April 26, 2018
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Public vasectomies promote family planning

By Ketaki Gokhale, Bloomberg

MUMBAI, India — “I can feel a bit of tugging, but it doesn’t hurt at all,” said Chris Wiren, as a surgeon performed a 10-minute vasectomy on the 39-year-old father of four live on stage.

Wiren’s operation was the first of 16 performed in front of hundreds of people last week at the Science Exchange in Adelaide, Australia. In a world-first display, surgeons explained each step and answered questions, seeking to demystify and promote a form of male sterilization that requires no needles, scalpel blades or general anesthesia. Wider use could help address the unmet need for safe and effective family planning methods of at least 200 million women.

The need is especially great in developing countries. Almost 50 million of the 190 million women a year who become pregnant annually undergo abortions to terminate pregnancies, and about 13 percent of maternal deaths are caused by complications of abortion, mostly in less developed regions.

“The benefit is the same everywhere, but it may be more important in poor countries because it’s an inexpensive, fast procedure which allows the male to remove much of the burden from the woman,” said Paul Ehrlich, Bing professor of population studies at Stanford University. “With the new techniques in vasectomies, you don’t even get an incision that needs to be stitched. You just get a little Band-Aid, that’s it.”

The daylong program at which Wiren was a volunteer was hosted by the Royal Institution of Australia, which seeks to raise public awareness about science. It was held to mark the inaugural World Vasectomy Day, which aimed to encourage 1,000 men to get the snip across 25 countries. The event in Adelaide, streamed live over the Internet, was the creation of Emmy Award- winning documentary filmmaker Jonathan Stack, whose film about human reproductive challenges, “The Vasectomist,” premiered in Australia last week.

“The hardest part is making vasectomy look cool,” said Stein, a Tampa, Fla.-based urologist who is featured in Stack’s film and conducted some of the live vasectomies. “Doing social marketing around human reproduction could be looked upon by some as perhaps a little bit over the top. I think at some point the message could sink in.”

More than 342,200 women died from maternal causes in 2008, and that number would have been 272,040 higher without contraception, researchers said in a report published in the Lancet medical journal last year. Meeting the unmet need for contraception could prevent an additional 104,000 deaths a year, the researchers wrote. The leading causes of pregnancy-related death are hemorrhage, hypertensive disorders, sepsis, obstructed labor and complications from unsafe abortions.

Forms of sterilization, including vasectomies and tubal ligations for women, and IUDs are among the most effective forms of birth control, resulting in less than one pregnancy per 100 women, according to advocacy group Planned Parenthood in New York. About 13 percent of U.S. women relied on male sterilization for contraception, according to United Nations data.

State health care systems in Canada and Australia help cover the cost of vasectomy, while the Indian government has a program that pays 1,100 rupees ($18) for lost wages.

Before the needle-free vasectomy technique was popularized more than a decade ago, the procedure involved injection in the scrotum and slits made with a scalpel on two sides of it to reach the sperm-carrying tubes. The tubes which Stein said resemble al dente spaghetti, are clipped and sutured, clamped, or cauterized to block the flow of sperm.

Fear of needles and incisions in their genitals is what drives the proliferation of myths surrounding vasectomy among men — the most prevalent: that it causes erectile problems, said Stein, who has performed 31,000 of the surgeries so far.

Some men and women in India, Bangladesh, Nepal and Pakistan believe that vasectomy impairs their mental health, reduces sex drive, and causes weakness, backaches and weight gain, said Anjali Sen, New Delhi-based regional director of the International Planned Parenthood Federation in South Asia.

“None of this has any basis in fact,” she said.

While female sterilization is far more common than male sterilization, vasectomy is safer, simpler, about half the cost of female sterilization, and probably more effective, according to the World Health Organization in Geneva.

A vasectomy in the U.S. costs $350 to $1,000, including the follow-up sperm count, according to Planned Parenthood. Sterilization for women costs up to six times as much. Vasectomies are covered by about 70 percent of health insurance plans for U.S. workers, according to the Association of Reproductive Health Professionals.

“In India and China, it’s easy to get people trained to do the procedure,” said Ehrlich, 81, the Stanford biologist who wrote the 1968 book The Population Bomb. “Men of those countries ought to be deliriously happy to spare their wives and girlfriends from carrying the load forever of contraception.”

That’s exactly the message that Wiren is hoping to help get across with his public vasectomy.

Anesthesia was applied directly through the skin with a high pressure spray. With Wiren’s scrotum exposed between drapes, surgeon Stein cut and blocked off the two tubes that carry sperm from his testes via a single puncture the size of a paper cut.

“If this is what it takes to promote science, I’m all for it,” Wiren, a research engineer, said over the telephone before the procedure. “It has relevance everywhere. It’s important men talk openly about their sexual and reproductive health.”


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