Arbitrary Cutoff

As Stanley Kurtz worries over falling birthrates, Salon asks Is it Hip to Snip? and reports on a new enthusiasm for vasectomies. Problem is, doctors often refuse to perform the procedure on young men who might change their minds down the road:

It's a common practice, for example, for some doctors to make arbitrary age cutoffs for vasectomies. "If someone were to call me and say, 'I'm 28, single and I don't want children,' I would not waste their time and money to come in and see me," says Dr. Michael Warren, a urologist at the University of Texas Medical Branch in Galveston…

Here's the question that young men who have gotten vasectomies are asking: Why is it acceptable to make the permanent choice to have kids at a young age and not OK to make the permanent choice to not have kids?

Comments

[Pavel]

One of my mates got his vasectomy reversed after 10 years. I'd like to see you try that with a kid.

[NoStar]

I found an urologist to cut me when I was 26. I had no kids. I did have to talk long and hard to convince him I did not want any ugly kids. Besides most of the women I dated already had kids and didn't need any more.

It's been 24 years and I have never wished I hadn't done it. I enjoy having step kids. I get to pass on to them the best part of me; my love of words and not my genes.

[Julian Sanchez]

A female friend reports that the same paternalistic attitude is common (I'd bet more so, just as a guess) vis a vis women and tubal ligation. The idea that *at 28* someone hasn't reached the age of reason is particularly offensive. I'd think if you were going to err on the side of caution, you'd more readily risk someone changing their mind and being unable to reverse the procedure (which still leaves open adoption as a possibility, and maybe even genetic offspring via medical technology) than take a chance on one more unwanted pregnancy.

[Jennifer]

Could be worse. As a childless female, I can't find ANY doctor willing to give me sterilization surgery under any circumstances. I tried when I was eighteen and got "But what if you change your mind?"; I got the same response when I was thirty. Apparently they're afraid that tomorrow the human population will drop to a three-digit number and my womb will be all that stands between us and extinction.

However, I COULD get sterilized if I had two kids first, but that kind of defeats the purpose.

[Jennifer]

Whoops. I see Julian already posted with the same point as mine.

[Evan Williams]

You know what this calls for? Government action! We need to be saved from our own stupid selves by the benevolent State.

Seriously, Julian makes a good point: at what age are we supposedly capable of making a decision about our own bodies without someone else sticking their fucking nose in and telling us we might regret it? At the most, the only thing the doctor needs to do is make you sign a legal form absolving him of future responsibility, lest you change your mind and blame him. Other than that, shut the hell up and do your damned job, asshat. If I come back in 20 years weeping and moaning because I've had a change of heart, all you need to do is say, "look, it was your choice, as a cognizant adult, to have the operation. Live with your decisions."

As a doctor, his role is to provide us with all the relevant information that us laypeople might not have. Inform me of the risks, especially that it might not be reversible. And once he has informed me, allow me to make the informed decision. His role is "physician", not "parent" or "caretaker".

[smacky]

Apparently they're afraid that tomorrow the human population will drop to a three-digit number and my womb will be all that stands between us and extinction.

Jennifer, maybe they esteem you highly and don't want to consider that you won't bring more people like yourself into the world. (Backhanded compliment, maybe?)

Although I agree with Julian and others that that paternalistic approach is offensive and insulting at a certain age, I think to some extent doctors need to be that way (or at least make a conscious decision to be that way) with patients seeking these procedures, even though the patient may be fully conscious of the repercussions and sure of the decision he/she is making. Who knows if there have been "medical malpractice" lawsuits from patients who did not feel they had "adequate warning" of the results and the costs of reversal? Just a thought....

Also, I think that this sort of medical paternalism or chauvenism is not limited to reproductive issues. For example, I saw my orthodontist a number of times after wearing braces for a few years in highschool, after my retainers had eventually broke or were lost, and my teeth went back to their original (unaligned) positions. All I could do was to ask for realignment through braces and/or other superficial orthodontic devices, but he insisted that is not what I really wanted...blah blah blah. My teeth are still not re-straightened.

On a slightly unrelated note, one of my friends wanted a preventive STD screening (pre-sexual contact), and his health coverage supposedly wouldn't allow it because he had not yet had reasonable suspicion or cause that he would "need one". In other words, he had to "do it" with someone and have symptoms before they would administer the exam (He already was not a virgin). So much for preventative healthcare in the US.

Medical chauvenism.

[mobile]

Yes, it is hip for Salon readers to get vasectomies.

[BladeDoc]

Like so many "why do the doctors do X" questions the answer is lawsuits. The reason that urologists and gynecologists are leary of performing sterilization procedures on young people without children is the fear of being sued for eliminating that person's ability to have children (redundant but true). All the patient has to do is go into court and cry and say that they didn't understand it was really, really permanent (vasectomies are only reversible ~60% of the time, tubal ligations are somewhat easier to reverse). People who already have kids are less sympathetic to juries(read -- smaller judgements awarded). I don't think that uro/gyn guys are being paternalistic in that they think it's the wrong decision to be sterilized at a young age, they just don't want to be sued for it. And no, those release forms are essentially worthless to protect from litigation.

[dhex]

lawsuits are part of it.

my 27 year old female friend has basically been told not to bother trying to get sterilized until she's at least 32. maybe that's the cutoff number where juries stop giving a shit?

[Gong Tao]

I think the problem here is much more fear of lawsuits than paternalism. All doctors are living in fear of lawsuits, and it is all too easy to imagine a jury deciding that someone's tale of a tragic inability to reproduce now that they have found their true love trumps any informed consent form they might have signed. "But the doctor should have KNOWN that he might change his mind!"

[Evan Williams]

"I think to some extent doctors need to be that way (or at least make a conscious decision to be that way) with patients seeking these procedures, even though the patient may be fully conscious of the repercussions and sure of the decision he/she is making. Who knows if there have been "medical malpractice" lawsuits from patients who did not feel they had "adequate warning" of the results and the costs of reversal?"

So, have a lawyer draft some big legal document. I know lawsuits tend to have a chilling effect, but when you have the opportunity to come up with a relatively airtight legal document beforehand, then I don't see why this is such a big deal.

[Ken Shultz]

Perhaps this will seem contrarian, but it seems like a good thing to me that there are surgeons out there that ask these kinds of questions rather than just takin' the money.

...I mean, I don't think there should be a law, but, just in case you haven't stood in line at the grocery store lately, not everyone that shows up and asks for a snip is as bright as Jennifer. Even if there wasn't a huge liability risk--in California patients have to sign a sterilization consent form, but don't think that'll outweigh a patient's tearful regret in front of a jury--I can see why doctors wouldn't want to take advantage of such people.

A lawyer once told me that even though I had a high probability case, because the time I would have to spend on the case was probably worth more than the best possible judgment, I'd be better off dropping the suit and not hiring him. I once saw a used car salesman try his best to talk my crazy friend out of buying a crappy Trans Am. I knew this guy who called up his stock broker with a hot tip he'd heard, and the broker told him to leave his stock where it was--told him to stop tryin' to churn his own account.

...Thank God for such people.

[dave munger]

So apparently the point at which sterilization would actually be the most useful is precisely the point at which it is not available. Sigh. So being "responsible" is impossible.

Yet try to walk into an abortion clinic and watch the hissing and jeering.

[Isaac Bartram]

However, I COULD get sterilized if I had two kids first, but that kind of defeats the purpose.

It occurs to me that this creates an incentive to lie.

Of course one would have to find a doctor that one would never see again.

[thoreau]

I certainly don't fault doctors who want to be absolutely sure before helping somebody make an (almost) irreversible decision. I'm actually glad that they err on the side of caution rather than erring on the side of making money. The concern might go overboard, but I can understand it.

As to Evan's comment:
So, have a lawyer draft some big legal document. I know lawsuits tend to have a chilling effect, but when you have the opportunity to come up with a relatively airtight legal document beforehand, then I don't see why this is such a big deal.

We live in a society awash with warning labels and fine print, yet people are still terrified (for good reason) of lawsuits. If signing a waiver was really the beginning and end of the matter, then I think more doctors would be willing to do it. However, the legal system doesn't seem to work that way. There's always a technicality. I teach optics in the evenings at a private college, and faculty meetings are basically briefings on how to avoid the wrath of lawyers, regulators, and accreditation agencies.

If nothing else, the plaintiff can always get a shrink to manufacture a diagnosis and argue that the urologist should have screened more thoroughly to rule out some manufactured syndrome before operating. (I actually have great respect for most psychiatrists, far more respect than most H&R posters have, but the fact remains that there are some out there who will give whatever diagnosis your lawyer needs. For a fee, of course.)

[sage]

Uh, doctors can tell if a woman has had a kid before.

[beloml]

But what about the children?

[blah]

post vasectomy pain syndrome, click my name for site, dontfixit.org, a scare site for men. Scared me for a while reading it, but went ahead and had the cut made. The most strange pulling sensation, that's for sure, but not really unbearable. Post pain, non-existant.

I am 9month post vas, but had to make it through interview to get it(two girls in house, more than enough.

[Pavel]

If we're going to "err on the side of caution" then let's be equanimous about it.

How many people prior to their late 20s (total and as a %) regret having their sterility procedures vs. regret having kids.

Why-- upon the arrival of a first-time pregnant woman in her 20s-- aren't obstetricians pushing for an early term abortion, unless the woman is really *really* sure?

Is there a serious answer to this question that doesn't completely revolve around pseudo-religious appeals to the "sanctity of life"?

[aj]

It appears that the counselling needed is for those considering reversal, what a waste of resources, $10k+, low odds of pregnancy after.

People need move on and accept their earlier decisions. Foster care/adoption perhaps?

[Ken Shultz]

"Is there a serious answer to this question that doesn't completely revolve around pseudo-religious appeals to the "sanctity of life"?"

I suspect the biggest difference ethically between an abortion and the snip is that in the case of an abortion, one entity--for want of a better term--is making a decision that affects another entity. That isn't true in the case of the snip--the entity doing the consenting is getting the knife.

...That is to say, there's a difference between trying to persuade someone to do something that affects a third party and trying to persuade someone to do something that affects oneself alone.

[Jennifer]

...I mean, I don't think there should be a law, but, just in case you haven't stood in line at the grocery store lately, not everyone that shows up and asks for a snip is as bright as Jennifer. Even if there wasn't a huge liability risk--in California patients have to sign a sterilization consent form, but don't think that'll outweigh a patient's tearful regret in front of a jury

So how about a waiting period to screen out impulsives? Say, if I want to get rid of any unnecessary and annoying internal organs of mine, I have to make a formal request in writing once a month for four months, or something. That way there's no chance of making a foolish, split-second decision with lifelong implications. And clarify in these documents that the patient is entirely responsible for this decision.

Besides, I'm a misanthropic sci-fi-loving ex-pothead atheist living "in sin" with a like-minded man. Considering what our kids would be like if we did have any, I'd think that the sort of people who support these anti-sterilization laws would be thankful if we didn't spawn our DNA into the next generation.

[smacky]

Considering what our kids would be like if we did have any, I'd think that the sort of people who support these anti-sterilization laws would be thankful if we didn't spawn our DNA into the next generation.

I wouldn't be thankful. Less cool kids around for my future kids to play with.

[Eva]

Uh, doctors can tell if a woman has had a kid before

Is this true? I understand the obvious cases (ie, in which the woman has had a c-section or has some other visible manifestation of having delivered a child.) But in the case of a non-eventful vaginal delivery is there still some sort of physical "tell"??

[smacky]

Is this true? I understand the obvious cases (ie, in which the woman has had a c-section or has some other visible manifestation of having delivered a child.) But in the case of a non-eventful vaginal delivery is there still some sort of physical "tell"??

Yeah, like the hallway that is a woman's "vagina" after she gives birth naturally. Or the urine dripping from her incontinent bladder is a giveaway, too.

[Phil]

I got my vasectomy nine years ago, at age 26, and it didn't take a lot of hemming and hawing with my urologist. He wanted to know if I was sure, and I told him I was, and that was pretty much that. They did, among the forms I had to sign, have one for my wife to sign as well; she wasn't required to, but they really preferred it. It indemnified them against ever having her sue them since I couldn't father children for her.

Prior to that, however, we had looked into a ligation for my wife, and got paternalism cubed. Even after making it clear that we understood the risks and everything, we were basically as much as told that they weren't going to perform one for her.

[Pavel]

That is to say, there's a difference between trying to persuade someone to do something that affects a third party and trying to persuade someone to do something that affects oneself alone.

A "third party"? That's a pretty loaded notion. A bunch of little cells that could potentially be a human life is not a "third party."

And even if they were, isn't cutting off the possibility of ALL the future human lives one might spawn of even greater impact to third, fourth (or in a man's case) billionth parties?

[Ken Shultz]

The difference, Mr. Pavel, is that while our responsibilities to the rights of a fetus remain a subject of great controversy, our responsibilities to the rights of sperm and ova aren't a point of controversy...at all.

Many argue that people hold rights prior to birth, but I don't know of anyone who argues that people hold rights prior to conception.

[tpd]

Funny, I would think that the doctor, having been the one to go to school and learn the procedure, can tell you to "fuck off" if he doesn't want to do the procedure on you. Maybe it has to do with lawsuits, but I think him not wanting to deal with the possibility of even one whiner should be enough.

Why not look for a libertarian vasectomy doctor that will take your money and not give you shit about your choice? And if you can't find one, you just found yourself a niche market.

[Ken Shultz]

"Why not look for a libertarian vasectomy doctor that will take your money and not give you shit about your choice?"

I resent the suggestion that there's something about being a "libertarian" that means that a doctor wouldn't "give you shit" about your choice.

...maybe you're thinking of objectivists.

[tpd]

Read it again, Ken. My words don't indicate that all libertarian doctors wouldn't give you shit, I am merely implying that the one to seek out who wouldn't give you shit would be a libertarian.

I may be wrong, but the point remains the same. Find some one who will give you the service you want for the money you offer. If that doctor doesn't exist, you got a market with some of the above commenters that is untapped.

As for resenting, the fact that you inferred what you did from my non-ambiguous words may indicate you've got something against libertarian doctors. But that's for you to decide.

[Ken Shultz]

"I am merely implying that the one to seek out who wouldn't give you shit would be a libertarian."

What is it about libertarians that makes you think that we're the ones who are likely to give you a vasectomy without any questions?

[NoStar]

Re: Post vasectomy pain.
It wasn't that bad. I played drums that night, although I did decline the request to play a 10 minute drum solo.

After my Dad got his, it was off to his bowling night.
Now that takes balls!

[kmw]

Ken sez:

Many argue that people hold rights prior to birth, but I don't know of anyone who argues that people hold rights prior to conception.

Believe it or not, there are some fringe Christian groups that believe vasectomies are morally the same as abortion or murder. Bill Gothard is the leader of one such group.

Just FYI triva. These people are so out there, most have never heard of them anyway.

[Lord Duppy]

For every action, there is an equal but opposite lawsuit. I'm no expert, but obviously something has to be done when a thorough contract can't stop an obviously frivolous civil suit.

I'm thinking about having girls sign a waiver before I sqrew them. As it is now she can change her mind and retroactively make it rape.

[thoreau]

Is it still a sin to masturbate and waste seed after having a vasectomy? There's no more sacred sperm left!

[NoStar]

thoreau, the sacred sperm is still there. I imagine them getting splitting headaches as they smash into a wall of cauterized scar tissue. I think it better they get headaches than me, so I flog away, guilt free.

[Jaybird]

Like Phil above, I got a vasectomy when I was 26. Unlike Phil, I was not yet married but only engaged.

All I had to do was sit through a short interview where the doctor explained to me that it wasn't necessarily reversible and he explained what would happen and are you sure you want this? and, after 20 minutes, he gave me a pill and said "take this an hour before you show up next Friday".

No problem.

[Stevo Darkly]

Believe it or not, there are some fringe Christian groups that believe vasectomies are morally the same as abortion or murder. Bill Gothard is the leader of one such group.

I think "morally the same as abortion or murder" is misleading or erroneous. I looked up Gothard; it looks like he is saying the natural end-consequence of sex is reproduction; having sex but preventing the possiblity of conception is going against nature, or God's will; so that's why Gothard thinks it's wrong. (And that's not so fringe; I think the Pope would say something similar.) But it's not morally the same as ending the life of an "entity."

[Pavel]

Is it still a sin to masturbate and waste seed after having a vasectomy?

If you're going to interpret the story of Onan properly, then it's a sin to even get a vasectomy in the first place.

It is not the spilling of seed, but the failing to impregnate his dead brother's wife that was Onan's crime against God in the original text.

The Catholic interpretation of this has been to understand as sinful the act of not "giving God a chance" in the miracle of conception during intercourse. Hence the ban on prophylactics.

Believe it or not, there is an official Vatican approved method to overcome the conundrum of collecting semen samples for fertility tests. That method involves using a perforated condom during intercourse. Once finished, what remains in the leaky condom can be used without sin.

[Mo]

Wow Pavel, thank you for giving me the something new to learn for today. That was really interesting, wierd, but interesting.

[Jeff]

Does anyone chuckle when they see signs for Cummins/Onan?
http://www.cumminsnorthwest.com/Onan/default.asp

[kmw]

Stevo Darkly,

I had the misfortune of growing up in Gothard's cult. Believe me when I say he thinks it's a stoning offense. Maybe not in public, but he sure does in private. He's a power-hungry demagogue. (He also once told me it was a sin to have my "sideburns" shaved above my ear lobe.)

He helped me become the atheist I am today, by forcing me to learn how to fight his lies with logic and reason. For that, I guess I'm greatful.

[Stevo Darkly]

kmw -- My apologies, I'm afraid I've overstepped my bounds in trying to explain Gothard's stand to you, obviously.

He sounds like a prime nutcase.

From what I've heard, the leading cause of atheism is an encounter with a nasty, nutcase clergyman.

[Douglas Fletcher]

This is weird. It seems any guy who decides he was meant to be a woman can find a doctor to cut off his balls, but a simple vascectomy is viewed as a possibly tragic mutilation by the medical profession.

And I thought lawyers were the champs at creative logic.

[speedwell]

When I was down and out and pregnant, a few years after college, I asked about the possibility of getting my tubes tied through Medicaid (welfare). I was told I had to have THREE children first. Your tax dollars at work.

Jeff, Cummins/Onan has been a subject for evil snickering in my family ever since my dad consulted for Cummins years ago.

[Lord Duppy]

"That method involves using a perforated condom during intercourse."

Call me twisted, but the first thing that came to mind when I read that was an image of someone attempting to perforate the condom after putting it on.

[Mr. Nice Guy]

I would like to hear more from those who got snipped. What was the actual procedure like? How long does it take to heal? What are the biological mechanics afterward? Is everything pretty much the same except there aren't any microscopic jimmies swimming around?

[Shawn Smith]

Mr. Nice Guy,

The actual procedure (for me) was a half hour visit to the doctor's office, a small needle local anesthetic applied, and then some pulling and stitching, and it was done. Oh, I had to shave the morning of the procedure (the worst part, by far). I was wearing frozen peas on and off for the next two days, but nothing ever hurt.

It was completely healed in less than two days, but it took somewhat longer for the hair to grow back and not be so itchy.

The vas deferens (the tube that caries sperm from the testes to the urethra) has a short section cut away and the cut ends are cauterized or stitched closed. Everything biological still works the same way; you still have cowpler's gland fluid, you still have as much seminal fluid, and your penis still works as it did before. There's just no way for sperm to get from the testes (where they are produced) into semen (where they become potential fertilizers.)

There are rare (I think about 0.01%) cases where the vas deferens will heal years after the operation, and you can become fertile again.

[Mr. Nice Guy]

Shawn:

Many thanks.. very informative. One more dumb question: once one is snipped, where does the sperm go, then? Does it simply stay where it's produced? Does the body stop producing it if the tanks are filled?

Needless to say, I'm thinking about going under the knife.. I just hope the man wielding it is a freak'n genius. I mean a guy who can split an ant's ass hair with his eyes close.

[Shawn Smith]

Mr. Nice Guy,

The sperm tend to get stopped at the first break in the vas (because it was constrictively tied or cauterized.) They don't live very long, and get reabsorbed back into the body. I'm not sure exactly how that last part works, but I haven't noticed any ill effects. My guess is that white blood cells recognize the dead sperm as more junk to throw out. If you've ever gone more than a few days without an orgasm, I would guess the same thing happens.

Also, the literature I have read indicates that your testes will produce sperm as long as there's nothing wrong with the testes. I haven't actually checked the part of my vas deferens closest to the testes to see if there are any sperm in there, so I can't be absolutely sure, but it seems reasonable to me.

My particular vasectomy didn't even require an incision. The urologist used a tool to poke two small holes (about the size of a blood donation needle) into the scrotum so he could pull out the vas and work on them outside the scrotum. The literature I got from the urologist before the procedure indicated that it was a way that had shorter recovery times and less pain. That seemed to be true in my case because, as I said before, the worst part of the whole thing was shaving my scrotum and having itchy balls for a few weeks while the hair grew back.

Your/The urologist will almost certainly be able to give you more up-to-date and complete information than I've given you here, of course.