee Hillary Clinton and Sen. Bernie Sanders (I-VT) while on the campaign trail, Democrats have come under fire for failing to ask about abortion care during the party’s debates.

Read more of our coverage of the Democratic National Convention here.

Ilyse Hogue, president of NARAL Pro-Choice America, told the story of her abortion on the stage of the Democratic National Convention (DNC) Wednesday evening in Philadelphia.

“Texas women are tough. We approach challenges with clear eyes and full hearts. To succeed in life, all we need are the tools, the trust, and the chance to chart our own path,” Hogue told the crowd on the third night of the party’s convention. “I was fortunate enough to have these things when I found out I was pregnant years ago. I wanted a family, but it was the wrong time.”

“I made the decision that was best for me — to have an abortion — and to get compassionate care at a clinic in my own community,” she continued. “Now, years later, my husband and I are parents to two incredible children.”

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Hogue noted that her experience is similar to those of women nationwide.

“About one in three American women have abortions by the age of 45, and the majority are mothers just trying to take care of the families they already have,” she said. “You see, it’s not as simple as bad girls get abortions and good girls have families. We are the same women at different times in our lives — each making decisions that are the best for us.”

As reported by Yahoo News, “Asked if she was the first to have spoken at a Democratic National Convention about having had an abortion for reasons other than a medical crisis, Hogue replied, ‘As far as I know.'”

Planned Parenthood Federation of America President Cecile Richards on Tuesday night was the first speaker at the DNC in Philadelphia to say the word “abortion” on stage, according to Vox’s Emily Crockett. 

Richards’ use of the word abortion was deliberate, and saying the word helps address the stigma that surrounds it, Planned Parenthood Action Fund’s Vice President of Communication Mary Alice Carter said in an interview with ThinkProgress. 

“When we talk about reproductive health, we talk about the full range of reproductive health, and that includes access to abortion. So we’re very deliberate in saying we stand up for a woman’s right to access an abortion,” Carter said.

“There is so much stigma around abortion and so many people that sit in shame and don’t talk about their abortion, and so it’s very important to have the head of Planned Parenthood say ‘abortion,’ it’s very important for any woman who’s had an abortion to say ‘abortion,’ and it’s important for us to start sharing those stories and start bringing it out of the shadows and recognizing that it’s a normal experience,” she added.

Though reproductive rights and health have been discussed by both Democratic Party presidential nominee Hillary Clinton and Sen. Bernie Sanders (I-VT) while on the campaign trail, Democrats have come under fire for failing to ask about abortion care during the party’s debates. In April, Clinton called out moderators for failing to ask “about a woman’s right to make her own decisions about reproductive health care” over the course of eight debates—though she did not use the term abortion in her condemnation.

Commentary Sexual Health

Parents, Educators Can Support Pediatricians in Providing Comprehensive Sexuality Education

Nicole Cushman

While medical systems will need to evolve to address the challenges preventing pediatricians from sharing medically accurate and age-appropriate information about sexuality with their patients, there are several things I recommend parents and educators do to reinforce AAP’s guidance.

Last week, the American Academy of Pediatrics (AAP) released a clinical report outlining guidance for pediatricians on providing sexuality education to the children and adolescents in their care. As one of the most influential medical associations in the country, AAP brings, with this report, added weight to longstanding calls for comprehensive sex education.

The report offers guidance for clinicians on incorporating conversations about sexual and reproductive health into routine medical visits and summarizes the research supporting comprehensive sexuality education. It acknowledges the crucial role pediatricians play in supporting their patients’ healthy development, making them key stakeholders in the promotion of young people’s sexual health. Ultimately, the report could bolster efforts by parents and educators to increase access to comprehensive sexuality education and better equip young people to grow into sexually healthy adults.

But, while the guidance provides persuasive, evidence-backed encouragement for pediatricians to speak with parents and children and normalize sexual development, the report does not acknowledge some of the practical challenges to implementing such recommendations—for pediatricians as well as parents and school staff. Articulating these real-world challenges (and strategies for overcoming them) is essential to ensuring the report does not wind up yet another publication collecting proverbial dust on bookshelves.

The AAP report does lay the groundwork for pediatricians to initiate conversations including medically accurate and age-appropriate information about sexuality, and there is plenty in the guidelines to be enthusiastic about. Specifically, the report acknowledges something sexuality educators have long known—that a simple anatomy lesson is not sufficient. According to the AAP, sexuality education should address interpersonal relationships, body image, sexual orientation, gender identity, and reproductive rights as part of a comprehensive conversation about sexual health.

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The report further acknowledges that young people with disabilities, chronic health conditions, and other special needs also need age- and developmentally appropriate sex education, and it suggests resources for providing care to LGBTQ young people. Importantly, the AAP rejects abstinence-only approaches as ineffective and endorses comprehensive sexuality education.

It is clear that such guidance is sorely needed. Previous studies have shown that pediatricians have not been successful at having conversations with their patients about sexuality. One study found that one in three adolescents did not receive any information about sexuality from their pediatrician during health maintenance visits, and those conversations that did occur lasted less than 40 seconds, on average. Another analysis showed that, among sexually experienced adolescents, only a quarter of girls and one-fifth of boys had received information from a health-care provider about sexually transmitted infections or HIV in the last year. 

There are a number of factors at play preventing pediatricians from having these conversations. Beyond parental pushback and anti-choice resistance to comprehensive sex education, which Martha Kempner has covered in depth for Rewire, doctor visits are often limited in time and are not usually scheduled to allow for the kind of discussion needed to build a doctor-patient relationship that would be conducive to providing sexuality education. Doctors also may not get needed in-depth training to initiate and sustain these important, ongoing conversations with patients and their families.

The report notes that children and adolescents prefer a pediatrician who is nonjudgmental and comfortable discussing sexuality, answering questions and addressing concerns, but these interpersonal skills must be developed and honed through clinical training and practice. In order to fully implement the AAP’s recommendations, medical school curricula and residency training programs would need to devote time to building new doctors’ comfort with issues surrounding sexuality, interpersonal skills for navigating tough conversations, and knowledge and skills necessary for providing LGBTQ-friendly care.

As AAP explains in the report, sex education should come from many sources—schools, communities, medical offices, and homes. It lays out what can be a powerful partnership between parents, doctors, and educators in providing the age-appropriate and truly comprehensive sexuality education that young people need and deserve. While medical systems will need to evolve to address the challenges outlined above, there are several things I recommend parents and educators do to reinforce AAP’s guidance.

Parents and Caregivers: 

  • When selecting a pediatrician for your child, ask potential doctors about their approach to sexuality education. Make sure your doctor knows that you want your child to receive comprehensive, medically accurate information about a range of issues pertaining to sexuality and sexual health.
  • Talk with your child at home about sex and sexuality. Before a doctor’s visit, help your child prepare by encouraging them to think about any questions they may have for the doctor about their body, sexual feelings, or personal safety. After the visit, check in with your child to make sure their questions were answered.
  • Find out how your child’s school approaches sexuality education. Make sure school administrators, teachers, and school board members know that you support age-appropriate, comprehensive sex education that will complement the information provided by you and your child’s pediatrician.

School Staff and Educators: 

  • Maintain a referral list of pediatricians for parents to consult. When screening doctors for inclusion on the list, ask them how they approach sexuality education with patients and their families.
  • Involve supportive pediatricians in sex education curriculum review committees. Medical professionals can provide important perspective on what constitutes medically accurate, age- and developmentally-appropriate content when selecting or adapting curriculum materials for sex education classes.
  • Adopt sex-education policies and curricula that are comprehensive and inclusive of all young people, regardless of sexual orientation or gender identity. Ensure that teachers receive the training and support they need to provide high-quality sex education to their students.

The AAP clinical report provides an important step toward ensuring that young people receive sexuality education that supports their healthy sexual development. If adopted widely by pediatricians—in partnership with parents and schools—the report’s recommendations could contribute to a sea change in providing young people with the care and support they need.