More Men Are Expressing Interest in Vasectomy After SCOTUS Abortion Decision

CHICAGO -- Vasectomy consults more than doubled in the first 3 months after the Supreme Court decision overturning national abortion rights, according to data from one large health system.

From June 24 -- the day the Dobbs v. Jackson Women's Health Organization decision was announced -- until Sept. 24, 2022, a total of 342 vasectomy consults were recorded at the University of Michigan Health System in Ann Arbor. During the same period in 2021, vasectomy consults numbered 152.

Consults for non-vasectomy urologic procedures did not change from 2021 to 2022. Moreover, vasectomy consults did not increase significantly during the same period from 2020 to 2021, taking into account the possible effects of the COVID-19 pandemic.

Men seeking vasectomy consults after Dobbs were more likely to be childless and unmarried but they did not differ from the 2021 consults with respect to age, race, income, or insurance, reported urology resident Alex Zhu, DO, of the University of Michigan, at the American Urological Association (AUA) annual meeting. He emphasized that the study analyzed consults and did not track the number of men who actually had vasectomies.

"Historically, many men have left the contraception decision up to their female counterparts," Zhu said. "With these changes in abortion legislation, more men may have felt more responsibility for their own contraception."

Although Dobbs clearly focused on women's reproductive rights, the decision's impact on male reproductive decisions was unclear. Various reports in consumer media suggested an immediate increase in vasectomy demand. Two separate reports in medical journals showed a spike in Google searches after Dobbs, particularly in states with few urologists.

"Many of you in the crowd noticed an increase in vasectomy interest after the Dobbs decision," said Zhu. "We certainly did at the University of Michigan, and we wanted to quantify the interest."

To attach a number to the perception, Zhu and colleagues reviewed medical charts for the 3-month period after Dobbs and for the same 3-month period in 2021. They focused on the number of vasectomy consults during the two periods, as well as the demographics of men seeking vasectomy consults.

Comparison of the two time periods confirmed the suspected spike in vasectomy consults but also revealed differences in the demographics of men requesting consults. As compared with the men in 2021, the men in 2022 were:

• 4.7 times more likely to be divorced or without a partner
• 2.4 times more likely to be in a non-married relationship
• 2.8 times more likely to be childless
• 2.1 times more likely to identify as agnostic/atheist/nonreligious (versus Catholic)

Overall, the age groupings of men seeking consults did not differ significantly between the two years. However, 12 men ages 18-24 sought consults following Dobbs versus none in 2021.

The findings left many unanswered questions, he continued. Will vasectomy consults translate into more procedures? Will the findings vary by state or geographic region? Will urologists see an increased demand for vasectomy reversal in the coming years?

The presentation provoked a discussion that lasted almost as long as Zhu's talk, as members of the audience offered different takes on the interpretation of the data and the potential implications.

"Dobbs has changed the paradigm for male reproductive health and responsibility," said Ajay Nangia, MD, MBBS, of the University of Kansas Health System in Kansas City. "I think we have to be very deliberate about looking at the sustainability."

"You looked at the demographics, and the younger and childless men [were driving the results]. I think it would be very important for you to take that same [population] out and look at it several months out to see if it's percolated out to be even worse," he added.

Several speakers said they are already booked for vasectomy consults for months and expressed doubt that the numbers could increase much beyond current levels. Others expressed the opinion that intrastate politics will have a major influence on male reproductive decisions.

One unidentified speaker quipped, "I think a lot of men living in Blue states may be having sex with women in Red states. Men are having a lot of vasectomies in Blue states."

Another speaker lauded the AUA for including studies with health policy implications in the program. "It should be urologists and [other] doctors making these decisions with their patients, not policymakers in some back office."

The rise in vasectomy consults is a "knee-jerk reaction by men assuming responsibility [for contraception] because their wives aren't going to be able to," said Larry Lipshultz, MD, of Baylor College of Medicine in Houston and a co-author of one of the vasectomy studies cited by Zhu. Even so, the demand for vasectomy will likely persist so long as "women can't depend on getting an abortion if they accidentally get pregnant. Men are taking more responsibility for making sure that doesn't happen."

The rise in vasectomy consults will be followed by an increased demand for vasectomy reversal, "a big uptick in about 5 years," Lipshultz told MedPage Today.

The Dobbs decision also will likely give a boost to ongoing innovation in vasectomy technique, seeking to shorten the procedure time and possibly make it less invasive, he continued. At least two new approaches are already in early stages of development: one involves injecting a "vasectomy gel" into the vas deferens, and the other is a percutaneous procedure that targets the vas deferens with a bipolar current.

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