Watson RA:

Urol Pract. 2024 Apr 4:101097UPJ0000000000000525. doi: 10.1097/UPJ.0000000000000525. PMID: 38579160 

Comment on

Short-Term Changes in Vasectomy Consults and Procedures Following Dobbs v Jackson Women’s Health Organization.

Zhu A, Nam CS, Gingrich D, Patel N, Black K, Andino JJ, Daignault-Newton S, Telang J, Dupree JM, Quallich S, Ohl D, Hadj-Moussa M.

Urol Pract. 2024 Feb 5:101097UPJ0000000000000528. doi: 10.1097/UPJ.0000000000000528. Online ahead of print. PMID: 38315830

This is an informative, well-written report.1 However, the authors make no secret of their support for vasectomy on demand without limitation. One might come away from this article with the conclusion that vasectomy is no more than a scrotal snip, as safe and salutary as a haircut (albeit a $3500 haircut). Careful consideration needs to be given to the causes for concern held by those of us who do not share these authors’ enthusiasm. Secular reasons that support the procedure are thoroughly documented in this article. However, when counseling a patient about an irreversible, lifetime decision, not only medical, but also ethical, social, and religious reasons to oppose the procedure warrant full exploration.2

The Dobbs decision itself did not cause this upswing in requests for vasectomy. Nor did this surge stem solely from a spontaneous grassroots reaction. Rather, it is the result of a major, well-financed media blitz which, as the authors note, has mobilized the aggressive social-media promotion of unrestricted vasectomy. The Dobbs decision was the occasion for but not the sole cause of this surge.

This short-term assessment,1 while noteworthy, is not adequate to determine long-term consequences. Is this post-Dobbs stampede to sterility a transient phenomenon? Or is it the beginning of a major, long-term shift in contraceptive choices? If this trend proves sustainable, what might be its effect on health care dynamics, including future population statistics?

Meanwhile, this vasectomy boom is intensifying a trend toward enlisting lesser-trained vasectomists practicing in smaller, more rural facilities. This shift may affect subsequent outcomes.

Vasectomy is, by deliberate design, permanently irreversible. A vasectomist goes out of the way to ensure against any chance of reconnection. The medicolegal consequences of a postvasectomy pregnancy far outweigh any thought of leaving an opening—literally or figuratively—for reversal down the road. Patients need to understand that there will be no turning back.

Reversible male contraceptives such as Vasalgel (nonhormonal intravas injectable gel)3 and intravas devices4 are in advanced stages of development. Worth waiting for?

Sperm preservation provides an imperfect, high-cost safeguard. As the authors note, not only is the initial intervention costly, but so is the long-term burden of funding sperm storage.1 And then, if ever implemented, artificial insemination may prove exorbitantly expensive, laborious, and fraught with the risk of failure. Not all insurance programs underwrite this venture in full.

It is especially concerning that the population segment now being most effectively persuaded to choose lifelong, irreversible sterilization is men who are very young, single, and childless. As the authors note, this segment of the population has been specifically excluded from vasectomy in respected ethical guidelines,1 such as those of the European Association of Urology.5

It is alarming to learn that men as young as 18 years old are submitting, in growing numbers, to a lifetime of irreversible sterility—as opposed to older, married men with children, for whom vasectomy would seem a far more appropriate consideration. Avoiding unwanted pregnancy is a laudable goal. However, convincing a teenager to decide never to have any baby ever, no matter how much wanted, for the rest of his life, seems an overreach. There are less extreme, more effective ways to protest a Supreme Court decision.

A young man who is “playing the field” might take comfort in the knowledge that the wild oats he is sowing are sterile. But will a bachelor in search of a prospective bride enhance his eligibility by assuring her that their marriage will be forever barren? She will never hold in her arms her own baby and his.

All men, but especially young, childless men with a long life ahead of them, should take a very serious look before they leap. It is a long way to the bottom, and there is no turning back. Men who oppose the Dobbs decision might best protest with their vote, not their vasa.


Note of the FIAMC website editors:

Dr. Watson was President of the Catholic Medical Association of the United States of America.