By Julie Alvin
I was at a cocktail party recently when, a few drinks in, someone (ok, it was me) bluntly asked the gathering of fellow moms in their late 30s and early 40s, “So… what’s everyone doing for birth control now?”
Lately, the topic seemed unavoidable. In my social media feeds, pundits were discussing the unsustainability of modern parenthood in America, and creators were lamenting the unpredictability of their perimenopausal bodies, menstrual cycles, and ovulation windows. In my group chats, a bunch of women were mostly sure they didn’t want any more kids and were categorically certain that they didn’t want to go back on the Pill. They found it unacceptable that, after all these years, they were still solely responsible for managing the physical and mental burden of family planning for their households.
“Vasectomy,” one cocktail party guest replied to my query. “Vasectomy,” echoed another. The same conversation came up in a group chat of college friends as we planned for our 20-year college reunion. One friend’s husband declared his vasectomy “the best decision he made in 2024.” Another friend’s husband had been dragging his feet on getting snipped; it took a chemical pregnancy (aka a very early miscarriage) to finally get him to make the appointment. Three years ago, one friend’s husband bid eagerly on a vasectomy at an elementary school auction. He was outbid, and their surprise third child just turned two.
For many families in this life stage, a vasectomy seems like a choice with few downsides. With a brief in-office procedure and a week or so of recovery time (plus a very specific ejaculation schedule and a moratorium on unprotected sex while all the sperm drains out of there), they get the peace of mind of a foolproof birth control method – one that doesn’t require daily medication, fussing with latex, monitoring your ovulation, or having a medical device inserted into a uterus that has withstood so much. (So much!) And the women, whose bodies have been through a lot (Decades of synthetic hormones! Invasive IUDs! Infertility procedures! Complicated pregnancies! Traumatic childbirth! Run-of-the-mill childbirth! Multiple c-sections!) get a permanent reprieve from the physical toll and mental load of family planning.
Alex, 43, and his wife Lucy, 41, have a 12-year-old and a 9-year-old, and he got a vasectomy shortly after their youngest was born. His own dad had a vasectomy, and he had no hesitations about doing it.
“I was adamantly opposed to having more than two kids,” Alex said. “The whole world is easier for families of four. We sit in the car together. We get the right number of hamburger buns. The siblings don’t have a third wheel. And having more kids might have slowed down our careers.”
Alex, who was the one to broach the idea of a vasectomy with his wife, describes the experience as uncomfortable but not painful, though he was worried about the recovery and asked the doctor if he’d be able to hold the baby afterward. His wife reminded him that she had held and nursed the baby immediately after getting a c-section – a far more invasive surgery.
“I feel really good about it,” Alex said. “We made the right choice.”
Some men are hesitant. Dr. Vikrant Uberoi, a urologist at a large mid-Atlantic collection of practices called Chesapeake Urology, performs about 100 vasectomies a year, and says that the vast majority of his patients tell him they are getting a vasectomy because their wife wants them to – often she is the one who made the appointment. When patients are reluctant, it’s most often because they are concerned about the pain, or that there will be a change to their sex life – that they won’t be able to ejaculate, it will hurt when they ejaculate, or their erections won’t be as strong. “None of that is the case,” Uberoi clarifies. As for the pain, he says “It’s a nothing procedure. It takes 10 minutes. You can be on your phone, you feel four seconds of discomfort, and then afterwards you get to sit, you don’t do chores for a little while, and you get to ice and watch TV.” Uberoi got a vasectomy in 2022.
Nick, 43, has three daughters aged 10, 4, and 7, and was put off the idea of getting a vasectomy when his wife, who wants him to get the procedure, showed him an animated video of what happens during the surgery. “I would not recommend women show their husbands that video,” he says. The idea of being awake during the procedure makes him “squeamish,” he says, and he’d be more willing to go through with it if general or twilight anesthesia were an option.
Another common concern is about the permanence of the procedure, which Uberoi takes very seriously. He makes sure his patients are thinking through all the paths their lives could take. He’ll occasionally get a patient who plans to get the procedure now but reverse it later if they change their mind.
“One of the things we have to emphasize is that you should consider it permanent,” Uberoi says. “There is a way to reverse it, but it’s not easy to do. It’s a major surgery, and it shouldn’t be part of the plan.” As for risks from the surgery, Uberoi says there is two percent risk of a hematoma in the scrotum, which self resolves, or a wound infection that would resolve with antibiotics. There is a 0.6 percent chance of chronic testicular pain.
Women whose bodies have undergone plenty of pain and ample physical, emotional, and sexual side effects thanks to birth control, pregnancy, and childbirth, often have little sympathy for these concerns, and a man’s worry that he won’t be able to have more kids if he gets divorced or his partner dies doesn’t often resonate with women whose ability to have more kids will plummet no matter what.
Marissa, 38, has three kids and has tried several different methods of birth control that didn’t agree with her for various reasons. She wants her partner to get a vasectomy but he won’t.
“My partner equates a vasectomy with castration,” she says. “He believes he is losing part of what makes him, him.” This isn’t a satisfying reason for her.
“We are 100 percent done having children,” she says. “I have carried the kids for nine months, breast fed, dealt with postpartum depression, and had to recuperate from birth three times. I feel like a partnership should involve the man taking responsibility for family planning.”
Marissa says her partner has agreed to get a vasectomy when he turns 45, in three years, which is too long for her,
“I’m not willing to wait, so I am going to get a tubal ligation,” she says. “I don’t want to take birth control, I don’t want to have to worry about the state of our country and its potential impact on my ability to choose, so I am going to go through with the procedure.”
Dr. Uberoi is based in the D.C. area and has seen a lot of federal workers seeking vasectomies recently since the start of the second Trump administration because they are concerned they’ll lose their jobs and health insurance. There was also a big uptick in procedures after Roe vs. Wade was overturned in 2022, he says. In his opinion, a vasectomy can offer peace of mind in this environment.
“I think it’s the safest form of birth control,” Uberoi says. “There are so many things in this field that are on the woman. There are very few things that men are responsible for in this aspect of life.”