It’s 2018 – why is female sterilization still performed more than vasectomy?

 

Sterilization [either male or female] is the most widely used birth control in the US [36%], followed closely by female hormone treatments such as the pill [30.6%].

But permanent birth control – sterilization – is vastly different for men and women in terms of cost, risk, and recovery for the patient.

According to come quick research via the Mayo clinic website, the risks of female sterilization [tubal ligation] include: Damage to the bowel, bladder or major blood vessels, reaction to anesthesia, improper wound healing or infection and continued pelvic or abdominal pain.

According to the same website, the risks of vasectomy are very low, and none are potentially life-threatening, unlike damage to the bowel or reaction to anesthesia.

So why is female sterilization [tubal ligation] still performed in the US two thirds more than male sterilization [vasectomy]?

Our family has benefited so much from Haakon’s 2015 vasectomy that I wanted to tell our story as a way to look at some of the reasons vasectomy may not be as popular as it should be.

I can’t remember how the idea that Haakon would have a vasectomy after our second child was born came up, but I know it seemed like a natural progression to me:  I’ve had two babies and lots of genital involvement around birthing [not to mention years of periods and pap tests before the babies, and after], and a vasectomy was an opportunity for something medical to happen in his body.

Although I was mildly concerned about Haakon’s vasectomy – I don’t like the idea of someone cutting into anyone’s junk any more than most people, and there is the risk of permanent complications with vasectomy – I never considered that I would, instead, have tubal ligation.

From Haak’s perspective, as a man who is pragmatic to a fault, his initial research about vasectomy made it clear that to suggest I would have the surgery instead of him would be “foolish,” he told me.

But here in Montana, I hear this all the time from women: “I was in there anyway [hospital, to have a baby] so I told them, just go on and tie my tubes. I wish Tom/Mike etc would get a vasectomy, but he would never do it.”

[About half of female sterilizations occur within 8 hours of giving birth, according to the national center for biotechnology information]

My assessment of how often female sterilization is performed over vasectomy is backed by figures provided by the national center for biotechnology information in 2008. According to their website, 27 per cent of sexually active women in the US rely on female sterilization as birth control, while 9.2 per cent rely on vasectomy.

Although the information I found online is dated, all the US-based reports I found drew from the same study, which also notes that “Overall, the sterilization rates for men and women have remained constant over the past 40 years [since 2008].”

Why is this, I wondered?

The fact that the numbers of female sterilizations are higher than male is probably influenced by the number of babies born via cesarean section – the US center of disease control and prevention website says that in 2017, 31% of all births were cesareans.

When a woman is already having major abdominal surgery and wants a permanent form of birth control, having a tubal ligation performed at the same time makes some sense.

But where sterilization is sought in stand-alone cases, vasectomy is not only faster and cheaper [“best $300 we ever spent,” says Haakon!] than tubal ligation, it is much safer for the person being operated on.

One of Haak’s co worker’s, Shannon, recently had tubal ligation surgery. I spoke to her on the phone 11 days after her surgery, and she was still using a back brace to protect her bruised stomach muscles.

She had also developed anemia and a blood clot near the surgery area which is not life-threatening but is hard and painful.

“I’m still in pain,” Shannon said, “I keep asking the doctor if this is a normal recovery because they told me I would only have to take it easy for a week afterwards.”

Shannon and her husband had been talking about permanent birth control for years, she said, and he had wanted to have a vasectomy but a history of hernia surgery made them both concerned about how suitable vasectomy would be in his case.

“Now that he’s seen me go through this,” Shannon told me, “he wishes he’d gone ahead with the vasectomy.”

Although Shannon and her husband were well informed and made the best choice for them, its clear that in most cases, tubal ligation carries higher risks than vasectomy.

Despite this fact, I do not want to minimize the risk of chronic pain or long-term implications for a person’s sex life, which is associated with vasectomy in rare cases.

Shannon’s youngest child is now 10, and despite her long and continuing recovery from the surgery, Shannon told me her only regret is that she didn’t do it sooner.

Having access to permanent, relatively safe birth control is indeed a treat – after muddling through ten years of using various temporary contraceptives, like condoms and the pill, Haak and I were both 100% ready to say goodbye to the possibility of pregnancy scares and all the organization required to avoid them.

And so it came to be that one sunny winter’s day in Moruya, NSW, I was waiting at a coffee shop across the street from the doctor’s office where Haak was having his vasectomy done. Callie was almost six months old, and I ordered and sat in the courtyard breastfeeding her.

My parents happened to be passing through, and they arrived at that moment.

“Should I order Haakon coffee?” Dad asked.

I paused to answer, and looked up from my half-finished flat white:

And saw Haakon, bounding down the steps of the doctor’s office. A similar image to my very first memory of him, when he was tanned and 20, and bouncing across a lawn to meet me.

“Couldn’t they do it?” I asked sympathetically, imagining that the doctor was called away or held up in some way.

“It’s done,” he answered, beaming.

And that, my friends, is the kind of after-effect of a life-changing surgery you will almost never get. Haak wasn’t even in the chair for 15 minutes and was enjoying a coffee in the sun 5 minutes later.

He still likes to tell people that the worst part about having a vasectomy was shaving his testicles in preparation for the surgery.

“The chafing from the stubble growing back was intense,” he told me this morning when I asked what he remembered most.

Haakon was “sore for a couple of days,” he recalled. He took no painkillers and was back at work three days later.

Although it’s hard for me to say if Shannon and Haakon’s recoveries are typical of the surgeries they had, it’s clear to me that something deeper than a pragmatic weighing up of the costs and benefits is in effect when heterosexual couples begin to research sterilization – something that culminates in many making the decision for the woman to undergo surgery rather than the man.

Hearing versions of the “I wish Carlos would get a vasectomy, but he would never do it,” conversation over the years has made me realize how our society ensures that the only genital sensations men have are pleasurable – and that women support this idea as much as men do.

It’s certainly been said before, but I’ll say it again – we seem to be stuck, as a society, in a pattern of accepting at face value a woman’s responsibility for all things reproductive, from unintended pregnancies and childcare to buying the condoms.

But it’s 2018 and vasectomy just might be the way forward – a way to revolutionize our relationships and sex lives.

 

I found information for this post from these sources:

CDC website, stats about cesarean rates: https://www.cdc.gov/nchs/fastats/delivery.htm

NCBI website, articles about rates of sterilization: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2492586/

Mayo Clinic, basic info about vasectomy and tubal ligation: https://www.mayoclinic.org/tests-procedures/vasectomy/about/pac-20384580

 

Thanks for reading!