Say the word vasectomy in the company of men and watch their reactions. Legs cross, faces cringe and hands conspicuously cover the body-part that is the subject of this simple surgical procedure. The good news is that this reaction generally comes from those who have not undergone a vasectomy. One man who has, 29 year old Charlie Steffen, says he still can't believe how simple and relatively painless the procedure was.
"Don't listen to the talk around the water fountain," Steffen advises. "Some guys get a kick out of telling stories to scare people."
Sterilization as a method of birth control has been on the rise since 1965. According to the National Center for Health Statistics, the number of married couples age 14 to 44 who have chosen sterilization has increased from 16 to 41 percent in the last 35 years. But it has been mostly women, not men, who have chosen to be sterilized. Since 1982, tubal ligation (the female method of sterilization) has been performed almost twice as often as vasectomy. What makes that number surprising is that vasectomy is less expensive and carries fewer risks than tubal sterilization. The simplicity of the procedure (it takes about 20 minutes) and effectiveness (nearly 100 percent) make vasectomy an attractive birth control option for men who do not wish to have (more) children.
Tinkering with the Scrotum
After Steffen and his wife Traci became pregnant with their third child, they decided that once the child was born, and they were sure the child was healthy, he would get a vasectomy.
"It was a mutual decision," Steffen said, "We have three beautiful children and that was our limit."
Steffen's doctor explained to him that the surgery could be done with either one or two incisions, but Steffen had heard from others who had only one incision that when the doctor pulls the vas deferens through one incision "It feels like your brains are being pulled through your scrotum." Steffen said that he used "gentle persuasion" to talk his physician into doing the procedure through two incisions. The physician preferred to only make one incision, because there is less risk of secondary infection. "The man did have a scalpel down there, after all. I didn't want to be too persistent, but I wanted two incisions."
The worst part of the experience for Steffen was, "having a man down there touching my unit beyond the usual cough test." But he said the experience was made more bearable by the fact that the doctor was around the same age as Steffen. He said that made him feel more comfortable than "some old guy with bad breath touching me." As a bonus, Steffen was given the ultimate compliment: "Oh Good," Steffen said the doctor uttered when he examined Steffen's organs, "you have perfect anatomy."
The pain was gone after a week for Steffen, but it returned one fateful day soon after when he made the mistake of wearing a pair of tight pants to work. "That really sucked. It was okay in the morning, but I was up and down stairs all day."
As for the procedure itself, Steffen's most vivid memories are from the shots given to anesthetize his scrotum. "That's what hurt the most." He also found the hot lights over his lower anatomy memorable.
"I've told everyone I know about my vasectomy," said Steffen, "I highly recommend it. Don't let the fear of pain scare you."
With vasectomy an option for men who choose to not have (more) children, the issues surrounding this procedure are not always as simple as the procedure itself. Some very complicated issues arise when this permanent method of birth control is considered. The choice is far-reaching for some, including issues of family, relationships, politics and ideologies.
Most men have reservations about surgically altering their fertility. Ernie Engebretson isn't one of those men. He believes most fears are relatively unfounded. Engebretson is an Information Technology Specialist who was days away from having a vasectomy when interviewed for this story. Engebretson is 27 and has no children. He is relatively fearless about the procedure, but does mention one reoccurring thought; "The doctor is down there with the scalpel in his hand and sneezes, and I lose feeling."
Engebretson has known other men who have had vasectomies and feels the risks of complications are so minimal that he was confident he would be back to work on the Monday following his Friday procedure. The only negative experience Engebretson said he had heard of was one man who suffered a secondary infection. He qualified that statement by pointing out that this particular man had sustained an injury directly to his testicles, immediately following his vasectomy, while playing baseball.
Unmarried, Engebretson and his partner have been together for over 6 years. She is 25. Neither of them want to have children.
"I've never had a desire to have children," Engebretson explained. "This is something I've wanted to do for a long time. By the time I was a sophomore I had already decided not to have children. When I turned 18 I started making calls and inquiries about getting a vasectomy, but doctors told me to wait, that I was too young."
Engebretson's recent consultation went much more smoothly. The doctor just asked him some basic questions and agreed to perform the operation. "Some doctors get a bit overzealous in making sure you are certain you are making a good decision," Engebretson said. "I've heard horror stories. One friend's doctor asked my friend, who has two children, 'What if both your children died?' My consultation was much more laid-back."
"It's a judgment call," said Dr. David Hutchinson, who performs vasectomies regularly. "If someone is under 30 he may be counseled toward temporary forms of birth control." Hutchinson said that he gives no consideration to the marital status of any patient seeking a vasectomy.
For Engebretson having a vasectomy is a simple choice. "It's worry-free. What if, using another method, we end up being one of those couples who get pregnant? It's such an effective method of birth control, and convenient. Since I do not want to have any children, I feel it's my civic responsibility to see that I do not."
Pressures to Propagate
There are other issues and responsibilities to consider when choosing a vasectomy or any other form of permanent pregnancy prevention. One question that some consider is what, if any, responsibility do grown adults have to their parents to pass on the family genes? Many parents of grown children look forward to becoming grandparents and consider grandchildren a crucial part of their legacy. Choosing not to have any children can create issues within the family.
One local elected official, referred to in this story as " John," spoke on the condition of anonymity because he does not want his elderly parents to know he has had a vasectomy.
"My parents don't know," John said. "If they did they'd be disappointed."
John said he has plenty of nieces and nephews, so it is not a matter of his family genes not being passed on. "They still ask me when I'm going to give them some more grandkids. They really love their grandkids, and I'm close to my parents. They just wouldn't understand why someone would [not have children]."
No one in John's family knows he's had a vasectomy. In a serious relationship, John had his vasectomy approximately six years ago. He feels if he wants children someday, he could adopt, or opt for a reversal of his vasectomy. Hutchinson warns patients, however, to consider a vasectomy permanent. "They can be reversed," he said, "but there are risks. It's expensive and it doesn't always work."
A Slight Twinge and a Flush-out Period
A female doctor performed John's vasectomy. "I was told to lay down and a local anesthetic was injected into both sides of the vas deferens," John said. "I didn't feel anything until my vas deferens was being tugged. When it was cut it was quick. I felt a slight twinge. I've had far worse dental experiences. The physician and I were talking the whole time."
Hutchinson stressed the importance of following your doctor's instructions after the surgery. There is a "flush-out" period following a vasectomy where sperm is still active in the prostate and the glands themselves. During this period a secondary form of birth control must be used. Some doctors recommend masturbation to speed up the flushing out process. Samples of ejaculate are tested by Hutchinson's practice for three months after a vasectomy to check for active sperm.
John has no scars. Ice packs and Tylenol 3 followed up his procedure. He did not describe which method he used to flush the sperm out of his prostate. John said he has had two negative tests, confirming that no sperm are present in his ejaculate.
John said the idea that vasectomy affects masculinity or virility is, "macho nonsense."
According to Hutchinson, many men ask about the effects of a vasectomy on male libido or testosterone level. Hutchinson said there is no effect whatsoever on libido. "Vasectomy does not reduce testosterone level. The sperm is re-absorbed into the body, and [re-absorption] is very safe. It's really a nice option, a lot of men swear by it."
Just Great, Uninhibited Sex
Steffen's wife Traci raves about the freedom they now enjoy. "No more pills and no more worry about getting pregnant. Just lots of great worry-free sex. Our sex life has been awesome. We just go at it day and night now because we can." Steffen added, "It's great because before the vasectomy, the thought would always be looming in my mind that she could get pregnant, and it would be in the back of my mind until she had her period each month."
Tubal ligation, the female sterilization method, is associated with many risks and costs between $2,000 and $4,000. A vasectomy costs between $250 and $500, is practically risk-free and rarely has side effects other than some tenderness a few days after the surgery.
"This procedure is safe for anyone with normal anatomy," Hutchinson said. "An exam is done beforehand ... it's like a hernia check. There is always a minor risk factor any time an incision is made. Infection, bleeding, there are ways to guard against them. One pretty rare complication is oozing of the tiny vessels around the vas deferens after the procedure.
"About 10 percent can get a sperm granuloma nodule at the end of the cut vas deferens. [This is caused by sperm leaking into surrounding tissues.] These are benign but can be uncomfortable in about 5 percent of men. They are treatable. They can be surgically removed."
Steffen said he has small nodules in his scrotum now, but they are completely painless.
Hutchinson recommends a two-day recovery period. "Against advice, some men go back to work the same day and if he is too vigorous too soon, he risks a scrotal hematoma [swelling of blood under the skin]."
Steffen was warned about this potential complication. "The doctor said if I did any strenuous lifting or activity there could be bleeding that could swell my scrotum to the size of a grapefruit." That was enough of a warning for Steffen. He said he followed his physician's instructions and took it easy.
The Sensitive Male
Each man interviewed expressed consideration for their partners when discussing the reasons they decided on a vasectomy. They spoke of the risks of tubal ligation versus those associated with male sterilization, and simplifying their partners' lives.
"Vasectomy is a nice option for the partner," said Dr. Hutchinson. "It's easier for men. There's no need for general anesthesia, so there is significantly less risk involved compared to tubal ligation."
The National Center for Health Statistics attributes the predominance of female sterilization over male sterilization to the rise in numbers of single mothers, and the relatively high rate of contraceptive failure with other methods, especially among socio-economically disadvantaged women. Steffen has another theory: "I've heard it a lot, 'I'm not doing it, she needs to do it.' Men force women to do it because they don't want work done on their scrotum."