It is hilarious and it happened again recently. I had just finished his quick and painless no scalpel vasectomy and was about to hand him his signed “diploma” (really) for “meritorious performance and uncommon bravery” when he said it. Just as the others had said it, with that screechy, high-pitched, Vienna Boy’s Choir voice: “Nice job doc; it didn’t hurt a bit!”
Even though it was made in jest, this comment suggests there is something about the culture of men that equates vasectomy with castration. The truth is that vasectomy is the most successful contraceptive available bar none and, unlike female oral contraceptives, requires virtually no compliance to maintain its effectiveness. It does not alter sex drive, erections, sensation, ejaculate volume or testosterone levels. In fact the way testosterone leaves the testis to supply the rest of the body is through an entirely different route (the bloodstream) than that taken by sperm (the vas deferens).
Nevertheless, something is removed, or different, after a vasectomy. Maybe it’s as simple as shooting blanks instead of having both barrels loaded. Maybe it’s the association of virility with the ability to sire offspring that defines Western culture, although you wouldn’t know this based on the meager birth rates in Western civilization of late. Maybe it’s the utter irreversibility of the decision to have a vasectomy performed. Whatever it is, it bubbles up and surfaces now and again in the gesture and guise of this faint, prepubertal voice.
Because of this subtle yet pervasive response to vasectomy that I have gleaned from patients, I now make it a point to counsel men before the procedure not only about what actually gets altered (fertility) with vasectomy but also what is preserved, which is essential maleness. In fact, many men feel liberated afterwards, not only from the anxiety of unwanted pregnancies but also from the “Condom Cha Cha” of their acne-filled youth to which they might prefer never to return.
I also discuss the fact that men should feel comfortable with the idea that vasectomy is a reasonable form of contraception for the “near future” as the idea of it being drop dead permanent can be seriously off-putting to many reasonable candidates. Simply stated, men’s lives are not filled with that many decisions that hold an equal weight of sheer permanence as that of vasectomy. This is also where the concept of sperm banking and sperm retrieval enter the conversation as ways to preserve or restore fertility after vasectomy. And, given the fact that 5-7% of U.S. men choose to have a vasectomy reversal in the U.S. alone is strong testament to men’s desire to continue to exercise reproductive choice in the face of what was previously understood to be a permanent decision.
So, my take on the shrill, jocular “thanks” occasionally offered after vasectomy is that it represents the well-informed response of the emancipated man who accepts that his manhood has nothing to do with how far his sperm travel.