To ask DP to have a vasectomy

[shouldhavecalleditoatabix]

So a bit of background. DP and I have been together 14 years. I had a very early pregnancy and subsequent termination. Went on to have DD1 (13) and DD2 (9). We both now work full time and definitely do not want any more children. I adore babies and I love our children but moving from 2:4 to 2:5 means bigger house, car and change of life. We know those younger years are tough and we had both DG's on each side to help. We are thoroughly enjoying life with older DC's. Also DG's are now getting on a decade later and I know they won't feel able to be so involved in care of any subsequent babies so another would be really difficult in all aspects. I am also approaching 40 and acutely aware of the risks a later pregnancy will bring. We have talked and joked about DP having vasectomy and he's always agreed but never actually done it. Tonight I am 2 days late. I don't think I am pregnant because each previous time I have recognised symptoms almost immediately but I am tired of worrying about it when there is a simple solution. Tonight I broached the v word again and DP is happy to do it but never actually makes it a priority but I have taken it one step further and said 'no sex until he makes the appointment'. AIBU?

@slipperywhensparticus well then we would decide what other options we have and move on I guess. We both really like the idea of being able to relax during sex for the first time in a long time without worrying about making babies. But if he makes an informed decision he isn't prepared to do it then that is absolutely fine. I was irritated that he hasn't done anything about it. But since then and this discussion I've actually realised it's a decision worthy of more time and conversation that we have given it this far.

If sterilisation is an option for you/your PCT, just to add that I got sterilised last week and it was very easy. Small incision in the belly button and one towards my groin. Recovery took a few days and I am already enjoying a worry-free sex life!

I do however want to move the conversation forward and get him to make the appt to discuss the process so we can then make an informed decision on whether it is the way forwards.

So we can then make an informed decision??? Who's the we? It's not up to you whether he has surgery to make him permanently sterile. That will be his decision regardless of your feelings about it.

Of course you have the right to say no more sex. That may or may not have an effect on your marriage.

I'm not understanding why the only options are hormonal contraception, vasectomy or abstinence? Why not use condoms alongside cycle tracking?

Interestingly the 10% risk of complications from a vasectomy (although I think from googling that that includes quite minor complications that resolve themselves) is exactly the same as the risk of maternal death from childbirth before medicine took over.

Even now it is ten times more risky to give birth than to jump out of a plane with a parachute.

@Hearhoovesthinkzebras we already use condoms and cycle Management but we have both agreed we would like a more permanent solution. He feels this as strongly as I do. The discussion WE would have is because we are a team but of course I have no say in whether he does it. I could however express an opinion. For instance, once we find more information maybe I feel concerned by the risks and say I don't think he should do it. That would be a reasonable suggestion and we are a team that value each other's opinion. What I obviously wouldn't say is "forget the risks, get it done DP because I am the authoritarian and you must obey'

Op I completely get where you are coming from.

I had had enough of taking hormones which were starting to make me feel crap and after 2 MMC post 40 one late term I made the decision no more. DP had seen us go through enough and said he'd 'think about it' although he never made any appointments.

We had a couple of scares and I did give an ultimatum. Condoms which we both dislike or no sex'

He eventually made the appointment.

The procedure was out of car, in, back in car in 20 mins.

I asked to see 'wound' he wouldn't show me.

He later admitted this was because it was so tiny, he didn't think it would court any sympathy

I'd put your case forward, our previously shite and worry inducing sex life now holds no bounds

Why not use condoms alongside cycle tracking?

Because that carries a risk of pregnancy - obviously.

And the OP is understandably sick of that risk and worry each month.

'Why not use condoms alongside cycle tracking?

Because that carries a risk of pregnancy - obviously.

And the OP is understandably sick of that risk and worry each month.'

Quite

We also did all that fiddly crap, it wasn't us and wasn't enjoyable.

Cue all the 'be more imaginative with Condoms' blurb....

No ya

I can't imagine saying to DH, 'no, no the risk is too great for you, diddums!' and him doing anything other than scoffing.

I imagine your DH scoffs at a lot of what you say. I doubt he's only one.

Who are these people that just get sterilised? Loads of people I know have found it impossible on the NHS. But why is the contraception always down to the woman??!

But why is the contraception always down to the woman??!

It isn't.

We also did all that fiddly crap, it wasn't us and wasn't enjoyable.
But being one of the 10% of vasectomised men who suffer a permanent complication like ed or intractable pain would make sex enjoyable?

You don't like using condoms because they spoil your enjoyment so the answer to that is to make your husband sterile?

If you don't want to use hormonal contraception, don't want to use barrier methods and cycle tracking then maybe you should abstain.

Out of interest, all of the posters who think vasectomies are a quick, painless procedure, no big deal - what would you do if your husband was one of the 10% who suffered a permanent complication? What if they were never able to have sex again but they had the op only at your insistence?

Out of interest, all of the posters who think vasectomies are a quick, painless procedure, no big deal - what would you do if your husband was one of the 10% who suffered a permanent complication? What if they were never able to have sex again but they had the op only at your insistence?

Do you have a source for the 10% figure? Because my googling gives 10% of complications including fairly minor things that resolve themselves - not permanent complications.

My googling also gave 7% of women having c-sections are still in pain 6 months later.

Do you have a source for the 10% figure? Because my googling gives 10% of complications including fairly minor things that resolve themselves - not permanent complications.

It depends on where you look. This study concluded that 15% of men suffered significant chronic orchalgia following vasectomy. This was 7 months post op. It did concede that a longer term follow up would be necessary.

onlinelibrary.wiley.com/doi/full/10.1111/j.1464-410X.2007.07128.x

@Mumoftwoyoungkids

I interpret the 10% figure as men with post operative pain that lasts at least 3 months. It may resolve later, or may not.

Here are some sources:

Canadian Urology Association give the chronic pain outcomes for vasectomy at between 1-14% www.cua.org/themes/web/assets/files/vasectomy4017_v4.pdf

American Urological Association says chronic pain serious enough to impact quality of life occurs after 1-2% of vasectomies.www.auanet.org/guidelines/vasectomy-guideline

British Association of Urological Surgeons, patient advice reports troublesome chronic testicular pain which can be severe enough to affect day-to-day activities in 5-14% of vasectomy patients. www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/Vasectomy.pdf

UK National Health Service says long-term testicular pain affects around 10% of men after vasectomy. www.nhsdirect.wales.nhs.uk/encyclopaedia/v/article/vasectomy/#risks

11th edition of Campbell Walsh Urology (2015) cites 10% incidence of chronic scrotal pain caused by vasectomy. www.postvasectomypain.org/uploads/default/original/1X/f4c5484aa9bc49d67c5a2c5236d528e032d0d5b7.JPG

European Association of Urology (2012) cites 1-14% incidence of chronic scrotal pain caused by vasectomy, usually mild but sometimes requiring pain management or surgery uroweb.org/wp-content/uploads/Dohle-G-et-al.-Act-Urol-Esp-2012-365276.-EAU-guidelines-on-vasectomy.pdf

Royal College of Surgeons of England says significant chronic orchalgia may occur in up to 15% of men after vasectomy, and may require epididymectomy or vasectomy reversal. www.ncbi.nlm.nih.gov/pmc/articles/PMC1964127

Journal of Andrology cites large studies that find Post Vasectomy Pain Syndrome 2-6% of the time onlinelibrary.wiley.com/doi/full/10.1002/j.1939-4640.2003.tb02675.x

UpToDate says "surveys have found that the incidence of "troublesome" post-vasectomy pain is reported by approximately 15% of men, with pain severe enough to affect quality of life in 2%. However, survey respondents may not have been representative of all men who have had a vasectomy." www.uptodate.com/contents/vasectomy-beyond-the-basics

My googling also gave 7% of women having c-sections are still in pain 6 months later.

Right. Chronic pain is a common complication of all kinds of surgery.

Ethan

Thanks - that’s useful.

At the moment we are fine with our contraception - I’ve been on the mini pill for years with no issues. I don’t like my “natural” body (20 day cycles!!!!!!) so I’m happy to take it as long as it is safe for me to do so. But I’m 40 now so presumably getting riskier so at some point we may need to make another choice.

And my mum recently helpfully told me that she was still having occasional periods at 54. Fifty bloody four! 14 more years of fertility. We got pregnant with both kids really easily so we can’t take chances.

There is no fool proof solution except no sex and neither of us want that.

'You don't like using condoms because they spoil your enjoyment so the answer to that is to make your husband sterile?'

Bloody Hell

WE didn't like using condoms and HE made his decision after 2 meetings with surgeon and deciding how to move forward.

If you led your life by stats you'd seldom do a single thing in life.

You'd certainly never give birth.

HE is delighted with HIS choice.

@Mumoftwoyoungkids

I completely get where you are coming from, and I can't decide for someone else whether or not vasectomy is worth the risk.

What I want to push back on is the idea that vasectomy is just a "quick snip" with "minimal" risk. Vasectomy carries a small but significant risk of debilitating long term pain that doctors do not have a cure for. That may mean much less sex going forward. It may mean an irritable, distracted partner who seems like he is a different person since the surgery. Neuropathy medication like neurontin, gabapentin and pregabalin can make you crabby and unfocused. It can make him much less physically active -- unable to jog or ride a bike. In rare cases it means dropping out of work and going on disability which could be a financial hardship. It may mean years of visiting doctors, getting diagnostic tests, spermatic cord injections, surgery to remove sperm granulomas, surgery to cut the rest of the nerves of the spermatic cord, reversal surgery, even surgery to remove the testicles.

People underestimate and do not comprehend these risks because our brains apply a feeling for how common something is based on how often you have encountered it. You have probably not met anyone who said they had chronic pain since their vasectomy. This is a trick though. People do not talk about it with strangers. It doesn't affect strangers. But if it happens to your husband, you will join the private club and the disease will move into your home and there will be no way to know whether it will ever move out. Then you will be the one who would like to talk about it, but feel that it is not a proper topic of conversation.

In no way do I wish to minimize the risks that women take with pregnancy. The bad outcomes from pregnancy are more frequent and have much more impact.

My suggestion is only is that people try non-surgical methods before they try vasectomy. In particular, Nexplanon has arguably the smallest risk of anything bad happening that cannot be fixed. IUD is also an excellent option for many people. If you are worried about ectopic pregnancy with IUD you can ask your husband to wear a condom. The risk of getting an ectopic pregnancy in that configuration are similar or even LESS than the chance of getting an ectopic pregnancy after your husband has a vasectomy.

I get that women may feel like they have been bearing all of the risk and burden for a long time and wish their husband would just go get the snip and do their part. That is understandable, but I don't think it is the best option.

I got a vasectomy 2 years ago. I was happy to do it. It is the only think I have done that I truly, thoroughly regret. I am still in pain every day. My wife and I have much less sex than before the vasectomy because I never initiate. I am always left feeling disappointed and sore afterwards. Recently my wife has gotten into great shape. Some of the best shape of her life. When she stands naked in front of me, I can appreciate how good she looks now, and I think I should be horny. I know I would have been before my vasectomy. I just don't feel anything. It's like the pain has rewired my personality.

It could be worse -- my wife could have gotten pregnant and died in childbirth. But it is not a good situation. Men who are being asked to take this risk deserve to be told beforehand what is on the line.

In particular, Nexplanon has arguably the smallest risk of anything bad happening that cannot be fixed. IUD is also an excellent option for many people

Both things the woman has to try.

What efforts are you making Ethan to campaign for more contraceptive options for men?

But I’m 40 now so presumably getting riskier so at some point we may need to make another choice.

Not true. Outdated nonsense but honestly, take the time to get swotted up on this if the mini-pill is working for you because HCPs will try to talk you into switching to a Mirena coil at every turn. I've had to learn to repeat, 'I'm happy with my contraception, it's not up for discussion' and 'I don't consent to that. I'm happy with my contraception' over and over in my 40s.

You can use the mini pill till menopause, you do not need to make another choice due to age.

Both things the woman has to try.

If a woman is not willing to try non-surgical options with low risk of permanent complications, she will be well equipped to understand why her partner is not willing to get a surgical option that cannot be undone.

What efforts are you making Ethan to campaign for more contraceptive options for men?

The most promising contraceptive option for men is called Vasalgel, which is a polymer that is injected into the vas. It is easier to reverse, probably has a better reversal success rate, and so far does not appear to cause chronic pain. It seems like a really good option, and I hope it will be available for my son.

I also think that if Vasalgel were available, more men would choose to get this procedure than vasectomy. In other words, it would result in fewer women shoulder the entire burden.

There are two major obstacles in the way of Vasalgel.

1. It is very new and only being performed in India so far. They need to get through all of the regulatory steps to deploy it in western markets. That takes money.

1. Nobody wants to fund Vasalgel because the myth that vasectomy is safe is so pervasive.

What have I done?

1. I have donated to help bring vasalgel to market. You can donate here also if you want to help: www.parsemus.org/donations/

1. Every day I post another link to an example of long term vasectomy complications to reddit in an attempt to convince people that yes, we really do need something better than vasectomy.

If a woman is not willing to try non-surgical options with low risk of permanent complications, she will be well equipped to understand why her partner is not willing to get a surgical option that cannot be undone

The pill for example increases the risk of breast an cervical cancer. There are a list of side effects that go on for pages. You’re suggesting a woman ingest synthetic hormones rather than a man considering an op. That’s before we even consider the role the woman plays in the man having children.

I’m sure you were very disappointed in the trials of the male pill were stopped. Apparently the side effects were considered too great for the males taking part. Side effects women are supposed to put up with for years so men can get their rocks off without having to do any of the contraceptive work.

As I said earlier male attitude to contraception is a great pregnancy-preventer in itself. I mean who wants to fuck a guy who thinks it’s everyone else’s job but his.

*You can use the mini pill till menopause, you do not need to make another choice due to age.g

That’s very reassuring to know. So far I haven't had any problems getting a new prescription but I have been offered the Mirena a couple of times. I had an implant about 5 years ago which made me bleed continually. Ironically the way they stopped me bleeding was by giving me the mini pill. At which point I decided that if I was going to go on that anyway I may as well do it without a weird stick in my arm.

The pill for example increases the risk of breast an cervical cancer. There are a list of side effects that go on for pages. You’re suggesting a woman ingest synthetic hormones rather than a man considering an op.

I didn't suggest oral hormones. I suggested condoms, diaphragm, implant, IUD, abstinence -- and acknowledged that vasectomy could be an acceptable last resort.

As for increased risk of cancer, it is not irrelevant to ask "by how much?" Plenty of chemicals we interact with increase the risk of cancer. In fact, more than one study, including a recent and huge study in Denmark indicate that vasectomy increases the risk of prostate cancer by about 15%.