Could Widespread Vasectomies Be a Better Form of Birth Control?

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Abortion laws in Texas and Mississippi — which bar abortions for pregnant people, including victims of rape and incest, well before many of them even know they're pregnant — are rightfully under fire. And, amidst the maddening mayhem, heated debates surrounding widespread vasectomies as an alternative form of birth control are cropping up across social channels.

The argument for vasectomies is to stop sperm at the source instead of putting the burden of contraception entirely on womxn, who are charged with making their bodies inhospitable to implantation by throwing their natural reproductive process for a total loop, as well as a slew of other health risks from migraines to cancer. After all, people with ovaries are only fertile for six days a month, whereas those with testicles can cause pregnancy every single day.

But are widespread vasectomies actually a viable option? Let's unpack what that would really look like — and why it's probably, unfortunately, never going to happen. [Collective sigh.]

What Is a Vasectomy, Anyway?

The American Urological Association estimates that around 175,000 to 500,000 men in the United States undergo vasectomies each year. A vasectomy is a generally simple and safe surgical procedure that involves snipping or tapering off the vas deferens, which supply the semen with sperm. Sperm develop in the testicles and are stored in a sac called the epididymis. From there, they travel through the vas deferens, which connect the semen-producing prostate gland and the seminal vesicles that allow semen to exit the body through the urethra. But a vasectomy stops them in their tracks. While the testes will continue to make sperm, it'll remain in the scrotum, die off, and the body will absorb it, according to Johns Hopkins Medicine.

There are two types of vasectomies: those with scalpels, and those without. Vasectomies that use scalpels usually entail two cuts in the scrotum. Vasectomies that forgo scalpels generally involve just one small hole. In both cases, surgeons use a variety of techniques to pull the vas deferens through the cut(s), snip the tube in two, close both ends, and then put them back in place before closing up the cut(s) or hole. Generally, it's a quick, 20- to 30-minute procedure that can be done with just a local anesthetic to numb the scrotum. Healing takes about two weeks, according to the National Institutes of Health. In fact, most people return to work and resume physical activity in just a few days.

Tips to cope with any postoperative pain include chilling out, wearing comfier underwear, and avoiding masturbation for a bit. That's why doctors continuously see a spike in these surgeries around March Madness, dubbed "Vas Madness" by urologists and ESPN alike. It's a time when a lot of sports fanatics are sitting around, watching TV anyway, so might as well recover during that time period.

Foiling the flow of sperm into ejaculate makes it tremendously difficult to impregnate a woman. After all, if the sperm can't swim over to the egg (let alone leave the body), the two can't tango. (Related: How Effective Is the Pull-Out Method, Really?)

Just How Effective, Risky, and Costly Are Vasectomies?

Speaking of failures, sure, a vasectomy can "go wrong" (i.e. pregnancy can still happen). If the procedure was not performed properly, the vas deferens grow back, or the person doesn't wait quite enough time prior to penile penetration, it's still possible for them to impregnate someone. The tubes need to clear out and expel any sperm that already made its way over to the seminal vesicles before surgery, which takes about three months or 15 to 20 ejaculations, according to the NIH.

That said, it's improbable. Only about one or two in 1,000 vasectomies give up the ghost — or sperm, in this case, according to the American Academy of Family Physicians. Comparatively, nine in 100 people on the pill or using the ring, and about 15 in 100 of those who use condoms as their only birth control method, will get pregnant each year. Even intrauterine devices (IUDs), which are largely touted as one of the most effective forms of birth control, can fail for about one in 100 folks, according to Planned Parenthood. (It's worth noting that, while sperm won't pass through semen, infections sure can! Vasectomies do not protect against sexually transmitted infections — but no type of birth control does beyond barrier options such as external condoms, and even those aren't foolproof.)

Further, unlike many forms of birth control used for bodies with uteruses, research purports that vasectomies don't influence hormones, take a toll on libido, or impact pleasure. Nor do they induce unpleasant side effects such as potential weight gain, nausea, or migraines. While scrotal hematomas and pulmonary embolism (blood clots) following vasectomies are possible, research suggests they're rare. But the same can't be said of cases linked to hormonal pills, which can up a woman's risk of blood clots fourfold. Some studies suggest that postoperative depression is another possible adverse side effect due to stressors to the ego and possible regret, but other research serves as a reminder that depression is nothing new for contraceptive users with uteruses. And a comprehensive review finds that vasectomies do not increase the risk of prostate cancer, though women who have used oral contraceptives for five or more years do indeed increase their risk of cervical cancer, according to the National Cancer Institute. (Related: The Mental Health Birth Control Side Effects No One Is Talking About)

Overall, only one to two percent of vasectomy patients experience complications. They tend to be much safer than tubal ligations (medical sterilization of the fallopian tubes, aka "getting your tubes tied"), which carry an array of risks (such as internal bleeding, infection, organ damage, ectopic pregnancy, etc.), according to John Hopkins Medicine. In fact, research shows that vasectomies are 30 times less likely to fail and 20 times less likely to have postoperative complications than tubal ligation.

Never mind that vasectomies cost upward of about $1,000, while birth control pills cost upwards of about $50 every month (which, mind you, does not count the cost of the doctor's visits to procure prescriptions). Over the course of just a decade, that's about $6,000 or a cool six times the cost of one vasectomy. And, BTW, tubal ligation also costs up to $6,000. And IUDs cost up to $1,300. In fact, the Kaiser Family Foundation finds that contraceptive costs account for about 30 to 44 percent of vagina-owners' out-of-pocket health care spending. And let's not even get into the fact that the gender pay gap is still alive and well, as the Pew Research Center reports. While birth control should be free under the 2010 Affordable Care Act, many people still end up paying for birth control because insurers can interpret the mandate differently, according to the KFF.

Fortunately, insurance should cover both vasectomy and tubal ligation. But let's not forget that a $1,000 vasectomy, with or without insurance, is a hell of a lot cheaper than raising a child.

In short: A vasectomy is the single-most successful method of male birth control, barring, of course, sheer abstinence — and it's one of the most statistically sound approaches overall, as far as risks of complications and pregnancy are concerned. When performed and executed properly, a vasectomy is a nearly 100-percent efficacious pregnancy-prevention procedure.

Why Are Vasectomies Such an Unlikely Alternative for the Masses?

At this point, you're likely wondering if vasectomies are permanent procedures — and fair enough. Yes, vasectomies are often done with the intention to last a lifetime (ditto with tubal ligation). But, yes, in many cases, they may be reversible if the surgeon can reconnect the cut tube. That said, the whole take-backsies ordeal is not quite as simple as is implied, and a successful reversal is never guaranteed. If the reversal is done within a decade of the initial surgery, the success rate stands at about 60 to 75 percent — but it can drop to 30 percent after 15 years, according to Penn Medicine.

Some doctors won't perform vasectomies unless their patients are 100-percent positive they don't want children (or more of them) down the line. That's also why some patients opt to freeze their sperm prior to the procedure should they face complications in the future. But what about if you compare this to contraceptives widely used by people with uteruses? Research into whether or not long-term birth control use can affect fertility is hugely understudied. And only about 50 to 80 percent of women who undergo tubal ligation reversal can get pregnant afterward, too.

The uncertainty that surrounds vasectomy reversals is undoubtedly at the root of why they're not more common or used as a standard method of birth control. But that's not the only place men are avoiding taking responsibility for their health — a Cleveland Clinic survey finds that men actually avoid going to the doctor altogether.

What's driving this avoidant behavior? For one, toxic masculinity. In fact, one study finds that people who hold strong beliefs surrounding masculinity are half as likely as those with moderate beliefs to see a physician for their annual physical. You can imagine, then, that it'd be a stretch to go seeking out potentially permanent solutions for pregnancy prevention.

Toxic masculinity would also claim that giving up sperm is akin to sacrificing "manhood." After all, ejaculatory and erectile dysfunction can crush the ego. Study after study shows that sexual dysfunction and male infertility are largely linked to low self-esteem. (Even though study after study after study also suggests that "manly man" behaviors including crazy intense physical activity and tossing back beers and burgers with the boys can diminish sperm count…)

Surprisingly, a 2015 survey found that 66 percent of men are actually willing to take a male birth control pill, while 44 percent said they'd be willing to get a shot and another 36 percent are curious about birth control implants. In fact, in 2016, scientists successfully tested a non-hormonal contraceptive gel, Vasalgel, in rabbits, and it showed promise as a long-term, potentially reversible male contraceptive and even more awesome alternative to vasectomies. The findings, published in Basic and Clinical Andrology, explain that the gel would be injected into the vas deferens to form a barrier to sperm. Alas, nothing further has come of this to date.

And, even if male birth control did become readily available, society doesn't seem to totally trust that those without vaginas would be on their A-game when it comes to properly adhering to the protocol to make said birth control effective. A 1995 Harris poll (via a 1995 New York Times piece) found that 73 percent of women and 70 percent of men believed that men were "not responsible enough" to choose birth control. And little has since changed. Recent research shows women are still the ones taking the lead on pregnancy prevention, even in long-term relationships. Studies show that many women don't even trust male condoms (especially not when "stealthing," the practice of sneakily slipping them off mid-intercourse, is a thing — and a thing called sexual assault).

Beyond these reasons, the reality is that we live in a world in which women's bodies are governed — and that would just never happen to men. That's simply because, shocker, the governing bodies governing women's bodies are made up of mostly men.