Hooray for vasectomies
A brief history of the world's best contraception.
I’m getting a vasectomy this week. In celebration, I do what I usually do: research. What follows is a brief history of the world’s best contraception.
Vasectomies as we know them — as opposed to castration — were invented in the late 19th century. The earliest vasectomies in people were attempted to control prostate disorders, albeit with little effectiveness. Still, their utility for contraception was quickly recognized. At the time, though, applications of contraception took a darker turn than they do today.
The history of contraception, and especially sterilization, has always been wrapped up in eugenics and class warfare. Vasectomy is no different. Albert Ochsner, founder and president of the American College of Surgeons in the 1920s, advocated for performing vasectomies on what he called “habitual criminals, imbeciles, perverts, paupers, morons, epileptics, and degenerates.” (That’s from the actual title of his academic article. Strangely, there’s no mention of his predilection for forced sterilization on his official profile.)
Except when forcefully sterilizing undesirables, American medicine has always been puritanical about permanent contraception, including in men. Through the 1960s, the American College of Obstetricians and Gynecologists used creative math to restrict voluntary sterilization to men or women whose age multiplied by their number of children exceeded 120: a 30-year-old mom with four kids, for example, or a 40-year-old dad with three. Or, I suppose, a 120-year-old with a nonagenarian only child.
No doubt, squeamishness among men themselves contributed to low uptake rates of vasectomy until recently. 60 years ago, just 40,000 vasectomies were performed a year in the U.S. Today it’s half a million. But the numbers have not grown significantly in the past few decades.
The increased popularity is likely due in part to improvements in the procedure. In the 1970s, Chinese surgeons developed the so-called “no scalpel” vasectomy. Instead of relatively large incisions using a blade, the new technique used razor-sharp forceps to puncture a tiny hole in the scrotum. The innovation eventually spread to the Western world and today accounts for nearly all vasectomies performed in America. The no-scalpel technique lowers the risk of bleeding and reduces pain — and it’s even associated with a quicker resumption of sexual activity. Plus, it turns vasectomies into 15-minute out-patient procedures requiring no more than local anesthesia for most men.
What’s wild is that, despite vasectomy’s stellar track record of safety, low complications and effectiveness, 2-to-3 times as many couples turn to the significantly more invasive tubal ligation method in women instead. Tying the fallopian tubes — or removing them, as is increasingly common — can be fairly straightforward following a planned C-section birth, and some women opt for combining the procedures. But it’s otherwise much more difficult than a vasectomy. After all, the vas deferens is practically outside the body already. Any form of sterilization is effective, so there’s no reason not to go with the cheaper, less invasive one.
I’ll report back with my own experience, but the data is clear: If you’re done having kids, look to vasectomy.
Sources:
Li SQ, Goldstein M, Zhu J, Huber D. The no-scalpel vasectomy. J Urol. 1991 Feb;145(2):341-4. doi: 10.1016/s0022-5347(17)38334-9. PMID: 1988727.
Chandra A, Martinez GM, Mosher WD, Abma JC, Jones J. Fertility, family planning, and reproductive health of U.S. women: data from the 2002 National Survey of Family Growth. Vital Health Stat 23. 2005 Dec;(25):1-160. PMID: 16532609.
Ochsner AJ. The surgical treatment of habitual criminals, imbeciles, perverts, paupers, morons, epileptics, and degenerates. Ann Surg. 1925 Sep;82(3):321-5. doi: 10.1097/00000658-192509010-00001. PMID: 17865322; PMCID: PMC1400322.
Johnson D, Sandlow JI. Vasectomy: tips and tricks. Transl Androl Urol. 2017 Aug;6(4):704-709. doi: 10.21037/tau.2017.07.08. PMID: 28904903; PMCID: PMC5583057.
A Spotlight on Vasectomy, Kaiser Family Foundation