Vasectomy in Men without Children: Demographics and Family Planning Attitudes from the National Survey for Family Growth

Najari, Bobby B.; Persily, Jesse; Peterson, Janey C.; Wells, Martin T.; Goldstein, Marc

doi:10.1097/upj.0000000000000150

Cited by 5 publications

(4 citation statements)

References 11 publications

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“…A weakness of this approach is the opportunity to introduce provider bias in determining whether the risk of regret is too high. Recent research suggests childless men are no more likely to regret vasectomy and should not be counseled any differently than men with children ( Bryk et al , 2020 ; Najari et al , 2021 ). Denying access to sterilization over the possibility of future regret has also been deemed unethical ( Lalonde, 2018 ; McQueen, 2017 ; Mertes, 2017 ).…”

Section: Discussionmentioning

confidence: 99%

“…The findings of this study suggest an opportunity for vasectomy providers to examine the role of evidence in their decision-making, and to examine and mitigate opportunities for bias to shape decision-making. Providers only reported evidence as driving their decision-making when it came to patients at high risk of regret, and some of the criteria they described being as high-risk are not consistently supported in the literature nor in the lived experience of those who provide reversals ( Masterson et al , 2013 ; Najari et al , 2021 ). There is a need to examine what kind of evidence is used and the way evidence is used to guide decision-making, as well as a need to practice reflexivity on how bias may shape decision-making.…”

Section: Discussionmentioning

confidence: 99%

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Vasectomy provider decision-making balancing autonomy and non-maleficence: qualitative interviews with providers

Hoover,

Shattuck,

Andes

2023

Gates Open Res

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Background Male sterilization, or vasectomy, is 99.9% effective at preventing pregnancy with less than a 2% risk of complications. Despite the high efficacy, low risk, low cost, and gender equity benefits of vasectomy, just 2% of women reported that they and their partners relied on vasectomy as their contraceptive method globally in 2019. Health care providers can be both a facilitator and a barrier in men’s health generally, and may be in vasectomy provision as well. This study sought to describe the decision-making rationales of experienced vasectomy providers when evaluating patient candidacy in complex cases. Methods Fifteen vasectomy providers belonging to the global Vasectomy Network google group from seven countries participated in online interviews using a semi-structured in-depth interview guide. Providers were asked about their vasectomy training, their reasons for vasectomy provision, challenging cases they have faced, and approaches used to manage challenging cases. Vignettes were used to further elicit decision-making rationale. Thematic analysis was conducted using MAXQDA20. Results Provider decision-making was predicated on ensuring patients were well-informed, able to consent, and certain about their choice to have a vasectomy. Once those foundational conditions were met, providers filtered patient characteristics through their training, laws and policies, sociocultural norms, experience, and peer influence to produce a cost-benefit breakdown. Based on the cost-benefit analysis, providers determined whether to weigh autonomy or non-maleficence more heavily when determining vasectomy patient candidacy. Conclusions Despite clinical best practices that promote prioritizing patient autonomy over non-maleficence, some providers continued to weigh non-maleficence over autonomy in vasectomy patient candidacy evaluations. Non-maleficence was particularly prioritized in cases providers deemed to be at higher risk of regret. The findings of this study suggest vasectomy provider training should emphasize evidence-based best practices in shared decision-making and patient-centered care to facilitate vasectomy provision that honors patient autonomy and rights.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Vasectomy provider decision-making balancing autonomy and non-maleficence: qualitative interviews with providers

Hoover,

Shattuck,

Andes

2023

Gates Open Res

View full text Add to dashboard Cite

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“…3 Moreover, recent data analyses have shown that men who were voluntarily childless prior to vasectomy are actually less likely to undergo a vasectomy reversal than Vasectomy Regret or Lack Thereof Health Psychology Research men with children (though feelings of regret were not analyzed). 28,29 This relationship is likely more complex than it appears at first, however, as there are consistent demographic differences between voluntarily childless men and men with children. For instance, voluntarily childless men tend to be less religious and have a higher income.…”

Section: Parental Statusmentioning

confidence: 99%

Vasectomy Regret or Lack Thereof

Anderson

Lucero

Vining

et al. 2022

Health Psychology Research

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Background Vasectomy is a procedure that results in permanent yet reversible sterility and remains a great contraceptive option for many. Previous research studies have highlighted frequency of vasectomy utilization, defining characteristics of individuals who opt for this method, various surgical techniques, and the risks and benefits associated with the procedure. What remains to be defined is why or why not individuals may experience post-vasectomy regret and whether the previous characteristics correlate. Objective The objective of this review is to synthesize information regarding reasons individuals may regret their vasectomy and seek reversal, what options exist for accomplishing the reversal, and patients’ fertility prognosis post-vasovasostomy. Methods This review utilized a combination of secondary and tertiary data analysis across a wide scope of academic databases pertaining to the topic of interest. Results Typically, most males who have sought a vasectomy are satisfied with their decision, however, approximately 6% of this population seeks reversal. Key factors influencing vasectomy regret include age at the time of vasectomy, parental status, pre- and post-operative relationship status, unresolved physical and psychosexual problems, and development of chronic scrotal pain following the procedure. Few options exist for vasectomy reversal including microsurgical reconstructive vasectomy reversal (VR) and sperm extraction for in vitro fertilization. There is no guarantee that fertility will be restored in any case but a major predictive factor for success is the time interval prior to reversal. Conclusion Vasectomy is intended to be a permanent form of contraception; however, a minor chance remains that individuals may experience post-operative regret due to various factors. This warrants proper comprehensive counseling by the patient’s provider regarding benefits and risks, procedural outcomes, opportunities for reversal, and fertility prognosis.

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“…3 Approximately 6% of US men rely on vasectomy for contraception. 4 As a result of this high demand and the time-sensitive nature of sterilization for family planning, when the COVID-19 pandemic necessitated the reduction of in-person appointments, urologists started to pivot to telehealth for vasectomy consultations. Due to the convenience of telehealth for many providers and patients, many urologists have continued to deliver care such as vasectomy consultation through telehealth after achieving anecdotal success with the format during the pandemic.…”

mentioning

confidence: 99%

No Detectable Association Between Virtual Setting for Vasectomy Consultation and Vasectomy Completion Rate

Hernandez,

Bernstein,

Zhu

et al. 2024

Urology Practice

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Introduction:The COVID-19 pandemic has fueled widespread incorporation of telehealth into urology practices. Vasectomy consultation via telehealth is convenient and improves access to care for male contraception. However, it does not allow for physical examination, inherently leading to possible day-of-procedure cancellations due to unforeseen anatomic concerns. This study aimed to compare vasectomy completion rates between patients undergoing virtual vs inperson consultation.Methods: All patients seen by a single provider at NYU Langone Health for vasectomy consultation between October 2016 and June 2022 were included in the study. Most patients seen before March 2020 had in-person consultations, whereas the majority of patients seen afterwards had virtual consultations without option for in-person visit due to the emergence of COVID-19. All patients seen virtually were examined in a consult room prior to being prepped for the vasectomy in the procedure room. Visit type, demographic information, and clinical outcomes data were collected for all patients. A chi-square test was used to compare the rate of vasectomy completion between those with in-person and virtual consultation. Analysis was performed using R, version 4.0.5.Results: Four hundred ninety-one patients were seen by a single provider for vasectomy consultation between October 2016 and June 2022. One hundred ninety-seven (40.1%) consultations were performed virtually and 294 (59.9%) consultations were performed in person. Three hundred seventy (75.4%) of all patients seen for consultation (both virtual and in person) ultimately underwent vasectomy. There was no evidence of difference in rate of completing vasectomy after virtual (75.6%) and in-person (75.2%) consultation (P ¼ .91). Two of the 197 (1%) patients who consulted virtually had their vasectomy procedures cancelled on the day of the procedure based on their preoperative exam; one because of abnormal epididymal sensitivity after prior scrotal infection, the other because of a history of orchiopexy that the patient was not aware of until the surgeon started inquiring about scrotal scars present.

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Vasectomy in Men without Children: Demographics and Family Planning Attitudes from the National Survey for Family Growth

Abstract: Introduction: To investigate the ethically challenging scenario of a childless man requesting a vasectomy, we compared vasectomy reversal rates and family planning attitudes in men who underwent vasectomy with and without fathering a child.

Cited by 5 publications

References 11 publications

Vasectomy provider decision-making balancing autonomy and non-maleficence: qualitative interviews with providers

Vasectomy provider decision-making balancing autonomy and non-maleficence: qualitative interviews with providers

Vasectomy Regret or Lack Thereof

No Detectable Association Between Virtual Setting for Vasectomy Consultation and Vasectomy Completion Rate

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