Literature Review

The United States has one of the highest rates of unintended pregnancy of all developed countries.₆ Currently, about half (51%) of the 6.6 million pregnancies in the United States each year (3.4 million) are unintended.₆  Most methods of contraception are for the female partner and often men do not have an active role in family planning. Currently the only non permanent method available to men is condoms.  While perfect use of condoms is greater than 90% effective, the failure rate increases to 18% with actual use. Data on condom use varies, but one source reports condom use by men during past 10 vaginal intercourse events was slightly higher (21.5%) than that reported by women (18.4%), and consistent with rates of condom use reported during most recent vaginal intercourse by men (24.7%) and women (21.8%).    

For men who have decided they do not want children, or are content with the family they have, the option of vasectomy is available. Two of the primary barriers that men face are lack of access to available services and cost. For example, in Illinois while there are many private urologists who perform vasectomies, the average cost is $1500.  Many of these providers do not accept Medicaid, and IL Title X does not currently reimburse for vasectomies.  It has been estimated that fewer than 5% of vasectomies in the US were paid for by public funding compared to 35% of female sterilizations, suggesting low access for men without health insurance.

Male sterilization (vasectomy) is the most effective form and only long-acting form of contraception available to men in the United States. Compared to female sterilization, it is more efficacious, more cost-effective, and has lower rates of complications. Despite these advantages, in the United States, vasectomy is utilized at less than half the rate of female sterilization. In addition, vasectomy is least utilized among black and Latino populations, groups with the highest rates of female sterilization.₇   Many family planning experts have concluded that the principal reason for the poor record of vasectomy services in much of the world was not men’s resistance to the method, but rather the failure of health professionals to make vasectomy services available­­­­.₁  To increase access to vasectomies family planning advocacy groups encourage provision of vasectomy services at the primary care level. ₂

Given the low access to vasectomy services, along with the safety and ease of the procedure  in conjunction with the high rate of unintended pregnancies in the US , educators and health care providers should be more aware of vasectomies.  This curriculum is designed to not only increase awareness and education about vasectomies, but also to provide the foundation for incorporating vasectomies in the training of family medicine physicians.