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The Big V 

Vasectomies are safe, effective and cheap — so why do men resist them?

Imagine never having to fumble awkwardly with a condom package or panicking when you realize you’ve skipped two pills. Parents are used to routines — but what if worrying about unwanted pregnancy weren’t one of them?

Touted as the simplest, cheapest form of permanent contraception ($700-$800), vasectomy seems to be the most reasonable option. Yet although an estimated 500,000 men opt for vasectomies annually, there are an estimated 2 million unplanned pregnancies in the United States each year.

Here’s how the procedure works in, um, a nutshell.

A doctor (usually a urologist, though general practitioners also perform vasectomies) makes small incisions on each side of the scrotum and pulls out the vas deferens (tubes that carry sperm) leading from each testicle. Then the physician cuts and seals the tubes (either by cauterizing, tying or attaching tiny surgical clips) and then closes the incision. Some patients need stitches, some don’t. The sealed vas deferens keep sperm from reaching the prostate where it mixes with semen. Two days of bed rest and icepacks are prescribed for recovery.

Sexual drive and performance are unaffected, but contraception is needed until sperm count can be tested.

Spokane urologist Roger Fincher says he rarely cauterizes because “If the man changes his mind, it’s more difficult to do the reversal” with the more damaged tissue. Both Fincher and another Spokane urologist, Dr. Steve Silverstein, make the same point: They want patients to plan for permanence.

“If a guy’s very anxious and concerned, I wouldn’t encourage him to do it,” says Silverstein. “The last thing I would want is for a guy to experience regret.”

But because of the tender nature of the subject, some men are understandably reluctant even to discuss the idea of having a vasectomy in the first place. “My wife had been on the pill on and off since high school — that’s a pretty big commitment on her part,” says Kevin, a 36-year-old father of two. Yet it took him two years to work through his fears before committing to the vasectomy.

“How safe is the procedure? Who is the absolute best guy to do it?” he wondered. Then there were the underlying fears. “Infection, healing, what happens if things go wrong? The worst fear was having them remove both testicles, and then I’d be a eunuch.”

“One of the worst enemies out there is other men,” says Fincher. “It’s a macho thing. Guys will almost go to any length to make up wild stories,” he explains. “Women tend to be reassuring, where they really try to diminish the fear factor. Guys do exactly the opposite.”

Silverstein urges men to consider “broad-based statistical analysis, rather than anecdotal” — in other words, the numbers, not the stories.

Although Doug doesn’t doubt the number (99.25 percent effective), his story puts him in the 0.75 percent margin. “My wife was actually on the operating table to have a hysterectomy [for a reproductive system condition] and the doctor did a pregnancy test,” before continuing with general anesthesia. That’s when Doug and his wife found out about their sixth child. (They’d been planning on four.)

Since women are accustomed to painful procedures (annual pap smears, childbirth) and have made a habit of handling birth control, why don’t women get sterilized?

They do, at up to twice the rate of men.

Tubal ligation is less invasive than before, but still requires a hospital surgery.  Unless performed after a delivery with a C-section, there are two methods: a laparoscopy, with up to three small incisions in the abdomen, or a laparotomy, an open surgery requiring a larger incision. In both cases, a doctor cuts, clamps or cauterizes the midsection of the fallopian tubes. The recovery time is longer than with vasectomies: up to nine days, and there are more serious side effects because the women’s procedures are usually performed under general anesthesia.

In contrast, a vasectomy is an outpatient visit to a clinic. But in addition to seeing any doctor visit as a sign of weakness, men are affected by their friends’ negative attitude toward vasectomy, says 38-year-old Doug. “When the guys razz them — give them a hard time, like, ‘The wife’s making you do this, huh?’ — the peer pressure can impact their ability to commit.”

Fincher recommends that patients don’t tell other men they’re planning to have a vasectomy. “This anxiety that is created,” he says, “is so unnecessary and damaging.”

“I think every urologist is dealing with a reluctant population,” admits Silverstein. That’s why he believes patient counseling is so important. “I spend five to 10 minutes on the procedure, and 45 minutes to an hour on the conversation beforehand. I try to be supportive, factual and patient. Eventually if you’re consistent, they come around.”

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