The explosive rise of vasectomies: towards gender equality?

In June 2022, and after 50 years, the United States Supreme Court he ended the constitutional right to abortion by overturning Roe v. Wade, as we know. The above would lead to a total ban on this procedure in about half of the states in this country. It generated controversy.

Three months after this decision, vasectomies skyrocketed with a 29% increase between July and September. According to an article published in May this year by The Economist , patients based their decision on three main reasons. First, there were those who considered that with the end of abortion, they had lost their only support when traditional contraceptive methods failed. In second place were those who had previously considered a vasectomy, and this decision hastened their decision. And finally – and less frequently – there were those men who saw surgery as an act of solidarity with women.

Whether this specific increase is a coincidence or a consequence, the reality is that worldwide, as well as in Chile, men who undergo vasectomy have experienced explosive growth, especially in the last decade and mainly in the private health sector. According to figures released last year by the Department of Statistics and Health Information (DEIS), over the past ten years the increase has been 500%. Now, what are the reasons for this phenomenon? They are multiple, they all agree, but one that could be relevant for some, but not decisive for others, is progress in terms of gender equality.

Among those who opt for a vasectomy, there would be three well-defined groups: that of men who decided to undergo the procedure as a couple’s decision and to free women from the use of traditional contraceptive methods; that of those who are separated and who do not want to have children with another couple; and that of young people who are childless and who do not want biological children in the future. The latter, although still smaller, is gaining more and more strength, which could be a reflection of a greater male voice around family planning.

Doctor Óscar Schatloff, who has performed more than a thousand vasectomies in his Urbamed clinic -where the procedure is carried out under local anesthesia and in 10 minutes-, tells an anecdote according to which, in the past, conversations between men took place concerning the number of children they wanted to have, not whether or not they wanted to have children. This has already changed, and the increasing number of vasectomies among young people speaks for itself.

For the doctor, the general increase in vasectomies “in any case” goes hand in hand with advances in gender equality. “Women with every reason and every sense are raising their voices that they don’t want traditional methods as a form of long-term contraception, because of all the adverse effects they can cause,” she says. , adding that she sees more and more women asking for information and then encouraging their husbands to attend the consultation with their husbands so that they can have surgery.

The same is suggested by the urologist and andrologist of the Clínica Alemana de Santiago, Francisco Osorio, who affirms that “gender equality is the key to this increase in vasectomies”. For him, if women are more empowered, men are also more aware that they must participate in the same way as their partners in family contraception. “Many times, on their own initiative, they are more aware of this issue, or at the request of couples.”

But this is not only what would explain the explosive increase. A factor that also seems very relevant is that today there is much more information available regarding the procedure, and as it has increased, word of mouth has shattered a series of myths that existed around this, mainly those who linked it to a decrease in sexual desire, or with erection alterations, all myths that have come to an end says Dr. Osorio. He also points out that, in the case of the German clinic, in the last 10 or 15 years the number of vasectomies has increased tenfold, and it is only in 2021 and 2022 that more than a thousand surgeries were performed per year.

If vasectomy is compared to the method of female sterilization, this second option carries many more complications and risks than the first. The first, explains Dr. Schatloff, is surgery that is done laparoscopically, requires general anesthesia, and there is manipulation of the organs in the abdomen. The latter increases the risk of injury to certain organs. Osorio explains that in the case of vasectomies, less than 2% of patients have complications, and those that do are not serious and resolve with anti-inflammatories, rest or antibiotics. Likewise, the effectiveness rate is 99%, which means that only 1 in 2,000 vasectomy patients could produce a pregnancy.

For sexologist Eleonora Delgado, the reasons why men may decide to have a vasectomy vary depending on their individual circumstances and personal motivations. However, there would be common factors. Among them would be the contraceptive reliability offered by this procedure, the possibility of avoiding “surprises”, or even a way of sharing the responsibility for contraception and family planning with the couple. There might also be, in some cases, a man’s feeling that he can maintain his fertility and the ability to make decisions about his reproductive life at will, without delegating it to anyone else, and in others, a vasectomy could even mean “almost passing for promiscuity,” says the professional. This, he explains, is because society has very little awareness of sexually transmitted diseases and the biggest concern is still pregnancy.

Still, Delgado is adamant that while solidarity with women and reproductive rights may be a motivating factor for some, she doubts it’s the primary reason for rising vasectomy rates. In this sense, he doubts that the prohibition of abortion – as is the case in the United States – has been a cause of the increase in the number of vasectomies. “I don’t think men think of abortion as a possible implication that they could help avoid, and therefore make the decision to have a vasectomy,” he says.

Delgado explains that some studies have suggested that as societies become more gender equal, there may be an increase in the acceptance and uptake of male contraceptive methods such as vasectomy. This can be seen as a reflection of a change in attitude towards gender roles and recognition of the importance of shared responsibility in family planning. However, “it is important to note that the relationship between vasectomy rates and gender equality is not necessarily direct causal,” he explains. He adds that other factors, such as access to health care, education, economic stability, cultural norms and individual preferences, also play a role in vasectomy rates. “Nevertheless, rising vasectomy rates may be influenced by the movement towards gender equality, but this is only one aspect of a much larger bio-psycho-social context “says Delgado.

The specialist points out that the increase in the rates of this procedure can be linked to several factors, including the change or distribution of gender roles, which she considers an important advance in terms of gender equality, but not decisive. Delgado says gender equality refers to equal rights, opportunities and equal treatment of people, and since the decision to have a vasectomy is personal, you would think someone does it out of a desire to take responsibility. a shared responsibility for contraception, out of a desire to support a couple’s reproductive decisions, out of a desire to change traditional models of masculinity that place the burden of contraception solely on women, and finally out of an understanding that the procedure is something something that helps the couple from health, relationship and individual development opportunities. “So you could say it’s progress, but something specific, and not necessarily collective,” he says.

The increase in vasectomies could be a demonstration that younger generations of men are breaking the myth that their masculinity is measured by their sexual ability, and what would keep them from having the procedure in many cases has more to do with social issues. or cultural, since the risk is very low.

Vasectomy is a simple, outpatient procedure, where the vas deferens, responsible for transporting sperm from the testicles to the outside, are cut. It is generally said that it is also reversible. However, doctors are adamant that this is not the case.

Dr. Francisco Osorio points out that during this procedure, the decision is made to consider it as a permanent method of contraception. “It’s for men or couples who are clear they don’t want to have any more children,” he says, adding that it’s not temporary and not recommended for use. as such. He explains that if the men regret it later, there are two possibilities: extracting the sperm in a procedure that takes place in the ward with anesthesia, using it later in in vitro fertilization, or reversing the vasectomy.

Dr. Óscar Schatloff says it’s true that a vasectomy can technically be reversed by joining the two ends of the vas deferens together, but the ability for pregnancy will depend on the amount and vitality of motile sperm the patient can produce. “This capacity gradually decreases in post-vasectomy patients since the accumulation of sperm in the testicle causes the organism to fade, and the production of new sperm decreases,” he says.

Osorio adds that to achieve a successful reversal, it must be done within the first 10 years. “There, the success rate is between 85% and 90%, which means that in this percentage the spermatozoa reappear in the semen. However, among this percentage, the rate of men who actually achieve pregnancy is between 50% and 60%.