In February 2018, just as my husband and I were planning his vasectomy, we discovered that I was pregnant with our third child. After the initial shock of our positive pregnancy test wore off, my husband scheduled an April vasectomy with the haste of a man who’d had his fill of consoling croupy infants at 3 A.M.
But when he announced he’d gotten the “snip-snip,” one of his friends, shocked, asked him why I didn’t just get a tubal ligation (i.e. get my “tubes tied”) instead. Another mutual friend confided in me that she’d been unable to convince her husband to opt for a vasectomy. Then, when I shared these responses on Twitter, similar stories rolled in: men balking at the procedure and genuine stories of surprise when someone willingly had it done.
This response is apparently pretty common. A 2017 Kaiser Health News story featured a California urologist who gives his vasectomy patients a certificate praising their bravery. There’s also an op-ed in the Guardian from the same year that describes vasectomies as “an appalling prospect, which as men we are hard-wired to avoid,” yet nonetheless instructs the reader to “man up” because they’re only a “snip away from being heroes.”
Yes, choosing an elective surgery is a brave act. But male sterilization procedures are safer and more effective than female sterilization procedures, and yet female sterilization is about three times more common than male sterilization as a birth control method. According to the CDC’s 2015-2017 National Survey of Family Growth, female sterilization remains the most common form of contraception among women aged 15-49 in the U.S., with 18.6 percent of women using this method. According to that same survey, just 5.9 percent of women rely on a male partner’s sterilization for birth control.
The implication here is that the burden—financial, physical, emotional, safety—of contraception falls to the person with the uterus unless otherwise specified. And this “heroism” framing only further reinforces that belief.
There are lots of reasons why vasectomy is still a relatively uncommon form of birth control. A big one is lack of information.
“The most common barriers [are] not knowing about vasectomy as an option and not knowing what it entails,” Alex Pastuszak, M.D., assistant professor of Urology at the University of Utah, tells SELF. These barriers are fertile soil (pun intended) for anxieties and misconceptions to take root.
“Everybody has different fears,” Mary Samplaski, M.D., assistant professor of Clinical Urology at the University of Southern California, Keck School of Medicine tells SELF. “There’s the short-term, ‘Is the procedure going to hurt?’ fear, and then there’s the long-term, ‘Is this going to hurt my erection; what if I change my mind?’”
Given this lack of information, here are some much-needed facts: Vasectomy is actually a less invasive procedure than tubal ligation. According to the American College of Obstetricians and Gynecologists, the vasectomy is widely regarded as the safer of the two options. Vasectomies are usually performed in an outpatient setting, complications are rare, and doctors expect most patients to feel well enough to return to work within one to three days.
During a vasectomy, doctors cut or block the vas deferens, one of two tubes in the scrotum that carries sperm from the testes to the urethra, in two places. Once the doctor cuts the vas deferens, sperm is unable to leave the testicles and is absorbed back into the body. In comparison, during a tubal ligation a doctor cuts and ties (or blocks) the fallopian tubes. Because it involves making an incision into the abdomen, tubal ligations carry a slightly higher risk of complications than vasectomies, including injuries to other organs including the bladder and the bowel. Both vasectomy and tubal ligation should be considered permanent (though there are procedures to reverse some, but not all, sterilizations).
Vasectomy is also more effective as a birth control method than female sterilization. According to the CDC, the typical failure rate of vasectomy is 0.15 percent, while the typical failure rate of female sterilization is 0.5 percent. (That said, the early failure rate of vasectomy—from three to six months after the operation—is in the range of 0.3 to 9 percent, so it is recommended that you do follow up with post-vasectomy semen analysis). Plus, if someone who has had a tubal ligation does get pregnant, it’s more likely to be an ectopic pregnancy, which can be dangerous if it’s not caught early.
Another big barrier to people getting vasectomies is the concern that it somehow diminishes manhood. It’s hard to measure “manhood” in an objective way, but this might help: A 2017 study published in the Central European Journal of Urology surveyed 294 couples and found that the procedure does not noticeably affect the volume of a person’s ejaculate or their ability to achieve an erection, and researchers called fears of reduced sexual satisfaction “unfounded.”
Finally, there’s also that pervasive cultural belief I mentioned earlier, about how responsibility for contraception defaults to the person with the uterus. And, as an extension of that, when the partner with the penis shoulders some of that burden, it’s an unusually heroic act of going above and beyond expectations.
Even health-care providers are susceptible to these beliefs. According to a 2018 study published in Social Science and Medicine that examined 101 transcripts from contraceptive counseling sessions, researchers found that counselors inadvertently contributed to something called the “feminization of responsibility” by emphasizing methods that required women to think of birth control in individualistic terms. Additionally, the study indicated that when counselors did discuss contraceptive choices for people with penises, they emphasized the “negative” aspects of the method.
This ‘heroic’ framing is problematic because it reinforces this “feminization of responsibility” belief, but also because it does little to demystify a procedure already beset by misconceptions and misinformation. While misinformation about contraceptive options is rampant for everyone, the normalized conversation around birth control methods for people with vaginas does make it easier for us to find resources to make an informed decision. But when we frame male sterilization as ‘so brave,’ it sounds inaccessible—intimidating, even—to the average person. And that just adds to the other existing barriers, like not having access to healthcare or being unwilling to visit a doctor.
Even when partners do choose vasectomy, the stigma seems to persist. In a small 2011 study of 16 men published in Feminism and Psychology, psychologists found that despite the positive result of men choosing vasectomy for their female partner’s sake, the sense of “heroism” evoked tends to reinforce the status quo, rather than challenge it.
Once my husband and I decided that we were done having kids, he proposed vasectomy as an option that would spare me any further invasive surgeries, like my three previous C-sections.
As a Black woman, the comparatively high Black maternal mortality rate is one reason I’m glad my husband considered the vasectomy. I hemorrhaged on the operating table and required blood transfusions after my second C-Section. When I gave birth to our third—and last—child via c-section last October, I declined my obstetrician’s offer to have a tubal ligation afterward, feeling empowered knowing the burden of contraception was not just mine to carry. I’m deeply appreciative, but this doesn’t make my husband a Marvel character.
In reporting this piece, when I spoke with other people who had gotten vasectomies, their experiences often aligned with my own situation. Rather than needing to be coerced, the vasectomy was a joint decision made after lengthy partner discussions.
For Sam S., 44, “the decision was a long, sort of agonizing one that I talked over with my wife extensively,” he tells SELF. His choice was rooted, in part, by a childhood memory of his mother’s difficult recovery period after her tubal ligation. “I did not want my wife to have to go through that,” he says.
Alvaro S., 46, and his wife, mutually decided he would have the vasectomy done because it would be less painful for him. “To be honest, in a way, it is taking one for the team,” he says, citing the hassle involved in hospital visits, after-care, and missing at least one day of work.
And sure, they were “taking one for the team,” so to speak—as with any medical intervention, there are obviously risks involved in the decision. But on that note, why isn’t female sterilization, or getting an IUD or hormonal implant, or taking birth control pills for years also considered “taking one for the team”? While men who have vasectomies are seen as all-star quarterbacks in the 4th quarter of their fertility, leading their team to victory, women who spend time, energy, and other resources managing their fertility over the course of decades are considered, well, normal. If using your available contraceptive method is “taking one for the team,” then many of us have been truly unsung heroes all along.
Ultimately, we should all encourage moving the needle toward the social acceptance of vasectomy as a real, normal option. Shared responsibility, where it is typical rather than exceptional for men to include themselves in discussions of long-term contraception, might not feel as gratifying as heroism. But it will go a long way toward erasing reproductive gender inequality—and isn’t that just as sexy?