The Rise of the Vasectomy

South Florida doctor says demand for vasectomies has shot up higher than at any time he can remember in his career.

“I used to do about four a week,” says Ranjith Ramasamy, 41, a microsurgeon and director of the reproductive urology fellowship program at the University of Miami’s Miller School of Medicine. “I’m now doing eight to 10 a week.”

Why so many trips for snips? Ramasamy sees clear links to a major development.

The U.S. Supreme Court’s Dobbs decision, leaked in May of 2022 and formally released in June, overturned the landmark Roe v. Wade ruling and gave states greater power to ban abortion. Google searches for “vasectomy” increased 121% in the week after the court leak compared to the week before, research by Ramasamy and colleagues found. They published a paper about it in a professional journal. The level of interest exceeded even a 70% increase in searches for “tubal ligation,” a procedure for women designed to be a more permanent way to prevent pregnancy.

From spikes in inquiries and clinic appointments around the country to patients recording (and even sharing) their own operations, vasectomies are grabbing some serious space on the cultural radar well into 2023.

“I think many patients feel like, as men, they want to contribute to the contraception equation,” Ramasamy says.

About half a million U.S. men get vasectomies in any given year, he says, echoing the figure given by the Mayo Clinic. The procedure cuts the supply of sperm to the semen by severing and sealing the vas deferens tube, serving as an effective method of contraception.

The percentage of men choosing to have the procedure had been dropping slightly over two decades, Ramasamy says, before seismic rumblings began to emanate from the nation’s highest court.

The majority of men who get vasectomies in his practice are in their thirties, forties or older, and many have children, but 10% to 15% are in their twenties, some of them single and childless, he adds.

On the other side of the country, one man who got a vasectomy says the court ruling definitely affected his decision. Grant Knutson, 46, and his wife decided they did not want children, though Knutson had been putting off the actual procedure, he says. The legal decision provided a galvanizing moment.

“Like we all do in life, you find an excuse to push it off,” Knutson, an arts administrator in Seattle, explains. “It’s not a part of the body you want cut or severed.”

In the end, ice and pain medication helped ease discomfort from the procedure, Knutson found.

His wife has health conditions that make some contraceptive options or an unplanned pregnancy risky, he says.

“We weren’t wavering on whether or not to have kids,” he says. “We really want to make sure there are no accidents.”

Some men have posted videos about their vasectomies, reaping attention online and in media reports. One was Keith Laue from Texas, who was 23 at the time of his procedure last year. Laue, who turns 24 this month, has more than 320,000 followers on TikTok.

He and partner Taylor Ribar, 24, said they already had one child and decided not to have another. Laue said he had local anesthesia and Valium for anxiety and the procedure took about 15 minutes.

“As men, it’s time that we start to support women and support our weight of birth control,” he says.

Another was Mike Pridgen, a 28-year-old comedian in New Jersey, who posted video of himself talking and reacting while undergoing the operation online. After a doctor warns of a “little pinch” in the video, he grimaces but says, “That’s not nearly as bad as I thought it was going to be.”

Of course, discussions about vasectomies have been going on for many years before the court decision, though sometimes cloaked in anonymity on the web.

“I’m 31 and tempted after a pregnancy scare earlier this year,” wrote a participant in a reddit.com dicussion. “A friend of mine had a vasectomy at 23. He had to convince several doctors that he wasn’t going to change his mind. He’s now 32 and although he’s lost a handful of relationships due to not wanting children, he has never changed his mind, and just found a girlfriend who feels the same way.”

Another male nearing 30 with no children said he had a vasectomy scheduled: “No pushback from the doctor, just some conversation to confirm I understood it should be considered a permanent choice and how serious I was about it.” He continued, “If you are 100% confident you don’t want biological children, it makes perfect sense to me. If there’s even a sliver of doubt in your mind, that’s where I think it’s something to be more cautious on making permanent decisions about while young.”

The cost of a vasectomy averages about $1,000, according to Medicare, though some clinics have been charging a bit more in recent months. One option before undergoing the procedure is freezing sperm for possible future conception if plans change. At Ramasamy’s practice, the cost of freezing is $460 initially, then $275 each year, he says.

Do men ever change their mind after getting a vasectomy? About 5% do, Ramasamy says. In his practice, he performs vasectomy reversal surgeries that aim to restore the pathway for sperm to make conception possible. This can occur for several reasons, but often it is a relationship with a new partner who wants children. There is no guarantee it will work, but if a reversal is done within 10 years of the original vasectomy, success rates can be as high as 90%, Ramasamy says. After that, the chances can drop to 60% to 70%, he adds.

A Mayo Clinic website says the odds for a couple of getting pregnant after a reversal can range widely depending in part on the age of the woman, from 30% to 90% in various circumstances.

And while some men go so far as to broadcast their own vasectomies, for many others the very idea of surgical incursion into their nether regions can be a bit unsettling. It has long fueled anxious jokes in popular culture. Take an episode of the erstwhile TV show “Brooklyn Nine-Nine,” where Terry Crews’ character does not care for police colleagues riffing about his scheduled vasectomy. Lay off or he will start “firing detectives,” he warns. Comes the reply from a female officer across the room: “Or blanks.”

Attempts to soothe such anxieties can be seen in many descriptions from vasectomy providers, aiming to impart a sense of routine everydayness to an action such as, “making a small opening in the scrotum.”

After rest and follow-up care to make sure the procedure was successful, men typically lose about 5% of their ejaculate volume, but testosterone levels are typically not affected and patients can engage in sex with high confidence they will not get a partner pregnant, providers say.

The procedure does not, however, carry any magic effect to decrease the risk of sexually transmitted diseases, Ramasamy reminds patients — particularly younger ones. Condoms or other precautions can still play an important role there.

Some 98% of vasectomies are performed on an outpatient basis, typically completed in less than an hour, with most patients getting local anesthetic while wide awake, Ramasamy says. Clinics vary in their marketing approaches, from brisk and businesslike to embracing a touch of levity. The latter is the case with DrSnip, a vasectomy clinic in Portland and Seattle. The name itself comes from a “humor-laced but informative article” by a journalist about the clinic’s founder in the 1990s, and executives figured, “What the heck, that’s how people talk,” and made it the official name.

Inquiries about getting a vasectomy at DrSnip roughly doubled after the leak about the Supreme Court decision and scheduled operations have increased about 20%, says Shrikesh Majithia, the chief executive officer.

“Now vasectomy is more talked about than it ever has been before in the last 10 years,” he says.

While the decision to get a vasectomy, of course, involves the consent of the man, often a female partner plays a significant role. As many as three or four out of every 10 inquiries to his business about vasectomies in recent months have come from wives or female partners, Majithia says.

“In a weird way, this is kind of a fun time to be in vasectomies,” he says. “It’s a golden age.”