500K American men get vasectomies every year. A specialist explains the easy and reversible procedure
This year, many vasectomy patients are young or single men concerned about unwanted pregnancy at a time when abortion care may not be as available as before. Thomas Barwick/Stone via Getty Images
About half a million men undergo a vasectomy in the United States in any given year. The percentage of men getting them had been dropping for the past two decades, but 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 report that more new patients are coming to see me. We used to perform about 20-25 vasectomies a month in our Miami clinic. But since the Dobbs v. Jackson decision came down, 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. It’s the first such increase I’ve seen in my 15-year career.
Other urologists have rising numbers, too. One Kansas City doctor said that he had a 900% increase in vasectomy inquiries in just the four days after the decision.
Most of our clinic’s new vasectomy patients are young or single men. They tell me they are concerned about getting a woman pregnant when abortion care isn’t as available as it was before. They also ask 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 straightforward, with 98% of them performed 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.
The doctor starts by making 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 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 usually go home and recover for about four hours with some ice on the area. Most can go back to work a day or two later if their job doesn’t involve manual labor. We recommend no sex and no heavy lifting for about a week after the vasectomy.
The recovery period is a popular excuse for sports fans to plan their vasectomy around major sports events on TV so that while they heal they can watch the Masters golf tournament, baseball’s World Series or the bowl games of American football. 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 later, the patient returns to the clinic. We take a sample of semen to check the sperm count. That tells us whether his vasectomy was successful. If any sperm are in the ejaculate, we might need to do a second one, but that happens in fewer than 1% of cases. Most 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.
If patients do change their minds, however, they can get their vasectomies reversed, and about 5% of U.S. patients do.
Most commonly 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 90% to 95% of the time. And pregnancies follow vasectomy reversals about 50% to 60% of the time, depending on the age of the woman.
Ranjith Ramasamy receives funding from Acerus Pharmaceuticals (Consultant, Grant Recipient), Boston Scientific (Consultant, Grant Recipient), Coloplast (Consultant, Grant Recipient), Endo Pharmaceuticals (Consultant, Grant Recipient), Empower Pharmacy (Grant Recipient), Nestle Health (Consultant), Olympus (Grant Recipient), Hims, Inc (Advisory Board).
For nearly 50 years, abortions were protected as a constitutional right. In June of this year, the Supreme Court claimed the 1973 decision of Roe v. Wade, the case that established this precedent, was based on a “remarkably loose treatment of the constitutional text,” and as such, overturned the ruling in a 5-4 vote. It is estimated that 36 million people were impacted by the decision as former laws become null and void, and even older laws from before Roe became relevant once again.
Stacker analyzed data from the Guttmacher Institute and the U.S. Census Bureau to investigate the number of women who live in areas where abortion access is already or likely to be restricted in the aftermath of the Roe reversal.
The legality of abortion is now up to individual states, many of which seek to ban it completely. In this new legal landscape, nearly half of all women in the U.S. live in areas where access to safe abortions will likely become more restrictive, if not impossible.
The 1973 court that heard Roe v. Wade ruled that a woman’s right to obtain an abortion was protected by the Due Process Clause of the Fourteenth Amendment and its implied right to privacy. While the right to privacy—meaning the right to be free from government intrusion in this context—is not explicitly mentioned anywhere in the Constitution, it exists under the penumbra and is considered a fundamental right. This room for interpretation, no matter how small, is often what makes privacy issues within a constitutional framework so controversial.
Although the court upheld a woman’s right to obtain an abortion, it did not do so absolutely. States were permitted to regulate abortions after the point of fetal viability—when a fetus can survive outside of the womb—except in cases when pregnancy threatened the health or life of the mother.
Most experts agree fetal viability happens around 24 weeks, but can really only be determined on a case-by-case basis. The inability to standardize fetal viability as a gestational demarcation opened the doors for states to set their own guidelines, as with Texas’ and South Carolina’s heartbeat bill and Mississippi’s gestational age act. Fetal viability was at the center of Dobbs v. Jackson Women’s Health Organization—the case out of Mississippi that catalyzed the June 2022 reversal of Roe.
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Currently, 22 states either have abortion restrictions or are likely to pass them in the coming months. In the remaining 28 states and Washington D.C., abortion is still legal. Sixteen predominantly Democratic states with a legacy of abortion advocacy have moved to enshrine abortion protection in state legislation not just for residents, but for out-of-state patients seeking care.
For women in states where these restrictions already or imminently will exist, accessing a safe abortion could require long waits, days of costly travel, end even prosecution, according to the Guttmacher Institute.
Women who travel out of state to receive an abortion, as well as the physicians who perform them, even in safe-haven states, may be at risk of prosecution based on the restrictive laws of their neighbors. Both Texas and Oklahoma, for example, have laws that allow private citizens to sue people who perform abortions or who otherwise help someone access one.
Louisiana and Oklahoma are the most restrictive states, with four different abortion restrictions on the books including trigger bans, six-week bans, pre-Roe bans, and constitutional prohibitions on protection.
Despite some states having more than one restriction in place, it is typically just one that takes precedence over the others. But in certain cases, these restrictions work in tandem. For example, states with constitutional amendments declaring they are not obligated to protect a right to abortion may also enact abortion bans at six weeks or may reinstate restrictive laws that were in effect prior to 1973, when Roe made them null and void.
The overturning of Roe was the “trigger” in 13 states that have already made way for, or will soon lead to, specific abortion restrictions, such as six-week bans or near-total bans like those being pursued in Louisiana, Oklahoma, and Utah. Near-total bans, the most restrictive of all, outlaw abortion in all instances, with few extreme medical exceptions.
Immediately after the Supreme Court’s decisions, trigger bans were enacted in Arkansas, Missouri, South Dakota, Wisconsin, and Mississippi. In other states, trigger bans will not take effect until some type of additional legislative action happens.
Abortion is still legal in Florida, Indiana, Montana, and Nebraska, but all four states have Republican governors who have expressed interest in restricting abortion access. These states make up the nearly 10% of women represented in the above visualizations where additional restrictions are likely.