AUSTIN — Although vasectomies pose fewer surgical risks and are more cost-effective than female sterilization procedures as a means of contraception, a lack of trained clinicians, funding and community education is preventing the male surgery from becoming more widely available in Texas, recent peer-reviewed research shows.
There is also a persistent problem with misconceptions about the procedure, including fear of losing sexual performance and fear of pain.
“There is a concern that any kind of procedure (for men) that takes place below the waist is going to be excruciatingly painful,” said Dr. Kari White, lead author on the study, which was published in the American Journal of Men’s Health in February. “But this is something that can be done relatively quickly, they can recover quickly and get back to work really soon. With female sterilization, that is much more involved in terms of levels of anesthesia and the amount of recovery that women have afterward.”
The study was conducted through the Texas Policy Evaluation Project, a University of Texas at Austin-based group that evaluates the impact of Texas legislation related to women’s reproductive health.
White noted that a vasectomy is usually an office-based procedure that requires only local anesthesia and takes about 20 minutes to complete, although, she said, some providers prefer to do the surgery as an outpatient procedure in hospitals. Men are able to go home the same day and are advised to rest, and can resume normal activities within two to three days, she said.
In contrast, a tubal ligation, one of the most common approaches to female sterilization, is usually done in a hospital under general anesthesia. Since it is an abdominal surgery, recovery takes days to weeks longer than recovery from a vasectomy, she said.
According to White’s study, two-thirds of the 54 publicly funded family planning organizations in Texas that responded to the research don’t offer vasectomy surgery on-site or pay for referrals with family planning funding. Only eight of them referred male clients to another provider with whom they had contracts for reimbursement. Just 11 organizations offered vasectomy surgeries at their facilities. Several organizations attributed the lack of vasectomy services to a lack of funding and trained staff to perform the procedures.
Many family planning clinics that receive Title X funding, a federal program that requires a range of contraceptives to be provided on-site or by referral to family planning clients, are unable to establish contracts for the surgery with trained clinicians in the community.
Money is a major factor.
Potential contractors considered the $250 reimbursement for a vasectomy permitted under Title X funding too low, researchers found. The reimbursement for a tubal ligation is usually $1,800, White said.
“(The vasectomy reimbursement) does not cover even the doctor’s office visit,” the executive director at a specialized women’s health organization said in an interview conducted for the study. “I think if the state were to increase the amount, then I believe we could participate and refer a lot of men. But right now, the reimbursement rate is just prohibitive.”
Due to confidentiality agreements between researchers and participants, the names of administrators and their organizations were not identified in the published study.
Researchers found that program administrators viewed urologists as the only providers who could perform vasectomies, so clinic staff would refer men or couples to a private practice urologist. Although vasectomies are commonly provided by urologists, family medicine clinicians, which are more likely to be on staff at publicly funded family planning clinics, can be trained to perform the procedure, the study says.
The study also found that since low-income men in Texas are not eligible for services through several of the state’s family planning programs, administrators viewed the procedure as too costly to make it widely available through other grant funding they received.
For places that provided both male and female sterilizations, there were usually two to four times as many female sterilizations as vasectomies, White said.
“However, it is important to note that some places did not offer female sterilization widely, either, for reasons of reimbursement,” White added. “Some organizations were able to make arrangements with a provider or facility to accept that rate. Others were not, and we heard that the providers or facilities they reached out to would charge at least $2,500 for female sterilization.”
According to the study, Latino men in particular were considered to be more opposed to undergoing the procedure; the opposition was mostly attributed to traditional cultural norms about masculinity.
One family planning program administrator said the cultural bias came from a “macho image,” and that men from Hispanic backgrounds prefer that their wives undergo female sterilization.
Only 8 percent of current contraceptive users in the United States rely on vasectomy, compared to 25 percent using female sterilization.
“A multilevel approach that simultaneously addresses these factors could allow publicly funded family planning organizations to offer comprehensive contraceptive services that include vasectomy,” White said.
This story was published in the San Antonio Express-News March 18, 2017.