What will it take to boost vasectomy use?

While vasectomy is a safe, simple, effective form of contraception, female sterilization is the preferred method of sterilization among couples in the United States. About 17% of women between ages 15-44 have had tubal sterilizations, while only 6% rely on male sterilization for birth control.1

What will it take to reverse that trend?

Underutilization of vasectomy is multifactorial, according to a new overview of U.S. vasectomy use and techniques.2 There are patient, provider, and system level factors that contribute to its underuse, says Grace Shih, MD, MAS, assistant clinical professor in the Department of Family & Community Medicine in the School of Medicine at the University of California, San Francisco (UCSF). Shih, a co-author of the review and accompanying editorial,3 is conducting a qualitative study of vasectomy use to explore patient level factors by race/ethnicity.

"Our preliminary analysis shows that there is a wide range of misconceptions about vasectomy," says Shih. "In addition, ideas of contraceptive responsibility, manhood, and regret/permanence are common themes."

Shih also is conducting a survey of California Family PACT (Planning, Access, Care, Treatment) clinics to check provider level factors. Results are pending on both studies, she notes.

What's the holdup?

Racial disparities still exist in male sterilization, according to the overview article. In particular, black and Latino men are less likely to rely on vasectomy for contraception than white men.4

While combined female and male sterilization rates are about 23-24% in all racial/ethnic groups, significant differences in distribution of the two types of sterilization exist across racial/ethnic groups. This disparity is most evident in non-Latino black populations, notes the overview. While 22% of women rely on female sterilization, just 1% rely on male sterilization. In Latino populations, 20% use female sterilization, while 3% use male sterilization.2

What steps can you take in your practice to increase access to vasectomy?

Increasing men's awareness, acceptance, and selection of the procedure is one key, states the editorial.4 Providers need to dispel common myths surrounding vasectomy, such as "vasectomy is like castration," "a man cannot have sex or an ejaculation after vasectomy," and "vasectomy makes men weak and less productive."5

Explain to men that a vasectomy will not change sexual function and experience. There will be no change in interest in sex, no difference in ability to reach orgasm, no problems with erection, and no change in sexual pleasure.5

Remind men that vasectomy is safe and effective; in fact, it is one of the safest and most effective family methods, according to Contraceptive Technology.6 The first-year failure rate in the United States is estimated at 0.15%, with a range of 0% to 0.5%; failure rates are believed to be similar to those for female sterilization and lower than those for reversible methods.6 (The Association of Reproductive Health Professionals offers a free vasectomy patient handout. Go to its web site, www.arhp.org. Select "Publications and Resources," "Patient Resources," then under "Fact Sheets," select "Vasectomy." It is available in English and Spanish.)

The current editorial call for increasing the number of providers trained in the no-scalpel vasectomy technique, An integral step to increasing vasectomy use is increasing the number of providers trained in the simple no-scalpel vasectomy (NSV) procedure.

Make it more visible

How does Shih promote vasectomy in her practice?

"Our primary method at UCSF has been to increase visibility of our vasectomy services to the community and to clinicians," she explains. "We have included our referral protocol in Department of Public Health bulletins/newsletters and collaborate with the Obstetrics and Gynecology Department to make sure our services are known.

Shih says plans are under way to present educational talks on vasectomy to familiarize providers with the no-scalpel procedure. UCSF clinicians and residents are encouraged to discuss vasectomy as an option for any couple desiring permanent sterility.

In California, Family PACT covers vasectomy services, so insurance coverage is less of an issue, notes Shih. 

References

  1. Mosher WD, Jones J. Use of contraception in the United States: 1982-2008. Vital Health Stat 2010; 23:23.
  2. Shih G, Turok DK, Parker WJ. Vasectomy: the other (better) form of sterilization. Contraception 2011; 83:310-315.
  3. Turok DK, Shih G, Parker WJ. Reversing the United States sterilization paradox by increasing vasectomy utilization. Contraception 2011; 83:289-290.
  4. Eisenberg ML, Henderson JT, Amory JK, et al. Racial differences in vasectomy utilization in the United States: data from the National Survey of Family Growth. Urology 2009; 74:1,010-1,014.
  5. Shih S. Turok D, Parker W. Vasectomy: the "other" form of sterilization. Presented at the 2010 Reproductive Health Conference. Atlanta; September 2010.
  6. Pollack AE, Thomas LJ, Barone MA. Female and male sterilization. In: Hatcher RA, Trussell J, Nelson AL, et al. Contraceptive Technology: 19th revised edition. New York: Ardent Media; 2007.