The Supreme Court's June 2022 decision overturning federal abortion rights established by Roe v. Wade resulted in a sudden increase in the demand for vasectomies.
That caught the public's attention. While most of the conversation focused on how the court's decision drove this increase, the real matter we should be focusing on is: why is male sterilization so much less common than female sterilization?
The answer is actually simple: resistance, caused by ignorance and complexity.
Because vasectomies are more effective than many other types of contraception and can take some of the responsibility off of women, it's important to encourage more men to consider this procedure as a viable option. To do this, reducing barriers to vasectomies is crucial. -- meager when compared to education about female contraceptive methods -- coupled with of vasectomy in popular culture prevent many men from considering vasectomies. Other barriers stem from the complexity of the procedure. This is due to unnecessary requirements for preoperative visits, confusing insurance processes, insufficient perioperative information, and finally, a lack of recognition of the many men have with the medical milieu. As a result, the likelihood of men choosing a vasectomy is greatly reduced in favor of the more invasive alternative for women.
Friction and Vasectomies
Successfully promoting healthcare interventions often relies on clinicians touting benefits and highlighting advantages over alternative options. So, a patient accepting a given procedure is assumed to result from an extensive promotional exercise. However, the degree of acceptance is inversely proportional to the level of friction (resistance) generated for the patient. The higher the friction, the lower the acceptance (higher resistance). Therefore, understanding how and where friction is generated -- in this case for vasectomy -- becomes as important as knowing how to make an effectively convincing plea.
Unfamiliarity
Men don't have the of a gynecologist. Considering a medical visit for an elective procedure might be quite an uncomfortable idea for men who are in good health. It might be difficult for some men to accept getting so close and personal with a medical professional for a vasectomy. That is a point of friction. In this case, providing the patient with easy access to the surgeon, as well as providing ample, clear, and direct information about the procedure can help ease the interaction and reduce the resistance.
Delayed process
I've heard from many patients who have already decided they want to get a vasectomy that they would rather just get the procedure done than first go through a preoperative evaluation. However, that men first undergo an in-person preoperative evaluation, and then they are asked to return at a later time for the actual procedure. This is another point of friction. We can reduce resistance by obtaining the patient's medical history using electronic methods and performing a genital examination at the time of the procedure (while establishing adequate expectations in the case of findings that would preclude them from a vasectomy).
Lack of control
Lack of control over one's healthcare is a from vasectomy. A few approaches to increasing the level of comfort for patients considering a vasectomy include: allowing patients to make their own appointments online without having to talk with a receptionist; giving them freedom to sufficiently review the information related to the procedure on their own time; and offering easy access to the surgeon for a preoperative discussion through a phone consultation or telemedicine.
Cost
The cost of a vasectomy can based on insurance status and location. Elevated costs, due to deductibles or high associated expenses, represent another point of friction. Healthcare systems and insurance companies can help overcome cost-related resistance by reducing the out-of-pocket cost of vasectomies, performing them consistently in the office setting, providing adequate insurance reimbursement to clinicians, and including them in .
If efforts to promote vasectomies focus mainly on educational campaigns highlighting their benefits, the current increase in interest may be . It is, therefore, important to consider how and where the vasectomy proposition creates resistance (friction) that can limit its acceptance. In order to reduce resistance and facilitate the participation of men in permanent contraceptive decisions, we need to better identify and address the multiple points of friction associated with vasectomy.
Esgar Guarín, MD, is medical director of in Pleasant Hill, Iowa, and a member of the medical advisory board at .