Contraceptive sterilization among married adults: national data on who chooses vasectomy and tubal sterilization

Sexual and couple outcomes of vasectomy: Results of a French questionnaire survey

INTRODUCTION

Vasectomy is a permanent contraceptive method that is increasingly appealing to French men with diverse patient profiles. An important question is the impact on sexual life. We aimed to specify the profile of men seeking vasectomy and its impact on their lives.

METHOD

Based on a consecutive series of 446 men undergoing vasectomy at a university center between April 2010 and March 2022, an online survey was launched in April 2022. In total, 177 patients responded to the questionnaire. The median time between surgery and questionnaire response was 33months (15, 50). At the time of vasectomy, the main age group was 36-45years (55%).

RESULTS

The reflection period before consultation exceeded 1year for 69%. At the time of surgery, only 8% of men were single and 18% were childless. Vasectomy was a couple's decision in 45% of cases. The main motivation was the shift in contraceptive burden for 76% of patients. Harmony in the couple was unchanged for 58% and improved for 33%. Libido remained stable for 79% and improved for 13%; 97% of men reported being satisfied with having undergone vasectomy; 96% had no regrets about surgery; 98% never considered having corrective surgery, and 99% never had a childbearing plan after the intervention.

CONCLUSION

Men increasingly share contraceptive burden. Vasectomy has no significant deleterious impact on sexual life. Satisfaction is high, and the vast majority of men undergoing vasectomy have no regret of their decision. Consequently, vasectomy should continue to expand in France.

LEVEL OF EVIDENCE: 3

Cost Removed! Do Different Factors Influence Motivation for Vasectomy Reversal When Cost Is Not an Issue?

INTRODUCTION

Vasectomy is a relatively common procedure performed for the purposes of sterilization; however, up to 6% of men that undergo vasectomy wish for its reversal at some point. Few studies have examined the motivation behind vasectomy reversal (VR), especially within special populations, such as the U.S. Military. The aim of this study was to examine the motivations of U.S. Military service members (SMs) who opted for VR surgery, considering their unique access to free health care.

MATERIALS AND METHODS

We conducted a retrospective record review of microsurgical VRs performed by a single surgeon (DJH) between January 2020 and May 2023. We evaluated patient's age at which vasectomy was performed, age at VR, reasons for seeking VR surgical care, number of children fathered before the vasectomy, and the age of the current partner.

RESULTS

A total of 106 patients underwent VR during the study period, and 102 of them had their medical records available for review. The average age at the time of vasectomy was 31.3 years, while the average age at VR was 40.2 years. The average spousal age at the time of seeking VR was 34.8 years. Before undergoing vasectomy, the men had fathered an average of 2.7 children. Most men were enlisted members of the military (68) and of all service branches, Army represented the greatest number (50). The vast majority of men (76) cited having a new partner after divorce as the primary motivation for seeking VR. Within this group, 57 were remarried, 15 were in a new relationship, 3 were newly engaged, and 1 desired fertility for future relationships. Additionally, 21 sought VR to have more children with the same spouse. Among them, motivating factors included changes to financial status and improvement in partner's health condition. A minority of patients (2) desired VR due to post vasectomy pain syndrome or religious beliefs.

CONCLUSIONS

Our study demonstrates that the primary driver for seeking VR surgical care among SMs was the desire for fertility with a new partner, which correlates with trends in the civilian sector. Approximately 20% of the men cited the wish to have more children with the same partner as their motivation. Non-fertility reasons, such as religious beliefs and post vasectomy pain syndrome, were also observed, albeit less frequently.

Explaining sex discrepancies in sterilization rates in the United States: An evidence-informed commentary

CONTEXT

With abortion no longer deemed a constitutional right in the United States (US), the importance of effective contraceptive methods cannot be overstated. Both male sterilization (vasectomy) and female sterilization (tubal ligation) have the lowest failure rates of available means of contraception. Despite the less invasive and reversible nature of vasectomy compared to tubal ligation procedures and even though some healthcare professionals dissuade certain women, especially those who are white and/or economically advantaged, from undergoing a sterilization procedure, female sterilization is approximately three times more prevalent than male sterilization in the US.

PURPOSE

We suggest that the discrepancy in sterilization rates is attributable to the burdens of pregnancy and birth experienced by women, beliefs that pregnancy prevention is a woman's responsibility, a dearth of sex education that results in lack of knowledge and poor understanding of contraception, perceptions of masculinity in which contraception is viewed as feminizing, and the increase in long-term singlehood that shapes the desire of individuals to avoid unwanted pregnancy that may result in single parenting.

IMPLICATIONS

Recent reports suggest that court rulings restricting abortion access and looming threats to contraceptive legality and accessibility may be prompting a national increase in male sterilization.

Sedated masculinity: the use of anaesthesia during vasectomy in Israel

Vasectomy is considered a permanent form of contraception for men that can help reduce reproductive inequality. Its underutilisation in the context of the threats it may pose to perceptions of traditional masculinity has been closely investigated, but the lived experience of the procedure itself has been largely overlooked. This paper examines the experience of having a vasectomy in Israel, focusing on the recommended form of anaesthesia. Drawing on 15 semi-structured interviews with Israeli men who have experienced vasectomy, we found that the choice of anaesthesia has a significant impact on the meaning and experience of vasectomy. Unlike the widespread use of local anaesthesia during vasectomy in other countries, vasectomy in Israel is performed almost exclusively under twilight sedation administered intravenously. Based on our findings, we argue that framing vasectomy as an operation that requires sedation is related to views of masculinity and reproduction. Our data suggest that vasectomy in Israel is constituted as a potentially traumatic event, and anaesthesia is employed to protect patients from feelings of embarrassment and discomfort. We conclude that the prevailing method of sedation perpetuates the silencing and marginalisation of vasectomy as a contraceptive method, and consequently, its very limited accessibility in Israel.

Male or female sterilization - the decision making process: Counselling and regret

OBJECTIVE(S)

To analyze the decision-making process of both male and female sterilization in order to improve counselling and prevent regret after sterilization in the future.

STUDY DESIGN

An online questionnaire regarding sterilization (counselling, sources of information and regret) was promoted on Facebook, Twitter and LinkedIn. A total of 1107 men and women who had undergone or considered sterilization in the Netherlands filled in the questionnaire.

RESULTS

A total of 88.9 % of the sterilized group and 67.4 % in the considered group responded that they felt well informed when they considered sterilization. However, less than half of the participants in both groups knew about all different sterilization methods. In both groups participants reported they consulted their partner the most when they considered sterilization. After sterilization 7.7 % reported having regret. Regret was reported more often when participants were sterilized ≤ 30 years. Most important reasons for regret reported by males were complications, pain, a new wish to conceive and divorce/remarriage. Most important reasons for regret reported by females were pain, complications, a new wish to conceive and menstrual symptoms. A total of 21.1 % in the sterilized and 38.0 % in the considered group responded they would have liked to use a decision aid when they considered sterilization.

CONCLUSIONS

Findings of this study provide insight in the decision-making process regarding sterilization. There is a lack of knowledge of different methods of sterilization and 7.7% regrets their sterilization afterwards. Furthermore, the results show an importance of developing a decision aid for couples considering sterilization.

Vasectomy Knowledge and Interest Among U.S. Men Who Do Not Intend to Have More Children

Vasectomy is used less often than female sterilization, and many men who do not want more children may lack accurate information about vasectomy. Between May and June 2018, we used a nationally representative online panel to survey U.S. men between 25 and 55 years of age who did not want more children about their vasectomy knowledge. We also asked about interest in undergoing the procedure if it were free or low cost and explored whether a paragraph addressing common misperceptions was associated with interest. We assessed characteristics associated with high vasectomy knowledge (≥3 accurate responses to four questions about vasectomy's effect on sexual functioning and method efficacy) and vasectomy interest, using chi-square tests and multivariable-adjusted Poisson regression. Of 620 men surveyed, 564 had complete data on the outcomes and covariates of interest. Overall, 51% of respondents demonstrated high vasectomy knowledge. Men who knew someone who had a vasectomy were more likely to have high knowledge (prevalence ratio [PR]: 1.50; 95% CI [1.22, 1.85]). One-third of the sample (35%) said they would consider getting a vasectomy. Men with high (vs. moderate/low) knowledge were more likely (PR: 1.36; 95% CI [1.04, 1.77]) to consider getting a vasectomy. Race/ethnicity, income level, and receiving the informational paragraph were not associated with vasectomy interest. Greater vasectomy knowledge affects men's interest in the procedure. Given that many U.S. men lack accurate knowledge, efforts are needed to address misinformation and increase awareness about vasectomy to ensure men have the information they need to meet or contribute to reproductive goals.

Vasectomy interest and awareness among patients and their partners in prenatal clinics in the United States

OBJECTIVE

Although vasectomy is safer, more effective and less expensive than tubal ligation, rates of permanent contraception are consistently higher in women than in men. We sought to explore vasectomy interest and awareness in patients and their partners during prenatal visits, a time when contraceptive counselling is typically performed.

METHODS

Anonymous surveys were distributed between January and July 2019 to a cross-sectional, convenience sample of pregnant women and their partners, if available, presenting for outpatient prenatal care at two hospitals (one public, one private) serving different patient populations in Chicago, Illinois, USA. Survey questions gauged participant awareness and interest in vasectomies.

RESULTS

Surveys were completed by 436 individuals (78% female, 24% male). Seventy percent of respondents indicated interest in vasectomy after achieving optimal family size, but most respondents had never discussed it with their healthcare provider. Factors associated with vasectomy interest included being partnered, having a lower household income, and knowing someone who has had a vasectomy. Almost 50% of respondents would be interested in obtaining information about vasectomies from their obstetrician or prenatal care provider.

CONCLUSIONS

Many patients and their male partners in the prenatal clinic setting were interested in vasectomy as a method for permanent contraception, but most respondents had never received counselling. Since comprehensive prenatal care includes contraceptive planning, obstetric providers are uniquely positioned to educate individuals on vasectomy.

"Thinking with my dad brain, not my man brain": Understanding Men's and Women's sterilization risk narratives

The interpretation of risk influences women's reproductive decisions. Research has yet to show how men understand and interpret risk, particularly in their decision to use contraception. Contraceptive sterilization provides a case through which we compare risk narratives between men and women, as it is the only analogous birth control for both men and women. A study of risk narratives held by sterilized adults and their partners reveals how risk narratives are gendered and how they contribute to contraceptive use. Using 75 in-depth interviews with sterilized heterosexual men (n = 25), women (n = 25), and unsterilized partners (n = 17 women, n = 8 men), the present study finds that men and women report similar risk narratives grounded in (1) birth control risks to health and life plans and (2) risks to maternal health from past pregnancies and age. As expected, women's risk narratives appear to stem from their embodied experiences and their interactions with medical authorities. Rather than addressing their own embodied experiences or experiences with medicine, men's beliefs mirror women's, and are centered on the dangers of hormonal birth control and pregnancy to women. This study is novel in showing the couple dyad as a site of men's beliefs about risk, as how heterosexual couples form ideas about health and life plan risk through a mutually shared gendered lens.

The Fixed Childfree Subjectivity: Performing Meta-Facework about Sterilization on Reddit

Although sterilization is the most common and effective form of birth control available, childfree individuals often report difficulty actually obtaining the procedure. The ideological and material constraints that impede access have been well documented, including physicians' pronatalist perceptions that childless women will regret sterilization when they mature or meet the right partner. However, researchers have demonstrated that childfree women experience low levels of regret after sterilization, indicating that physicians' reluctance is empirically unfounded. In order to mitigate physicians' hesitancy, childfree individuals organize and communicate online in order to share health-related information, seek support, and engage in identity work to more effectively procure the procedure. The current study contributes to critical health, interpersonal, and family communication conversations by employing performative face theory to study online interactions on the childfree subreddit, the largest and most active online forum dedicated to child freedom. Through critical-qualitative analysis of a cross-section of subreddit posts about sterilization, this study demonstrates how subreddit discourse draws upon ideological and metaphorical associations to articulate the fixed childfree subjectivity, which rejects negative significations of regret in favor of positive notions of repair and permanence. Users further engage in subversive meta-facework, or facework presented online about facework users engaged in offline, which maintains shared face and denaturalizes taken-for-granted linkages between gender, identity, and parenthood. Implications for health activism across individual, relational, communal, and cultural levels are discussed.

Men's Vasectomy Knowledge, Attitudes, and Information-Seeking Behaviors in the Southern United States: Results From an Exploratory Survey

Vasectomy is one of the few options men have to manage their reproductive capacity and take on a more equitable role in pregnancy prevention. While the method is underused throughout the United States, the southern states have a lower prevalence rate compared to the rest of the country. Existing survey research does not assess what men know or think about the procedure as a means of understanding why this is the case. We created and conducted an exploratory survey to assess men’s knowledge, attitudes, and information-seeking behaviors about vasectomy in the Southern United States. We used targeted Facebook advertising to recruit men ages 25–70 years living in 7 southern states to complete an online survey (n = 397). Using regression analyses, we identify that participants who had a vasectomy knew more about the procedure than participants who had not. Participants who had not had a vasectomy had less positive attitudes about the procedure across all six attitude subscales compared to participants with vasectomies. We highlight potential avenues for future research to understand why this may be the case. Finally, the majority of participants knew someone who had had a vasectomy. This suggests that men disclose having a vasectomy to others. The interpersonal dynamics around vasectomy decision-making and disclosure remain unknown and a viable area for future research. Findings from this exploratory survey may be used by public health officials interested in implementing campaigns to increase knowledge about vasectomy and reduce stigma, which may encourage more positive attitudes about the procedure.

A qualitative exploration of men's perceptions of the terms "male sterilization" versus "vasectomy" in the southern United States

OBJECTIVES

Clinical literature and contraception information guides use the terms "male sterilization" and "vasectomy" interchangeably. We investigate the meanings men attach to "sterilization" and how those meanings compare to perceptions of "vasectomy."

STUDY DESIGN

Cisgender, heterosexual men, ages 25 to 67, living across seven U.S. southern states participated in individual telephone interviews from May to December 2019. Interviews explored men's experiences with contraception, including their perception of the term "sterilization." We audio-recorded and transcribed the interviews and conducted thematic analyses using an inductive approach.

RESULTS

While most participants described "vasectomy" as a relatively benign procedure, they described "sterilization" as "sinister," "bleak," and "barbaric." Participants' discussions of sterilization invoked associations with eugenicist practices and specific historical examples of forced sterilization. While some participants recognized that vasectomy is a means of achieving sterilization, most viewed the term "sterilization" as incongruous with the modern medical procedure of "vasectomy," precisely because sterilization has been used as a form of reproductive oppression.

CONCLUSION

Our findings suggest that men have strong affective responses to the term "sterilization." Participants' knowledge of historical eugenicist practices has implications for the acceptability of vasectomy as a permanent contraceptive option in our contemporary context.

IMPLICATIONS

The phrase "male sterilization" can be associated with eugenics and coercive reproductive practices. Using the term for reproductive counselling, education, or research purposes may have implications for the acceptability of vasectomy as a permanent contraceptive option.

Individual- and country-level correlates of female permanent contraception use in sub-Saharan Africa

Background

Female permanent contraception is a cost-effective contraceptive method that can help clients with the desire to limit childbearing achieve their reproductive intention. However, despite its benefits, the use of FPC remains low in sub-Saharan Africa (SSA), and limited studies have examined the correlates of its uptake. In this study, we assessed the individual- and country-level factors associated with the use of FPC among married or in-union women using modern contraceptive methods to limit childbearing in SSA.

Methods

This study was a secondary data analysis of individual- and country-level data obtained from the Demographic and Health Surveys (DHS) Program and three open data repositories. The study included 29,777 married or in-union women aged 15–49 years using modern contraceptive methods to limit childbearing from DHS conducted in 33 sub-Sahara African countries between 2010 and 2018. We performed descriptive statistics and fitted multilevel logistic regression models to determine the predisposing, enabling, and need factors associated with the use of FPC.

Results

Approximately 13% of the women used FPC. About 20% of the variance in the odds of using FPC was attributable to between-country differences. In the full model, the significant individual-level factors associated with the use of FPC compared with other modern contraceptive methods were: age (odds ratio [OR] = 1.10; 95%CI = 1.08–1.12), living children (OR = 1.11, 95%CI = 1.04–1.16), high household wealth (OR = 1.39, 95%CI = 1.18–1.64), rural residence (OR = 0.83, 95% CI = 0.71–0.97), joint contraceptive decision with partner (OR = 1.68, 95% = 1.43–1.99), contraceptive decision by partner and others (OR = 2.46, 95% = 1.97–3.07), and the number of living children less than the ideal number of children (OR = 1.40, 95%CI = 1.21–1.62). The significantly associated country-level factors were births attended by skilled health providers (OR = 1.03, 95%CI = 1.00–1.05) and density of medical doctors (OR = 1.37, 95%CI = 1.01–1.85).

Conclusions

Our results suggest that both individual- and country-level factors affect uptake of FPC in SSA. Increasing geographic, economic, and psychosocial access to FPC may improve its uptake in SSA.

The process of opting for female permanent contraception: A qualitative study of women's experiences in Sweden

OBJECTIVES

We aimed to explore Swedish women's decision-making experiences regarding permanent contraception.

STUDY DESIGN

In this study, we included 17 women aged 30-48 who were scheduled to undergo female permanent contraceptive procedures. We conducted semistructured interviews using two broad open-ended questions. We analyzed these data using systematic text condensation based on the principles of psychological phenomenological analysis.

RESULTS

The interviewees experienced no counseling or support from health care workers regarding permanent contraception until they specifically asked for it. Participants reported that they themselves place the responsibility of permanent contraception solely on women. Consequently, our participants described feeling hesitancy and ambivalence in the process of deciding to have the procedure. Once the decision was made and the women were on the waiting lists for surgery, they experienced relief and empowerment.

CONCLUSIONS

Our findings suggest that health care providers in Sweden miss opportunities to support patient-centered decision-making regarding permanent contraception. This study indicates that women make deliberate and considered decisions regarding permanent contraception and are best positioned to know when the procedure should take place in their reproductive lives.

IMPLICATION STATEMENTS

Health care professionals should discuss permanent contraception as an option with all women desiring contraception to allow them to decide if that method is right for them.

Intention to use vasectomy and associated factors among married men in Addis Ababa, Ethiopia

Background

Vasectomy is one of the highly effective and non-reversible types of long-term family planning methods for men. Ethiopia has a limited number of studies on the use of vasectomy, and they are focused on men rather than married men. The current study was aimed to identify the intention to use vasectomy as a method of contraception among married men in the study setting.

Methods

A community-based cross-sectional study was conducted from February 1 – April 30, 2018. A sample of 422 married men was recruited using a systematic random sampling method. We conducted face to face interviews with a structured questionnaire (i.e. closed-ended questions). Data were entered into Epi data version 3.1 and SPSS version 23 used for data analysis. The statistical association between the outcome variable (Intention to use vasectomy) and the explanatory variables were first tested with binary logistic regression. Multivariable logistic regression was used to control for confounding effect of each predictor.

Results

The study findings showed that the intention to use vasectomy as a method of family planning was reported as high (24%). About 34.8% of the respondents had good knowledge and nearly a quarter (23.2%) of them had a positive attitude toward the acceptance of vasectomy use. In multivariate analysis, age range between 30 and 39 years [AOR = 2.4, 95% CI = (1.16–4.82)], having good knowledge about vasectomy use [AOR = 6.22, 95% CI = (3.17–12.21)], and having a positive attitude toward vasectomy use [AOR = 7.81, 95% CI = (4.25–14.38)] were factors significantly associated to use vasectomy as compared to their counterparts.

Conclusion

The level of acceptance of vasectomy (24%) was high compared to the level of its use in developing countries (i.e. if acceptability translates to use). The study revealed that age, good knowledge, and a positive attitude towards the use of vasectomy were important predictors of the intention to accept vasectomy. To further promote the use of vasectomy effective communication strategies in family planning programs are needed.

The French pill scare and the reshaping of social inequalities in access to medical contraceptives

While the consequences of various "pill scares" have been relatively well-documented in the public health literature revealing a drop in pill use and a rise in unplanned pregnancies and abortion rates, researchers rarely considered that these controversies would affect women contraceptive practices differently according to their social background. Indeed, social differentiations in reaction to "pill scares" could contribute to reinforce the social gradient in the use of contraceptive methods and choice of visiting the health professionals who prescribe them. These could contribute to an increase in health inequalities on access to contraceptive methods. Using data from three state nationally representative cross-sectional surveys conducted in France in 2010, 2013 and 2016, we studied the changes in women's contraceptive uses around the French "pill scare" that occurred in 2012-2013. We focused on the changes in the use of all contraceptives available under medical prescription (called medical contraceptives) on one hand, and on each specific method (pill, IUD, implant, patch or vaginal ring, and female sterilization) on the other hand according to the women's social background. We saw a social gradient in contraceptives changes. The decline in the use of contraceptive methods available under medical prescription was particularly marked for women from lower and higher classes in which we observe a decrease in pill use between 2010 and 2013, whereas it was observed only between 2013 and 2016 among middle class women. Moreover, while some women from upper class shifted from pill to IUD between 2010 and 2013, this was not the case for their less privileged counterparts. As a consequence, it seems that the French "pill scare" led to the reshaping of social inequalities in access to medical contraceptives.

Changing Educational Differentials in Female Sterilization

CONTEXT

Female surgical sterilization is widely used in the United States. Educational differentials in sterilization are large, but poorly understood. Improved understanding of these differences is important to ensure that all women have access to the full range of contraceptive methods.

METHODS

Data from the National Survey of Family Growth (1973-2015) from 8,100 women aged 40-44 were used to describe trends in sterilization and other contraceptive methods by educational attainment. Demographic standardization was employed to examine how compositional changes in marital status and age at first birth contribute to aggregate changes in sterilization prevalence.

RESULTS

In 1982, women with a high school diploma and those with at least a bachelor's degree reported similar levels of sterilization use (38% and 32%, respectively), but by 2011-2015, prevalence had declined to 19% among college-educated women and had increased to 44% among those with a diploma. The trend among college graduates was largely attributable to delayed fertility; all other things being equal, if their age at first birth had not increased, the prevalence of sterilization would have declined by approximately 3% instead of 14% between 1982 and 2002. Increased use of sterilization among women with a high school diploma was only weakly related to changes in birth timing and marital status.

CONCLUSIONS

Among women with a high school diploma, elements other than childbearing and marital status-such as contraceptive preferences and access-appeared to influence their contraceptive behavior. Sterilization differentials between high school and college graduates may reflect or exacerbate other socioeconomic disparities that affect women's health and well-being.

Using Deliberative and Qualitative Methods to Recommend Revisions to the Medicaid Sterilization Waiting Period

BACKGROUND

Sterilization is used by one-quarter of women in the United States for contraception and is a preferred birth control method among women with Medicaid. A history of coercive sterilization practices in the United States led to federal regulation of consent for Medicaid sterilization (including a mandated waiting period); this regulation can be a barrier to sterilization in Medicaid-insured women. This study aimed to develop a revised model of Medicaid sterilization policy grounded in the experiences of women impacted by current regulations.

METHODS

This prospective study used in-depth interviews with 32 Medicaid-insured women who had obtained or tried to obtain sterilization to elicit recommendations regarding the Medicaid waiting period. Deliberative methods (a planning cell including 20 key community stakeholders) were used to evaluate women's recommendations and propose a revised policy for sterilization under Medicaid.

RESULTS

In-depth interview data demonstrated that women were often not made aware of the 30-day waiting period during informed consent before sterilization. Once informed about the policy, women described the Medicaid waiting period as "unfair," because it did not apply to all women. After deliberating women's recommendations to change the policy, key stakeholders came to a consensus around replacing the current waiting period policy with an improved consent process that would acknowledge the problematic history of coercive sterilization. Participants could not endorse removing the waiting period altogether without evidence that the health system had shifted away from coercive sterilization practices.

CONCLUSIONS

Using deliberative methods and the recommendations of women with Medicaid insurance, community stakeholders recommended developing a revised Medicaid sterilization consent policy that acknowledged the historical context of this procedure.

Reproductive health care in Catholic-owned hospitals

Mergers that affiliate a hospital with a Catholic owner, network, or system reduce the set of possible reproductive medical procedures since Catholic hospitals have strict prohibitions on contraception. Using changes in ownership of hospitals, we find that Catholic hospitals reduce the per bed rates of tubal ligations by 31%, whereas there is no significant change in related permitted procedures such as Caesarian sections. However, across a variety of measures, we find minimal overall welfare reductions. Still, fewer tubal ligations increase the risk of unintended pregnancies across the United States, imposing a potentially substantial cost for less reliable contraception on women and their partners.

Analysis of urban vs. rural vasectomy demographics: a multi-institutional, retrospective comparison

Background

Each year in the US, approximately 500,000 men choose to undergo a vasectomy for permanent sterilization. Despite being a very common procedure, studies reporting demographic data and characteristics that motivate men to choose a vasectomy are somewhat limited. With this analysis, the primary objective was to determine if a difference existed between the ages and number of children among men choosing to have a vasectomy at urology practices in urban (Austin, TX = City A, population 947,890) and rural (Temple, TX = City B, population 76,277) settings. A secondary objective was to establish if there was a trend in these variables over time.

Methods

After IRB approval was obtained from each institution, a retrospective chart review was undertaken to identify men who had undergone a vasectomy at each facility from 2011-2017. Demographic data was recorded. Statistical analysis was done using student's t-test and linear regression.

Results

The mean age at time of vasectomy in City A was 37.41 years versus 36.18 in City B (P<0.001). Men in City A underwent vasectomy after a mean of 1.96 children as opposed to a mean of 2.60 children in City B (P<0.001). There was no statistically significant trend in average age or number of children over time.

Conclusions

Men in an urban setting underwent vasectomy at an older age and with fewer children when compared to a rural practice environment. While studies evaluating demographics of men undergoing vasectomy have previously been performed, our results are unique in terms of a direct comparison between different population concentrations.

Use of secondary contraception following vasectomy: insights from the Pregnancy Risk Assessment Monitoring System, 2007-2011

Background

To assess postpartum use of secondary contraception with vasectomy within Pregnancy Risk Assessment Monitoring System (PRAMS).

Methods

Secondary contraception and type of method used were assessed among married women reporting partner vasectomy 4 months after a recent live birth in female residents of 15 US states and New York City who participated in the 2007–2011 PRAMS.

Results

Between 2007 and 2011, 1,004 married women who had a recent live birth participating in PRAMS reported they and their partners relied on vasectomy for postpartum contraception. Among these couples, 57.8% reported not using additional forms of contraception postpartum. Of those reporting additional contraception, condoms were most commonly used (50.0%), followed by oral contraceptive pills (26.5%), and withdrawal (9.5%). Multivariable modeling showed that use of secondary contraception was twice as high among women reporting a second birth versus women reporting a fourth or higher birth [adjusted prevalence odds ratio (POR) =2.0 (1.1–3.2)]. No other sociodemographic characteristics (maternal age, maternal race, parental education, household income) were significantly associated with use of secondary contraception with vasectomy.

Conclusions

Most couples within PRAMS reporting partner vasectomy as postpartum contraception did not use secondary contraception in the months immediately after vasectomy, and, of those who did, most relied on less effective methods. Clinicians need to better understand reasons for limited use of secondary contraception with vasectomy to improve counseling strategies for reducing unintended pregnancy.

Attitudes towards vasectomy and its acceptance as a method of contraception among clinical-year medical students in a Malaysian private medical college

INTRODUCTION

This study explored attitudes towards vasectomy and its acceptance as a method of contraception among clinical-year medical students, and determined the association between their demographic characteristics, and attitudes and acceptance.

METHODS

A cross-sectional survey was conducted among clinical-year medical students from a Malaysian private medical college using a self-administered questionnaire.

RESULTS

There were 330 participants with a female preponderance and a mean age of 22.0 ± 1.1 years. The largest proportion of respondents were from Year 3. The vast majority were ethnically Malay (91.8%) and followed Islam (92.4%). Overall, 60.9% of participants had a positive attitude towards vasectomy and 76.0% showed good acceptance. Gender, academic year, ethnicity and religion variables were not associated with attitudes and acceptance (p > 0.05). A significantly higher proportion of male respondents thought that vasectomy was religiously forbidden and would give a bad impression. A significantly higher proportion of Year 5 students agreed to the statement 'I would recommend vasectomy to relatives, friends and people close to me' compared to Year 3 and 4 students.

CONCLUSION

Students' perception of vasectomy as a contraceptive method was encouraging. Our results suggest that their knowledge improved as medical training progressed, and attitudes evolved for the better irrespective of their traditional, cultural and religious beliefs - highlighting the importance of providing students with evidence-based learning about male sterilisation, which is more cost-effective and is associated with lower morbidity than female sterilisation. A qualitative study involving students from different ethnicities and religions would provide a better understanding of this subject.

Surgical sterilization among US men and women with employer-based insurance: A claims data analysis

OBJECTIVE

To assess variability in the use of surgical sterilization among privately insured U.S. men and women.

STUDY DESIGN

We queried the MarketScan Commercial Claims database using CPT, ICD9, and HCPCS codes to identify 658,509 individuals between 18-65 years old (0.37% of total) who underwent male or female sterilization between 2009-2014. We examined annual trends using Cochran-Mantel-Haenszel test. We analyzed differences in age, geographic distribution, and family size using Wilcoxon sum-rank and generalized chi-squared tests.

RESULTS

Between 2009-2014, 422,290 men (0.55% of total men) and 236,219 women (0.24% of total women) with employer-sponsored insurance underwent male and female sterilization, respectively. Annual male sterilizations decreased from 77,565 (0.60%) in 2009 to 61,436 (0.51%) in 2014 (p<.001), while annual female sterilizations decreased from 43,766 (0.26%) to 30,465 (0.19%) (p<.001) over the same time period. Median age at time of male or female sterilization was 38 and 37 years, respectively. The decision to undergo sterilization at age 35 or older was associated with family size of 4 or more individuals (p<.001). Sterilization was more common in urban areas, with 84% of male sterilizations and 79% of female sterilizations performed in urban areas. 79% of men compared to 60% of women who underwent sterilization were the primary policyholders of their employer-sponsored healthcare plans (p<.001).

CONCLUSION

Male sterilization was twice as common as female sterilization in this privately insured cohort. Use of surgical sterilization was associated with increased age and larger family size. There was a decline in the annual number of male and female sterilizations during the study period.

IMPLICATIONS

Male sterilization is more common among US men with employer-based insurance than among the general population. The decline in sterilization may reflect cultural factors and the rise of long-acting reversible contraception. Analyzing the sociodemographic factors impacting sterilization may provide insight into contraceptive choice and improve reproductive health services.

HIGH PREVALENCE OF VOLUNTARY STERILIZATION AMONG AMERICAN WOMEN EXPLAINED BY TRADE-OFFS RESULTING FROM MALE PARENTAL COMMITMENT

Tubal ligation is the modal form of family planning among American women aged 30 and older. As the preference for tubal ligation over cheaper, lower risk and more reliable methods, such as vasectomy, has puzzled experts, a theoretical approach that explains this preference would be useful. The present study investigates the high prevalence of voluntary sterilization among American women from the perspective of life history theory, arguing that the trade-offs between investing in current and future offspring will favour tubal ligation when women cannot obtain reliable male commitment to future parental investment. Data came from the National Survey of Fertility Barriers (NSFB), a nationally representative survey of 4712 American women aged 25-45 conducted between 2004 and 2007. Four novel predictions of the prevalence of tubal ligation, drawn from life history theory, were developed and tested: 1) it is most common among unpartnered women with children, and least common among married women with children; 2) it is negatively correlated with age at first birth; 3) it is least common among highly educated women without children, and most common among less educated women with children; and 4) among women with two or more children, it is positively correlated with lifetime number of long-term partners. These predictions were tested using multivariate regression analysis. The first prediction was not supported: women with children were more likely to be sterilized, regardless of their marital status. The other three predictions were all supported by the data. The results suggest that trade-offs influence women's decisions to undergo voluntary sterilization. Women are most likely to opt for tubal ligation when the costs of an additional child will impinge on their ability to invest in existing offspring, especially in the context of reduced male commitment.

Opinions and Attitudes About Vasectomy of Married Couples Living in Turkey

This study was conducted as a descriptive study, designed to determine the opinions and attitudes of married couples living in Turkey about vasectomy. The sample consisted of 350 women. Researchers used a questionnaire to collect data. Descriptive statistics and chi-square analysis were used. The results showed that 14% of women and 43.0% of men were of the opinion that undergoing a vasectomy procedure was a sin. Chi-square analysis determined statistically significant differences between the male and female groups ( p < .05). More than 88.0% of the men were not willing to have vasectomy and 35.4% thought that vasectomy had a negative effect on marriage and sexual health. In addition, 58.9% thought that vasectomy had a negative effect on men's health. Women were more likely than men to see vasectomy as merely a cultural taboo instead of a sin. Sociocultural factors, such as ideas that contraception is the woman's responsibility, that sterilized men lose status in society, or that sterilized men lose authority in the family, as well as misconceptions about vasectomy such as concerns about sexual functioning, psychological effects, and effects on physical strength, were determined to be the main barriers for vasectomy use in Turkish culture. The study recommends determining strategies for overcoming sociocultural barriers by raising awareness and increasing the utilization of vasectomy. Couple-specific family planning programs can make an important contribution toward improving awareness of the benefits of vasectomy.

Power and the gendered division of contraceptive use in Western European couples

Recent research has approached contraceptive use, or "fertility work", as another household task that is primarily managed by women. Building on the theoretical frameworks of relative resource theory and gender perspectives, this study investigates the association between partners' power (measured as their relative education, division of housework and decision-making) and the choice of male versus female, or no contraception. Data from the Generations and Gender Survey for four Western European countries (Austria, Belgium, France and Germany; 2005-2010) are used to examine the hypotheses with multinomial logistic diagonal reference models. The results show that man's and woman's educational level are equally important predictors for a couple's contraceptive method choice. Furthermore, the findings suggest that households in which the man performs more housework or the woman has more say in decisions are more likely to rely on male methods or female sterilization, rather than on the more commonly used female reversible methods.

Barriers to Offering Vasectomy at Publicly Funded Family Planning Organizations in Texas

Few publicly funded family planning clinics in the United States offer vasectomy, but little is known about the reasons this method is not more widely available at these sources of care. Between February 2012 and February 2015, three waves of in-depth interviews were conducted with program administrators at 54 family planning organizations in Texas. Participants described their organization’s vasectomy service model and factors that influenced how frequently vasectomy was provided. Interview transcripts were coded and analyzed using a theme-based approach. Service models and barriers to providing vasectomy were compared by organization type (e.g., women’s health center, public health clinic) and receipt of Title X funding. Two thirds of organizations did not offer vasectomy on-site or pay for referrals with family planning funding; nine organizations frequently provided vasectomy. Organizations did not widely offer vasectomy because they could not find providers that would accept the low reimbursement for the procedure or because they lacked funding for men’s reproductive health care. Respondents often did not perceive men’s reproductive health care as a service priority and commented that men, especially Latinos, had limited interest in vasectomy. Although organizations of all types reported barriers, women’s health centers and Title X-funded organizations more frequently offered vasectomy by conducting tailored outreach to men and vasectomy providers. A combination of factors operating at the health systems and provider level influence the availability of vasectomy at publicly funded family planning organizations in Texas. Multilevel approaches that address key barriers to vasectomy provision would help organizations offer comprehensive contraceptive services.

Barriers to Offering Vasectomy at Publicly Funded Family Planning Organizations in Texas

Few publicly funded family planning clinics in the United States offer vasectomy, but little is known about the reasons this method is not more widely available at these sources of care. Between February 2012 and February 2015, three waves of in-depth interviews were conducted with program administrators at 54 family planning organizations in Texas. Participants described their organization’s vasectomy service model and factors that influenced how frequently vasectomy was provided. Interview transcripts were coded and analyzed using a theme-based approach. Service models and barriers to providing vasectomy were compared by organization type (e.g., women’s health center, public health clinic) and receipt of Title X funding. Two thirds of organizations did not offer vasectomy on-site or pay for referrals with family planning funding; nine organizations frequently provided vasectomy. Organizations did not widely offer vasectomy because they could not find providers that would accept the low reimbursement for the procedure or because they lacked funding for men’s reproductive health care. Respondents often did not perceive men’s reproductive health care as a service priority and commented that men, especially Latinos, had limited interest in vasectomy. Although organizations of all types reported barriers, women’s health centers and Title X-funded organizations more frequently offered vasectomy by conducting tailored outreach to men and vasectomy providers. A combination of factors operating at the health systems and provider level influence the availability of vasectomy at publicly funded family planning organizations in Texas. Multilevel approaches that address key barriers to vasectomy provision would help organizations offer comprehensive contraceptive services.

Ready, Willing, and Able: Contraceptive Use Patterns Across Europe

An "East-West" divide in contraceptive use patterns has been identified across Europe, with Western European countries characterized by the widespread use of modern contraception, and Central and Eastern European countries characterized by a high prevalence of withdrawal, the rhythm method, or abortion. Building on the Ready-Willing-Able framework, this study aims to gain more insight into the micro- and macro-level socioeconomic, cultural, and technological determinants underlying contraceptive use. Data from the Generations and Gender Survey (2004-2011) covering four Western and seven Central and Eastern European countries are used, and multinomial multilevel analyses are performed. Results reveal that individuals who intend to delay parenthood are more likely to use any contraceptive method, whereas holding more traditional values and having a lower socioeconomic status are associated with a higher likelihood of using no or only traditional methods. Regional reproductive rights and gender equality interact in complex ways with these associations. At minimum, our results underline the complexity of the processes underlying the persistent difference in contraceptive use across Europe.

CUA guideline: Vasectomy

<p>Vasectomy is a safe and effective method of birth control. Although it is a simple elective procedure, vasectomy is associated with potential minor and major complications. The early failure rate of vasectomy (presence of motile sperm in the ejaculate at 3‒6 months post-vasectomy) is in the range of 0.3‒9% and the late failure rate is in the range of 0.04–0.08%. The no-scalpel vasectomy technique is associated with a lower risk of early postoperative complications and the use of cautery or fascial interposition will reduce the risk of contraceptive failure. As such, detailed preoperative counselling and careful assessment of the post-vasectomy ejaculate (for presence of sperm) is imperative. Failure to provide and document adequate information and counselling to patients may lead to litigation.</p><p>The focus of this guideline is the management of men presenting for vasectomy. Specifically, the topics covered include: preoperative counselling, vasectomy efficacy and complications, technical aspects of vasectomy, post-vasectomy semen testing, and interpretation-communication of post-vasectomy semen results. By performing an extensive literature review, we have generated an evidence-based consensus on the management of these men. The objective of this guideline is to help standardize the treatment of men presenting for vasectomy.</p>

Mexican Men's View of Vasectomy

The present study explored the views of Mexican men concerning vasectomy. One hundred and five men who had not had a vasectomy were asked to complete the following phrase "If you no longer wanted to have more children and a vasectomy was suggested, you would react with . . . or you would think . . . " with at least five different answers. Participants then had to rank each of their answers according to how well they describe the participant's feelings in the hypothetical situation. The results were analyzed using the Natural Semantic Networks Technique. The most common words used by participants with a limited educational background were reject, followed by fear and anger, and they did not use any words that implied acceptance of vasectomy. In contrast, the most common words used by participants with higher education were curiosity, followed by acceptance and interest; however, they also used the words fear and insecurity. The most frequent attitudes reported by men with limited education were negative, whereas participants with a higher education reported more ambivalent attitudes. These findings are discussed in light of sociocultural features and could be helpful in designing reproductive health programs with more effective counseling to diminish negative views about vasectomy.

Optimizing outcomes in vasectomy: how to ensure sterility and prevent complications

Vasectomy provides a long-term effective sterilization for men and is performed on nearly 500,000 men annually in the United States. Improvements in technique have led to a decreased failure rate and fewer complications, although significant variations in technique exist. Use of cautery occlusion with or without fascial interposition appears to have the least failures. A no-scalpel approach lowers risk of hematoma formation, infection and bleeding post-operatively. A patient can be considered sterile when azoospermia is achieved or the semen analysis shows less than 100,000 non-motile sperm per milliliter. Incorporating these principles may allow the physician to optimize outcomes in vasectomy.

The perplexing links between contraceptive sterilization and (dis)advantage in ten low-fertility countries

This study investigated the association between contraceptive sterilization and socio-economic status (measured by educational attainment) in ten countries, using data from the 2006-10 National Survey of Family Growth and the 2004-10 Generations and Gender Surveys. The findings confirm that a long-standing association between socio-economic status and sterilization persists in the contemporary United States: female sterilization is associated with economic disadvantage, whereas male sterilization is associated with economic advantage. The latter association is found to be unique to the United States, but female sterilization is associated with disadvantage in most of the other countries studied. While basic demographic background factors such as early childbearing and parity can explain the observed associations in most of the countries, a strong gendered association between sterilization and socio-economic status remains in the United States and Belgium even after adjusting for these factors.

Perceived Interest in Vasectomy among Latina Women and their Partners in a Community with Limited Access to Female Sterilization

The low prevalence of vasectomy among Latino men in the United States is often attributed to cultural characteristics despite limited evidence supporting this hypothesis. We assessed male partners' perceived willingness to undergo vasectomy through surveys with 470 Mexican-origin women who did not want more children in El Paso, Texas. Overall, 32% of women reported that their partner would be interested in getting a vasectomy. In multivariable analysis, completing high school (OR=2.03 [1.05, 3.95]), having some college education (OR=2.97 [1.36, 6.48]) or receiving US government assistance (OR=1.95 [1.1, 3.45]) was associated with partners' perceived interest. Additionally, we conducted two focus groups on men's knowledge and attitudes about vasectomy with partners of a subsample of these women. Despite some misperceptions, male partners were willing to get a vasectomy, but were concerned about cost and taking time off work to recover. Health education and affordable vasectomy services could increase vasectomy use among Mexican-origin men.

Relationships of Tubal Ligation to Endometrial Carcinoma Stage and Mortality in the NRG Oncology/ Gynecologic Oncology Group 210 Trial

BACKGROUND

Stage is a critical determinant of treatment among endometrial carcinoma patients; understanding patterns of tumor spread may suggest approaches to improve staging. Specifically, the importance of exfoliation of endometrial carcinoma cells through the fallopian tubes into the peritoneum is ill defined. We assessed the hypothesis that tubal ligation (TL), which should impede transtubal passage of cells, is associated with lower endometrial carcinoma stage at presentation and, consequently, lower mortality.

METHODS

The NRG Oncology/Gynecologic Oncology Group (GOG) 210 Trial included 4489 endometrial carcinoma patients who completed a risk factor questionnaire that included TL history. Pathology data were derived from clinical reports and central review. We used logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations between TL with stage and peritoneal metastasis, overall and by tumor subtype. Cox regression was used to estimate hazard ratios (HRs) and 95% confidence intervals for TL and mortality. All statistical tests were two-sided.

RESULTS

Compared with stage I, TL was inversely associated with stage III (OR = 0.63, 95% CI = 0.52 to 0.78) and stage IV carcinomas (OR = 0.14, 95% CI = 0.08 to 0.24) overall and among individual tumor subtypes. TL was inversely related to peritoneal metastasis overall (OR = 0.39, 95% CI = 0.22 to 0.68) and among serous carcinomas (OR = 0.28, 95% CI = 0.11 to 0.68). In multivariable models unadjusted for stage, TL was associated with lower endometrial carcinoma-specific mortality (HR = 0.74, 95% CI = 0.61 to 0.91); however, adjustment for stage eliminated the survival advantage. Similar relationships with all-cause mortality were observed.

CONCLUSIONS

TL is associated with lower stage and mortality among women with aggressive endometrial carcinomas, suggesting transtubal spread is clinically important. Future studies should evaluate whether detection of intraluminal tumor cells is prognostically relevant.

Marital status and female and male contraceptive sterilization in the United States

OBJECTIVE

To examine female and male sterilization patterns in the United States based on marital status, and to determine if sociodemographic characteristics explain these patterns.

DESIGN

Survival analysis of cross-sectional data from the female and male samples from the 2006-2010 National Survey of Family Growth.

SETTING

Not applicable.

PATIENT(S)

The survey is designed to be representative of the US civilian noninstitutionalized population, ages 15-44 years.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Vasectomy and tubal sterilization.

RESULT(S)

In the United States, vasectomy is the near-exclusive domain of married men. Never-married and ever-married single men, and never-married cohabiting men, had a low relative risk (RR) of vasectomy (RR = 0.1, 0.3, and 0.0, respectively), compared with men in first marriages. Tubal sterilization was not limited to currently married, or even to ever-married women, although it was less common among never-married single women (RR = 0.2) and more common among women in higher-order marriages (RR = 1.8), compared with women in first marriages. In contrast to vasectomy, differential use of tubal sterilization by marital status was driven in large part by differences in parity.

CONCLUSION(S)

This study shows that being unmarried at the time of sterilization--an important risk factor for poststerilization regret--was much more common among women than men. In addition to contributing to the predominance of female, vs. male, sterilization, this pattern highlights the importance of educating women on the permanency of sterilization, and the opportunity to increase reliance on long-acting reversible contraceptive methods.

Interest in nonsurgical female permanent contraception among men in Portland, Oregon and eastern Maharashtra, India

OBJECTIVE

We examined the men's attitudes and perceptions toward the concept of female nonsurgical permanent contraception (NSPC) or novel approaches to permanent contraception (PC) that do not require incisions or surgical equipment/hysteroscope.

STUDY DESIGN

Cross-sectional survey of married/partnered men in Portland, OR, and rural eastern Maharashtra, India. Descriptive analysis was performed.

RESULTS

In India (N=150), most men (80%) anticipated that their partners would undergo PC in the future, compared to 30% in Portland (N=170). About a third (39.6% in India, 82% in Portland) reported being uncomfortable with PC for partners due to the need for surgery. Most men (85% in India, 82% in Portland) expressed a preference for a hypothetical new method of female NSPC over surgery, if safe and effective.

CONCLUSION

Most men sampled in two diverse settings expressed interest in NSPC for women.

IMPLICATIONS

Men's perceptions of new female contraceptive methods are important to the contraceptive development process. Men may find a safe and effective nonsurgical method of permanent female contraception more acceptable than surgical PC.

Reconsidering racial/ethnic differences in sterilization in the United States

OBJECTIVE

Cross-sectional studies have found that low-income and racial/ethnic minority women are more likely to use female sterilization and less likely to rely on a partner's vasectomy than women with higher incomes and whites. However, studies of pregnant and postpartum women report that racial/ethnic minorities, particularly low-income minority women, face greater barriers in obtaining a sterilization than do whites and those with higher incomes. In this paper, we address this apparent contradiction by examining the likelihood a woman gets a sterilization following each delivery, which removes from the comparison any difference in the number of births she has experienced.

STUDY DESIGN

Using the 2006-2010 National Survey of Family Growth, we fit multivariable-adjusted logistic and Cox regression models to estimate odds ratios and hazard ratios for getting a postpartum or interval sterilization, respectively, according to race/ethnicity and insurance status.

RESULTS

Women's chances of obtaining a sterilization varied by both race/ethnicity and insurance. Among women with Medicaid, whites were more likely to use female sterilization than African Americans and Latinas. Privately insured whites were more likely to rely on vasectomy than African Americans and Latinas, but among women with Medicaid-paid deliveries reliance on vasectomy was low for all racial/ethnic groups.

CONCLUSIONS

Low-income racial/ethnic minority women are less likely to undergo sterilization following delivery compared to low-income whites and privately insured women of similar parities. This could result from unique barriers to obtaining permanent contraception and could expose women to the risk of future unintended pregnancies.

IMPLICATIONS

Low-income minorities are less likely to undergo sterilization than low-income whites and privately insured minorities, which may result from barriers to obtaining permanent contraception, and exposes women to unintended pregnancies.

Rethinking the value of sending vasectomy specimens for histologic examination: an analysis of arterial vasculature and failure to transect the vas deferens

OBJECTIVES

The testicular, deferential, and cremasteric arteries and their branches surround the vas deferens (VD), leaving them susceptible to injury during vasectomy. Literature describing the caliber of arteries seen in vasectomy specimens is lacking, making it difficult to categorize the significance of an observed artery. We aimed to establish reference values for arterial size typically encountered in vasectomy specimens and assess our institutional experience with failure to transect the VD.

METHODS

The luminal diameter of the largest artery in 231 consecutive VD specimens from 116 patients was measured microscopically. For comparison, the diameter of the largest artery within 10 spermatic cord cross-sections from inguinal orchiectomies was obtained. The immediate vasectomy failure rate based on histologic assessment was calculated using specimens from 2008 to 2012.

RESULTS

The luminal diameter of the largest artery encountered in a vasectomy specimen was 1.00 mm or less in 96.5% of cases. Artery sizes greater than or equal to 2.50 mm were only seen in spermatic cord resections. From 2008 to 2012, three (0.36%) of 837 patients undergoing vasectomy had specimens that showed failure to transect both VD.

CONCLUSIONS

Although the American Urologic Association and European Association of Urology state that histologic evaluation of vasectomy specimens is not required, we encourage the surgeon to send VD specimens for histologic examination. Doing so allows early identification of the failure to transect the VD and the resection of surrounding vasculature, providing quality control feedback to the surgeon.

Relating economic conditions to vasectomy and vasectomy reversal frequencies: a multi-institutional study

PURPOSE

It was theorized that the use of permanent contraceptive methods may vary with economic conditions. We evaluated the relationship between vasectomy/vasectomy reversal frequencies at several large referral centers and national economic indicators during 2 recessions spanning 2001 to 2011.

MATERIALS AND METHODS

We performed an institutional review board approved, retrospective chart review to identify the number of vasectomies/vasectomy reversals per month at several large referral centers from January 2001 to July 2011. The rates of these procedures were pooled, correlated with national economic data and analyzed in a multivariate linear regression model.

RESULTS

A total of 4,599 vasectomies and 1,549 vasectomy reversals were performed at our institutions during the study period. The number of vasectomies per month positively correlated with the unemployment rate (r=0.556, p<0.001) and personal income per capita (r=0.276, p=0.002). The number of reversals per month negatively correlated with the unemployment rate (r=-0.399, p<0.001) and personal income per capita (r=-0.305, p<0.001). Neither vasectomy nor vasectomy reversal frequency significantly correlated with the inflation rate or the S&P 500®. Regression models confirmed that the unemployment rate explained more of the variance in vasectomy/vasectomy reversal frequencies than other indicators.

CONCLUSIONS

We noted a correlation between the number of vasectomies/vasectomy reversals performed at our institutions and national economic indicators. The strongest association was with the unemployment rate. This points to the importance of financial pressure on family planning decisions.