Contraceptive sterilization among married adults: national data on who chooses vasectomy and tubal sterilization
ABSTRACT Vasectomy has been found to be a highly cost-effective contraceptive method. For couples, tubal sterilization and vasectomy have the same result, but the two methods are used by different segments of the population.
We conducted an analysis of data from male and female samples of the 2006-2008 National Survey of Family Growth, nationally representative samples of men and women in the United States aged 15-44 years.
Among married men, 13.1% reported vasectomies (95% confidence interval 10.4%-16.3%), compared to 21.1% (17.8%-24.9%) of married women who reported tubal sterilizations. Men with higher education and income had greater prevalence of vasectomy than those less educated, while women with lower education and income had the highest prevalence of tubal sterilization.
Efforts to promote vasectomy use need to understand the reasons behind these differences. Increasing the availability and use of vasectomy will require education about its benefits.
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ABSTRACT: It has been theorized that utilization of permanent contraceptive methods may vary with economic conditions. Here we evaluate the relationship between vasectomy/vasectomy reversal frequencies at several large referral centers with national economic indicators over a period of two recessions spanning 2001 to 2011. An IRB approved retrospective chart review was conducted to identify the number of vasectomies/vasectomy reversals per month at several large referral centers from January 2001 to July 2011. The incidences of these procedures were pooled, correlated with national economic data, and analyzed in a multivariate-linear regression model. There were 4599 vasectomies and 1549 vasectomy reversals performed at our institutions during the study period. The number of vasectomies performed per month was positively correlated to the unemployment rate (r = +0.556, P < 0.001) and personal income per capita (r = +0.276, P = 0.002). The number of vasectomy reversals performed per month was negatively correlated with the unemployment rate (r = -0.399, P < 0.001) and personal income per capita (r = -0.305, P < 0.001). Neither vasectomy nor vasectomy reversal frequencies significantly correlated with the inflation rate or the S&P 500. Regression models confirmed that the unemployment rate explained more of the variance in vasectomy/vasectomy reversal frequencies than other indicators. We noted a correlation between the number of vasectomies/vasectomy reversals performed at our institutions and national economic indicators, with the strongest association with unemployment rate. This points to the importance of financial pressures on family planning decisions.The Journal of urology 01/2014; 191(6). DOI:10.1016/j.juro.2013.12.045 · 3.75 Impact Factor
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ABSTRACT: Sterilization, male and female combined, is the most common use of contraception in the United States. Despite the lower risk, higher cost-efficacy, and high efficacy of vasectomy compared with female sterilization, more US women rely on female sterilization than male sterilization. Reasons for low use of vasectomy include lack of knowledge and misconceptions about the procedure, lack of access, provider bias, and patient preferences. This article will provide a basic overview of male and female sterilization, an exploration of vasectomy barriers, and ways obstetrician-gynecologists can increase vasectomy uptake including regular recommendation of vasectomy to patients in long-term committed relationships considering sterilization.Clinical Obstetrics and Gynecology 10/2014; 57(4). DOI:10.1097/GRF.0000000000000060 · 1.53 Impact Factor
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ABSTRACT: Objectives: The testicular, deferential, and cremasteric arteries and their branches surround the vas deferens (VD), leaving them susceptible to injury during vasectomy. Literature describing the caliber of arteries seen in vasectomy specimens is lacking, making it difficult to categorize the significance of an observed artery. We aimed to establish reference values for arterial size typically encountered in vasectomy specimens and assess our institutional experience with failure to transect the VD. Methods: The luminal diameter of the largest artery in 231 consecutive VD specimens from 116 patients was measured microscopically. For comparison, the diameter of the largest artery within 10 spermatic cord cross-sections from inguinal orchiectomies was obtained. The immediate vasectomy failure rate based on histologic assessment was calculated using specimens from 2008 to 2012. Results: The luminal diameter of the largest artery encountered in a vasectomy specimen was 1.00 mm or less in 96.5% of cases. Artery sizes greater than or equal to 2.50 mm were only seen in spermatic cord resections. From 2008 to 2012, three (0.36%) of 837 patients undergoing vasectomy had specimens that showed failure to transect both VD. Conclusions: Although the American Urologic Association and European Association of Urology state that histologic evaluation of vasectomy specimens is not required, we encourage the surgeon to send VD specimens for histologic examination. Doing so allows early identification of the failure to transect the VD and the resection of surrounding vasculature, providing quality control feedback to the surgeon.American Journal of Clinical Pathology 03/2014; 141(3):360-6. DOI:10.1309/AJCPAPHJEG2J5MIF · 2.88 Impact Factor