It was a casual party, but once the talk turned to vasectomies, the conversation was clipped.
“The doctor said I was too young,” noted one partygoer, Cary, 25, an unmarried conservationist from De Kalb. “He said, `You’ll change your mind.’ When I tried to convince him that I will not change my mind, he said, `What if you get married and your wife wants children?’ “
Cary rolled his eyes. “If I meet a woman who wants children, chances are she’s not the woman for me.”
Cary is a firm believer in zero population growth and intends to practice what he preaches. “There are enough unwanted children in the world already,” he said. “I just don’t believe people should have any more children.” His longtime girlfriend isn’t interested in breeding either.
Before Cary finished his story, a second guest was telling the same tale. And then a third-all of them younger than 25 and all eager to join the ranks of the sterile.
None, however, was eager to tell his story along with his full name to the public-thus the deletion of surnames. “I couldn’t even talk to my dad about this,” Cary explained.
“I thought I was the only person at my age to even consider a vasectomy,” noted Chicagoan Chris, 24, who is unemployed and married to a woman who is allergic to birth control pills. Chris visited his urologist last year and was told that his doctor would not perform a vasectomy on any man younger than 30 with no children. The next urologist he visited told him the same.
For years, the debate concerning a woman’s rights over her body have raged, propelled by the abortion issue and contraceptive rights. For men, the debate is non-existent, except in these few intimate conversations where young men are lamenting that they don’t have the final say in what happens to their bodies either.
“It’s like doctors think we can’t make our own decisions,” Cary said. “I am an adult, and this is my decision. I get tired of people telling me that I’ll change my mind. When someone tells me they want to have kids, I don’t tell them, `Oh, you’ll change your mind!’ “
There are no medical guidelines establishing what man can or cannot receive a vasectomy, so in the end each operation is left to the doctor’s discretion. And in most cases, doctors performing sterilizations are conservative.
According to the Association for Voluntary Sterilization, the average candidate for a vasectomy is a white male in his 30s with two or three children and a higher-than-average education and income. In 1991, 590,000 men underwent vasectomies, a number that has been fairly consistent since the 1970s, when the operation became popular.
“In all that time, as far as I know, there has never been talk of laying down guidelines for vasectomies,” said Pam Harper, director of communications for the Association for Voluntary Sterilization. “The rule of thumb is to make sure the person has all the children they want and is fully informed about the decision.”
Many urologists also require that the patient’s partner be a part of his decision and sign a consent form before the man is sterilized.
And, as Cary and Chris discovered, age is always considered.
“With both vasectomies and tubal ligation, the main question is age,” Harper notes. “That’s because we have research proving that the younger the person is who is sterilized, the more likely he or she is to regret the decision.”
Thinking ahead
Dr. Arnold Belker, for 25 years a clinical professor in the division of urology at the University of Louisville School of Medicine and a spokesman for the American Urological Association, said he will not give a very young man a vasectomy.
“I sympathize with him, but I could not bring myself to give him a vasectomy either,” Belker said, responding to Cory’s and Chris’ plight.
Belker said he has never given a vasectomy to a man younger than 25.
“It’s not that I think physicians should put themselves in judgment or make decisions for the patient,” he explained. “It’s because the physician has to live with his own decisions. If we do a sterilization on a 24-year-old, the chances that he will regret it are much higher than with a man who was 30 when he was sterilized.”
Vasectomy reversals are possible but, unlike the simple vasectomy, reversal is major microsurgery. And even if the vas deferens, which was severed in the vasectomy, is reconnected, the chances that fertilization will occur are not good.
Harper said the Association for Voluntary Sterilization hasn’t documented a trend toward an increased number of younger men wanting a vasectomy but added that “it’s hard to get good statistics because it’s performed right in the doctor’s office, not in a hospital like a tubal ligation.”
Just keep calling
Even if more men under 25 were to seek sterilization, it’s unlikely they would be able to get it, Harper said. “When a man is young, it is very difficult. Most men find their doctors by asking their friends, and most men under 25 don’t have friends who have vasectomies. His only option, really, is to just keep calling until he finds a willing doctor.”
Dr. John Krieger, a professor at the Medical School of the University of Washington in Seattle, said teenagers have come in and requested sterilization.
“I’ve never done them. I’ve never done any man younger than his mid-20s,” he said. “I don’t like doing vasectomies on men who are that young or don’t have any children. It’s just my personal bias, but my own experience has been that I’m a different person in my mid-40s than I was in my 20s. People at that age aren’t always ready to make permanent decisions.”
Said Harper: “The patient certainly has a right to make his own decision, but these doctors have seen a lot of men and are accustomed to seeing men who come back unhappy and want a reversal. (The) screening process is a way of preventing this. With divorce as common as it is and remarriage and second families, doctors will be quick to point out that a vasectomy might not be right for a young patient.”
Too quick, some researchers say. Susan Philliber, of Philliber Research Associates in New York, has spent her career gathering statistics for sterilization and reproduction, and she said she finds that sterilization is a seldom-recommended method of contraception.
“We aren’t doing enough to counsel men and women on sterilization,” Philliber said. “The medical community worries about pushing sterilization because this society has traditionally held the ability to have children as sacrosanct. The sanctity of reproductive choice tells us that even if a woman has four children and beats them and sets them on fire, she should still be allowed to have more and get custody of them.
“One of the reasons people aren’t counseled in sterilization is because it is permanent. But having a child is just as permanent.”
A hot topic
Although the topic of men’s rights to sterilization hasn’t been a hot button with the members of the American Urological Association, talk of it is occasionally bounced about, Belker noted.
“Medicine is as much an art form as a science, and rules are made to be broken,” he said. “There are just too many social and medical variables to regulate vasectomies.”
One local urologist even refused to have his name used in this article. “It’s too controversial,” he said. “I don’t want to start getting calls from men who are angry because they think they don’t have the right over their own body.”
In the meantime, Cary has temporarily stopped trying to find a willing urologist. “It makes me too angry to even think about it,” he said. “In fact, it almost makes me laugh. I can have as many kids as I want and no one cares at all, but I try not to have any and it becomes a federal case.”
Chris, however, believes he has the solution to his problem. “My wife and I have an appointment with a urologist next week,” he noted. “I told him we already have three kids.”
