Vasectomies appear to have gone dramatically out of fashion, with a decline of 64% in the number of men undergoing the procedure within the last 10 years, leaving women once more shouldering the responsibility for contraception.
But the reasons for the apparent shift are complex, say experts. Part of it is bad publicity, with many men seemingly put off by scare stories about pain and unfounded worries about the implications for their sex lives, but there are also concerns that NHS funding for the procedure may be slipping away.
In 2004-5, there were 31,216 vasectomies carried out in England, but in 2014-15, that fell to just 11,113 according to NHS Digital. Image is definitely an issue, according to Genevieve Edwards of Marie Stopes, who says “the snip” is an offputting misnomer. “That is not what happens. If you were going to launch vasectomy as a product, you wouldn’t start there,” she said.
“People worry massively and have lots of misconceptions about it – how painful it is, the impact on their sex life, whether they will still have orgasms. People are really confused about it.”
The perceptions lag behind the reality, Edwards said. “There is no snipping at all. It is a 15-minute procedure with lots of anaesthetic and Bob’s your uncle.”
But the later age of having children is also a factor, she believes. In the past, a couple may have had several children before they were 30. “If you and your partner had another 20 years of fertility ahead, another two decades of the pill, you might pack him off to the doctor,” she said. But if a woman will be facing the menopause in just a couple of years, they might carry on with contraception rather than opting for a vasectomy.
Suggestions that men no longer want a vasectomy in case their marriage breaks up and they have a second partner who wants children are wide of the mark, she believes.
Marie Stopes is a leading provider of vasectomies for the NHS as well as privately and has been trying to boost interest among men. It ran a campaign this spring on websites and at football grounds called “Have you got the balls?” inviting men to think about it. It appeared to have some effect, because 200 more men came along for the procedure last month than in September the year before.
If awareness and interest is dropping in England, that is not the case elsewhere. Marie Stopes clinics get quite a lot of male clients from France and the Middle East. In the Middle East, the procedure is rarely done, so men head for clinics where it is routine and they feel in safe hands. In France, vasectomy was illegal until relatively recently, under the Napoleonic code that banned self-harm. Although it is legal now, it is not easy to access and men who ask for it must go through counselling and a cooling-off period. Many jump on the Eurostar instead.
But cost in England may be becoming an issue. At a time of increasing financial pressure on the NHS, some clinical commissioning groups are considering reducing the number of vasectomies they will pay for, or dropping them altogether. The North East Essex clinical commissioning group (CCG) will no longer fund it. Its website states: “The community vasectomy and female sterilisation services are considered as one of many forms of contraception and are deemed to have no or limited clinical value.” It will be available, however, “in cases of complex health needs”.
The procedure costs £400, but arguably saves money on other forms of contraception over the long term. It also allows men to take over responsibility from women, who have had to worry about their fertility and the possible side-effects of hormonal contraception for much of their lives.
While vasectomy has declined, the use by women of long-acting reversible contraceptives, known as LARCs – such as implants and intra-uterine devices (the coil) – has risen.
“There has been a huge push on getting women to use long-acting reversible methods,” said Katherine O’Brien, a spokesperson for BPAS, the British pregnancy advisory service. “It is cheaper for doctors to be providing these things. We know that if you speak to women and their partners, if they have discussed the possibility of a vasectomy with their GP, the doctor often says to them, why don’t you just have the coil or an implant?”
The attraction of LARCs is that they can be left for several years but the contraceptive effect is reversible – and a vasectomy often is not. But implants are hormonal, which some women do not want, and sometimes there is bleeding. “When women go back to the GP, they are told to go back on the pill to cope with the bleeding,” said O’Brien. “It is really extraordinary. They chose the LARC because they didn’t want to take the pill.”
The Family Planning Association says it advocates “as much choice as possible”. It too is worried about the decline of the vasectomy and fears there will be a postcode lottery as some CCGs decide to pay for it, while others will not. “We are worried that if men aren’t able to access vasectomy, it does put more of a burden onto women,” said a spokesperson. The conversation heard in the clinic is of the woman in a partnership saying that contraception was her responsibility until the couple had completed their family – and now it is the man’s turn.
The vasectomy is a simple procedure, carried out under local anaesthetic. It involves a small incision on each side of the scrotum, allowing the doctor to access the tubes that carry sperm out of the testicles. These are cut and sealed. It can also be done with keyhole surgery. Ejaculation is as normal afterwards, but the semen contains no sperm.
Number of vasectomies in England falls 64% in 10 years
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