Vasectomies: Why men get the snip and how it works
11:49 Share

Earlier this month, a doctor in Taiwan uploaded a now-viral video to Instagram.

It showed him giving himself a vasectomy. That procedure cuts the tubes that carry sperm from the testicles, meaning that the doctor can no longer get his wife pregnant if they have sex. He said he was doing it as a gift to her since she didn't want to have any more kids. Now, before we go any further, just remember, he's a doctor. You should not try this at home. All of that sent me down a surprising social media rabbit hole. Videos where men, many of them in their 20s, explain why they got the SNP.

So on today's episode, we're going to find out what's involved in a vasectomy and hear from men who have had the procedure. I'm William Lee Adams, and this is What in the World from the BBC World Service. ♪

Here to tell us more is Jeff Foster. He's a doctor here in the UK, and he has an interest in men's health. Jeff, hi. Hi, thanks for having me. So Jeff, I want to start by playing you this clip from someone who's had a vasectomy. This is Kenyan media personality Nick Indeda. Let's hear why he had it done. Well, because I did not want to have children, number one. And number two...

Before I had the vasectomy, my partner used to use contraception. And I could literally see the toll it would take on her body. And sometimes she would talk about how she wishes there were other ways. And I saw online, actually, that Marie Stopes was doing a free vasectomy week. My partner and I got together. We went. It was very easy peasy, really. So is it really easy peasy, as he says?

The procedure itself is actually easy peasy, but it's the implications themselves.

for what the procedure means afterwards and the long-term impact of having a vasectomy that's not quite so simple. People often describe this as getting the snip. How does the procedure actually work? Okay, so it is actually a really simple procedure. So almost all vasectomies are now done under local anaesthetic. They're classed as day case. You go in the morning and you come out an hour later. The procedure itself lasts about 15 to 30 minutes.

and you have a little local anaesthetic at the back of the scrotum. You make a tiny little cut. You go into the scrotum and you find the vas deferens, which is where the sperm comes out. And then you either cut it or you diathermy it. So you sort of cauterize it. And either way, you remove the tube from connection and then you tie it off or you clip it and you make sure it's sealed up on the way out and you're done. Good to go.

We usually tell patients wear some tight underwear to support your scrotum on the way home, have some pain relief and you should be back on track in a couple of days. And so does the scrotum still have sperm in it? Will your body keep making sperm after the tube is cut? Yes, forever. Well, nearly forever. Now, is it problematic if that sperm is not released? No, absolutely not. So if you don't ejaculate regularly and your sperm just sit there in your testicles, they'll just get reabsorbed and nothing bad happens.

There are cases of autoimmune problems where your body can react to your own sperm over time, but that isn't really such a big issue for most men with fertility. The biggest problem around vasectomies is the longer you wait after having a vasectomy done, if you change your mind and want it reversed, it gets harder and harder to reverse the process. Because if you imagine...

You've either cut the tube or you've tied a little knot in it or you've put something at the end of it to stop it functioning to link up with the other half of the tube. That forms a scar and the scar gets meatier and knottier over time. So that if you did your reversal within the first three years, we say you've got a 75% chance of getting your sperm back to what they should be to establishing a pregnancy. If you leave it more than 20 years, you've got less than 5%. Do you find that younger patients are interested in getting vasectomies?

I'd say yeah, yeah. So I think this concept that men are thinking in their early 20s, I just never want to have kids and this is the way I can fix it and vasectomy is the answer and I think we are seeing more of that coming through, which is interesting because certainly when I was 25, I didn't want to have kids and then five, ten years later your life changes and the difficulty is the permanency around the vasectomy that means you may not want to have kids but do you really want to make that permanent decision? Music

So Jeff and I were talking about penises just a few minutes after meeting. Now, not everyone's comfortable with that kind of talk. So we know there's a stigma when it comes to men discussing their sexual health.

We heard from Nick earlier, who decided to have a vasectomy, so let's hear how people reacted when he told them about his decision. Most of them was what? You are now officially less of a man. How dare you do something like that? You're making men look bad. You have a controlling woman.

We're going to hear more from Dr. Foster in a minute, but first I want to give you a sense of how many men around the world get vasectomies.

The countries with the highest vasectomy rates are the UK and Canada. In Canada, around 20% of men have had a vasectomy. Whereas in China, only 0.02% of men have. That's virtually non-existent. Vasectomy rates are also low across Africa. According to the UN, less than 0.1% of African men have had the procedure. We should point out that vasectomy rates fluctuate for a number of reasons. Let's look at the United States.

In recent years, more Americans have started turning to the procedure. That's partly down to a U.S. Supreme Court ruling in 2022 that overturned Roe v. Wade. That was the court case that established a constitutional right for a woman to have an abortion, and it prevented individual states from banning women from having them.

Now, as a result of that, several states instated total or partial bans on abortions, and that's encouraged men in a number of states to take more responsibility. You can see this from the Google search trends. On the day that Roe v. Wade was overturned, searches for the word vasectomy jumped by 850%, and the states with the most searches were Texas and Florida, both of which had bans in some form.

Now, this was something that played on the mind of Justin Luiz. He lives in Nashville, Tennessee, and had a vasectomy when he was in his late 20s. What really did it for me and really expedited that decision was definitely the overturning of Roe v. Wade in June of 2022. That was just shocking, but at the same time, not at all shocking, just because of the state of American politics as of recent events.

It just made it so clear that this was an easy decision for me to make. If the choice was taken and had been taken from women, then men ought to be making the right choice for everyone. And so it was an easy decision, an easy choice for me to make because I had one still. ♪

I want to get back to Dr. Foster now. Jeff, last night on the bus, I fell into this weird genre of Instagram vasectomy reels, and I'm hoping we can play a little game off the back of that. I'm going to read some of the most common questions and fears that people had, and you can just tell us whether they're true or false. So the first one is, a vasectomy is very painful. I would say not true.

So most patients are given some basic pain relief, which they take for the first 48 hours after the procedure. The procedure is done under local anaesthetic, and we usually say people don't have sex for a week, and after that you can usually crack on, if that's the right phrase. Here's the next one. Definitely not.

So your erectile function is not directly linked to anything in your scrotum. I mean, obviously your scrotum produces testosterone and that is important, but that's a different tube to your vas deferens where your sperm comes out. So in terms of producing testosterone and all the nerves that make you erect and give you other sexual function, completely separate. Vasectomies don't always work and men end up getting women pregnant by accident. That is true. Vasectomies are not 100%, but no form of contraception would be.

So we usually say there's about a failure rate of about 0.05%. So about one in 2000 vasectomies will need to be redone or will fail and somebody will get pregnant. But if you look at that as a failure rate, that

that's better than almost every other form of contraception out there. And this one stems from a bit of vanity. Having a vasectomy will make my semen look funny. Once the vasectomy's finished and it's all cleared up and you're able to have sex again, for all you could see, everything looks completely the same as previous. And lastly, I can no longer catch or transmit STIs and therefore don't need to use a condom if I've had a vasectomy.

It's really weird this one, isn't it? I don't know why people would imagine that just because you've had a vasectomy, the risk of STDs doesn't exist. It seems so bizarre because, of course, you're still having completely unprotected sex. So, of course, you can still get all forms of horrific STIs, everything from chlamydia up to HIV. If you simply don't have a formal sheath protection, those risks are still there. The vasectomy purely protects you from pregnancy only.

So we're done with the myths, but we continue with this idea of protection. It obviously takes two people to tango. Men are involved in 100% of unplanned pregnancies. How can a woman guarantee that she's safe? If a man says, oh, I've had a vasectomy, you should believe me. Good question. I don't think offering a certificate would be particularly helpful in these scenarios. You can't.

So I think vasectomies only really work in couples that are happy together and are in a stable and long-term relationship because then you can trust your partner because they're with you. If this is somebody who's perhaps more single and looking to play the field a little bit, then a vasectomy is going to offer the female partner no reassurance whatsoever. And Dr. Foster, do you have any final advice for men of any age who are considering getting a vasectomy?

Yeah, I think if you're under 30, really, really think hard about this because it is classed as reversible, but it's not simple. For most men, this is a permanent change. If you're over 40 and you've had your kids, then great. But even with that, it's not a painless procedure. And we say that about 1 to 14% of men still can get nerve pain or irritation after the procedure. It's not 100% risk-free. Nothing is. This is still surgery.

But it is also a great procedure for many men who don't wish to have kids with their partner. And especially if their female partner or wife or whatever has had maybe complications with contraceptives or maybe has other medical problems and can't tolerate the pill or a coil or something similar. This is a great way to say, actually, you know what? We can remove all of that problem for her and we can still have a great, loving relationship together. Jeff, thank you so much for explaining that. Thank you.

So the tube that carries sperm from the testicles to the penis, that is in a way on and off. But the decision on whether to get the procedure, that's a lot more complicated. That's all for today. Thanks for listening to another episode of What in the World from the BBC World Service. I'm William Lee Adams. We'll see you next time. Joining me in the studio is a science someone who always makes me smile. Unexpected Elements brings you the most surprising science...

Professor Sella is wearing a giant banana costume. This is my first time ever interviewing a banana, especially one that's a professor of chemistry. Bananas are fundamentally hilarious, but it's also the extraordinary lubricant properties of bananas. Unexpected Elements from the BBC World Service. What's banana in Romanian? It's banana, so it's the same thing. Oh, that's disappointing. Search for Unexpected Elements wherever you get your BBC podcasts.