In any given year, about half a million men in the United States undergo a vasectomy. Although the percentage of men getting them had been dropping for the past two decades, it looks like those numbers are going up in the wake of the June 24, 2022, Supreme Court decision overturning Roe v. Wade.
It’s too early for official numbers, but as a urologist and microsurgeon specializing in vasectomies, I can personally report that more new patients are coming to see me. We used to typically perform about 20-25 vasectomies a month in our Miami clinic. Since the Dobbs v. Jackson decision came down, however, we’re now fully booked at 30 vasectomies scheduled each month through next year. I’m also seeing about 30% more online queries about vasectomies. In my 15-year career, it’s the first such increase I’ve seen.
Young or single men make up the majority of our clinic’s new vasectomy clients. They say they are concerned about getting a woman pregnant when abortion care isn’t as available as it was before. They also inquire about freezing their sperm first in case they want biological children in the future. Frozen storage is a viable option, and some patients have even successfully frozen their own sperm.
Quick and simple
Most vasectomies are simple and straightforward. In fact, 98% of them performed are in an outpatient clinic. For the duration of the 15- to 20-minute procedure, most men are wide awake in a medical office.
Only 2% of vasectomy patients get them in a hospital under anesthesia. That’s usually because of anatomical issues or previous surgeries complicating the procedure – or the personal preference of the patient to go to sleep.
To start, the urologist makes a small opening in the scrotum. Then the doctor pulls out the vas deferens, the tube that delivers sperm out of the testes and to the ejaculatory duct. After placing permanent clips on the tube in two places, the doctor removes a small piece of the tube between the clips. The clips remain in place, closing and permanently sealing the cut tube ends. Now there is no longer any connection between the testes where sperm is produced and the urethra, where it once exited the body.
Patients typically go home and recover for about four hours with some ice on the area. Most can go back to work just a day or two later if their job doesn’t involve manual labor. For about a week after the vasectomy, we recommend no sex and no heavy lifting.
The recovery period is a popular excuse for sports fans to plan their vasectomy around major sports events on TV. That way, they can watch the Masters golf tournament, baseball’s World Series, or the bowl games of American football while they heal. In fact, “March Madness vasectomy” promotions timed to college basketball playoffs are among the reasons March is a popular month for appointments.
More concerns than changes
About two to three months after the procedure, the patient returns to the clinic. We take a sample of semen to check the sperm count. That is used to confirm whether his vasectomy was successful. If any sperm are in the ejaculate, we might need to do a second one. This only happens in fewer than 1% of cases. The vast majority of the time, we can give the patient the all-clear that their procedure is complete.
Of course, this is a surgery, so patients naturally have significant questions and concerns. A common one I’ll hear from a patient is that getting a vasectomy will make him “less of a man” because he is no longer able to father children. But that is absolutely not true. It won’t make you less of a man.
Some men fear it will damage their penis because the procedure is so close to it. But a vasectomy will not damage a man’s penis or any other surrounding structures. And he will not have any changes in sexual function or enjoyment after recovery from the procedure.
While everything else is the same as before, ejaculate volume obviously decreases slightly after a vasectomy. This worries some men. But it’s not a noticeable decrease, since sperm is only 5% of semen volume.
However, if patients do change their minds, they can get their vasectomies reversed. About 5% of U.S. patients do.
Most often this involves a man with a new partner who wants to have biological kids. Nearly all vasectomy reversals succeed, with sperm returning to the ejaculate around 90% to 95% of the time. And, depending on the age of the woman, pregnancies follow vasectomy reversals about 50% to 60% of the time.
Written by Ranjith Ramasamy, Associate Professor of Urology, University of Miami.
This article was first published in The Conversation.