Since June 24, 2022, when the supreme court ended the federal constitutional right to abortion by overturning Roe vs. Wade, many people have been scrambling to figure out what this means for their bodily autonomy, family planning, and contraception choices. Though there are still options available for acquiring an abortion, emphasis on methods for preventing pregnancy has significantly increased with good reason. As a result, many people with penises, including men, nonbinary people, and trans women, have discussed or considered the option of getting a vasectomy.
This minor surgical procedure is an important option for people making sexual health, birth control, and family planning decisions, though it is important to stress that it shouldn't be a blanket solution for the loss of abortion access to so many millions of people in the United States now face. Vasectomies, though important and valuable in securing your bodily autonomy, have been and continue to be weaponized against minorities in efforts of forced sterilization to their contextual history in the eugenics movement. This is especially true for incarcerated people of color, Black Americans, immigrants, indigenous people, and people with disabilities, according to Harriet A. Washington in her essential text Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to Present. Throughout history, state-sanctioned or medical practitioner enforced vasectomies have been pushed on people with marginalized identities as a direct way to prevent them from continuing to have children. The implications of this violence are really important to know and understand in the face of this loss of rights via the fall of Roe vs. Wade.
Additionally, it should be pointed out that another aspect of abortion's essential medical care value in reproductive health is that it can terminate a pregnancy without the risk of permanent sterilization or infertility. Though vasectomies can be reversed, experts recommend that you don't get one with the intent to reverse them later on, says Peter Stahl, MD, urologist, and SVP of men's sexual health and urology at Hims & Hers. "For all intents and purposes, vasectomies are typically considered permanent because the procedure to reverse them is highly technical, and your chances for a successful reversal go down every year after you have the procedure," Dr. Stahl says.
For those that want vasectomy, though, the basics of how to get one, what happens during the procedure, and what it feels like are important to know.
What is a vasectomy?
A vasectomy is a minor surgical procedure performed on people with a penis to act as a contraception method. "This technique works by intentionally blocking the transport of sperm through the vasa deferentia, or the tubes that connect the testicles to the urethra," says Dr. Stahl. This does not alter one's sexual function, ability to orgasm, or ejaculation ability, all of which stay intact and return to normal a couple of weeks after the procedure.
How to get a vasectomy
"You can get a vasectomy by consulting with a urologist or other healthcare professional," says Dr. Stahl. "The consultation involves answering some basic questions about your medical and reproductive history and having a physical examination to make sure that you are a good candidate for the procedure."
In some states, the consultation can be performed on the same day as the vasectomy, and in other states, there is a mandatory waiting period between the consultation and the actual procedure, Dr. Stahl says. "Most vasectomies take about 30 minutes and are performed in an office setting under local anesthesia, but vasectomies can also be performed under sedation or other forms of anesthesia," he adds.
Are vasectomies painful? (And other commonly-asked questions and misconceptions)
"Vasectomies can be uncomfortable for some people, but local nerve blocks are very effective at greatly reducing and usually altogether eliminating pain during the procedure," Dr. Stahl says. Afterward, it is common to feel a dull ache for one to two days, but that can usually be controlled with anti-inflammatory medications, icing the area, and wearing a scrotal supporter.
It is recommended that one avoids sexual activity for a period of time after the procedure to allow the site to heal fully and avoid any tenderness. Once you can resume sexual activity, it's still important to use another method of contraception until a post-op vasectomy analysis has been performed. According to Dr. Stahl, this will determine if the procedure worked and if there is any residual sperm in your ejaculate. This is really important to know and remember when the intent of getting a vasectomy is to prevent pregnancy.
A common misconception is that vasectomies impact sexual function. "In particular, people are often worried about changes to ejaculation and losing the ability to get and maintain an erection," says Dr. Stahl. "Since only about one to two percent of the ejaculate volume comes from the testicles, there is no noticeable impact on the quantity of semen expelled from the penis during ejaculation."
Additionally, Dr. Stahl points out that the nerves and blood vessels that control erection are very, very far from the anatomic place where a vasectomy is surgically performed (the spermatic cord), so the vasectomy has no impact whatsoever on physiologic erectile function.
Can vasectomies fail, and are they reversible?
Vasectomies fail about one percent of the time, Dr. Stahl says. "Failure can result from technical errors during the procedure or from spontaneous reconnection of the two cut ends of the vasa deferentia. This is why it is very important to continue using contraception until a post-vasectomy semen analysis indicates that the procedure was successful," he adds.
Vasectomies are reversible. However, reversing a vasectomy is not easy and requires highly specialized microsurgical training, Dr. Stahl says. Success rates range from 70 to 95 percent, depending on the amount of time that has elapsed since the vasectomy and the specific type of procedure required. Reversal procedures are also typically not covered by insurance and can be expensive.
This is an important aspect to note about vasectomies, because some folks talk about them like they are IUDs (in that you can get taken out after a number of years when you're ready to have kids). However, this procedure is best viewed as close to, if not entirely, permanent. You absolutely should have agency over making this choice, but being sure that you don't want to have kids in the future is important to consider as well.
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