Episode 57: What men AND women need to know about vasectomies

Dr. Sophia:
Hello everyone. Welcome to the Dr. Sophia ObGyn podcast. I'm an obgyn practicing for over 15 years in my native New York City. And I love to help women learn about their bodies, empower them, and embrace themselves. On this podcast, we talk openly and with heart about all things affecting women from pregnancy, menopause periods, sexual health, fertility, and so much more. Disclaimer, this is general medical information based on my professional opinion and experience. For specific medical advice, please refer to your physician. Hello everyone and welcome to the Dr. Sophia ObGyn podcast. Today we will be talking about a topic that is not very common at all, and it is male sterilization or vasectomy. As always, this is a topic that was brought about by a conversation that Touseef and I were having regarding some of my patients and their partner's reaction to the option of permanent sterilization on the male side. So, without further ado, please welcome my good friend and co-host Touseef Mirza.

Touseef Mirza:
Hello everybody. Obviously we talk a lot from a women's perspective. This is a male procedure, but affects a lot the female indirectly, because usually that usually happens if you, if you're in a relationship. And so that decision making between two people who do not wanna have kids anymore and wanna be together for the rest of their lives comes to a decision. And Sophia was telling me about the different types of exchanges that happen and also taboos around what exists around vasectomy that can actually make a woman's life much more difficult. And it doesn't have to be that way. So we wanted to open this up and really talk about the whole ins and out of vasectomy in terms for the male, but also how it impacts the women in the relationships.

Dr. Sophia:
So when we say ins and outs, I am not a urologist, so I'm not going through every part of the procedure, the steps, et cetera. But just kind of giving you the overview and really it's actually coming more so from the woman's perspective.

Touseef Mirza:
So let's start with the basics. When we say vasectomy, I know you said it means permanent sterilization. What is it? When we say vasectomy, what happens?

Dr. Sophia:
So a vasectomy is actually when a man would go to his urologist and have the tube, it's called the vas deferens that connects the testicles and the epididymis. The epididymis is where actually the sperm is created. So from the testicles it connects, it's the tube that connects to the seminal duct through the prostate, and then combines basically with the seminal fluid, which then becomes a part of the ejaculate. So the sperm is actually separate from the fluid. It then has to mix with the fluid that then becomes a part of the ejaculate.

Touseef Mirza:
Okay. So basics then, in terms of when a man. So when a man AKA, he cums, when he cums, what's coming? The white substance is sperm. In French, we say “spermatozoide”. What is it in English?

Dr. Sophia:
Sperm.

Touseef Mirza:
Sperm. I grew up in Montreal. Sometimes the French words just pop in my head. So the sperm and the semen. Those two things actually are not coming from the same place.

Dr. Sophia:
That is correct.

Touseef Mirza:
So where is the sperm coming from and where is the semen coming from?

Dr. Sophia:
The semen comes from the seminal fluids. Or the seminal duct that creates the seminal duct creates your seminal fluid.

Touseef Mirza:
So that's the liquid.

Dr. Sophia:
The liquid part. The sperm, the actual replicating-

Touseef Mirza:
The little guys?

Dr. Sophia:
Yes. The swimmers.

Touseef Mirza:
The swimmers, the little guys.

Dr. Sophia:
Those come from the testes and through the epididymis. And from there they travel through the vas deferens.

Touseef Mirza:
To meet the semen?

Dr. Sophia:
Yes

Touseef Mirza:
So based on that information, it means that when you have a vasectomy, it doesn't mean that you don't have any more semen coming out.

Dr. Sophia:
No. A man who's had a vasectomy still cums, still has semen, still has fluids. Yes. They still are.

Touseef Mirza:
So I think this is very important because I think some people think that, you know, they say vasectomy, chop, chop, and then it means that nothing's gonna happen down there.

Dr. Sophia:
No, absolutely not. That is not what happens at all. They still come and they still have fluid that comes out with that orgasm.

Touseef Mirza:
And so when we say a vasectomy, we are basically just cutting the tube from where usually the sperm would go and meet the semen.

Dr. Sophia:
That is correct.

Touseef Mirza:
Okay. That's important information to know. And so that way the sperm basically just stays in the testes.

Dr. Sophia:
Yes.

Touseef Mirza:
Okay.

Dr. Sophia:
That is correct.

Touseef Mirza:
So they're still there

Dr. Sophia:
A hundred percent. They're there, their swimmers are still there. They're just not swimming up the tube.

Touseef Mirza:
Right, they're just staying home.

Dr. Sophia:
Just stay home. I like that. They just stay right there. And they're a little home.

Touseef Mirza:
And they're not venturing out.

Dr. Sophia:
They're not venturing out. Yes, that is correct. But technically, yes. These men still produce sperm even after they've had a vasectomy. It doesn't stop their sperm production. It simply stops the travel of that sperm out.

Touseef Mirza:
It can't exit the roadblock. Like you can't exit. But you're still, you're still there.

Dr. Sophia:
You're still there, you're still creating it.

Touseef Mirza:
It's associated with hormones right? Like in terms of testosterone.

Dr. Sophia:
What's associated with hormones?

Touseef Mirza:
Sperm? Is that an indication of hormonal health for a man or not? Is that separate?

Dr. Sophia:
No, these are two separate things. Their testes are still working and doing their own thing in terms of creating their testosterone and their hormones, et cetera. If anything, it's just a concept of, because they still have sperm, they still have the possibility of fertility.

Touseef Mirza:
Because you're not removing the sperm, the sperm always stays because you haven't removed anything.

Dr. Sophia:
Yes. Because you have not removed the actual sperm production.

Touseef Mirza:
The reason why I'm asking about testosterone is that some men say, well, I don't want to lose my virility. Or that they feel that they won't have as-

Dr. Sophia:
Much, causing them to be less of a man.

Touseef Mirza:
They'll have less testosterone because now they have a vasectomy. But basically that's not true because basically everything is functioning as normal. We're just hundred percent, we're just stopping-

Dr. Sophia:
The connection, the tube,

Touseef Mirza:
The connection for it to go. That's it somewhere. But that's it. That's it. Everything else is normal.

Dr. Sophia:
It’s exactly the same.

Touseef Mirza:
Exactly the same. Okay.

Dr. Sophia:
Before the vasectomy, the man ejaculates like after he had the vasectomy. Just that their sperm is not coming out.

Touseef Mirza:
But is it there?

Dr. Sophia:
They still have semen that comes out. Yeah. There's no question about that. Right. And their testosterone does not change because they've had a vasectomy. Their testosterone is exactly what it was. A function of their testicular health, a function of their own health. That's really what drives men's hormones. It's how healthy they are.

Touseef Mirza:
And then in terms of the actual procedure, is it painful? Does it take a long time to do? Just in general?

Dr. Sophia:
So a vasectomy typically takes somewhere between 20 and 30 minutes in the office. So this is an office-based procedure.

Touseef Mirza:
So you're not fully under, you're not in full anesthesia.

Dr. Sophia:
You’re not going under anesthesia. No. You are having only local anesthesia. And in terms of any pain management, it's literally with Motrin or Tylenol.

Touseef Mirza:
So no codeine, nothing. It's just manageable.

Dr. Sophia:
It's ibuprofen or motrin. Same, same drug and acetaminophen or Tylenol, same drug.
Touseef Mirza:
Okay. And then you manage it and then?

Dr. Sophia:
It's for two days. If they have discomfort, usually it's for about two days and you don't even have to take drugs. We sometimes say just use an ice pack. I want people to understand how minimally invasive this procedure is. It's an office visit. It's quick, it's very well tolerated. As far as pain, the procedure itself is not painful because you do have local anesthesia. It's numbing like something like lidocaine where you don't feel anything. And it's even to the point where the procedure itself can be done with such a smaller or no cut procedure. It's just the instrument that they use in order to grasp the tube. That just kind of pierces right through the skin. But it's not like getting a blade or something to cut the skin off.

Touseef Mirza:
To actually open it up.

Dr. Sophia:
Exactly. Okay. That's how, like how cool it has become cool. In terms of easy to do this procedure.

Touseef Mirza:
And when we say pierce the skin, this is at the level of the scrotum? So it's also very local, right? It is just like one area.

Dr. Sophia:
It's the scrotum. The scrotum hangs outside of the body and is completely isolated.

Touseef Mirza:
From the rest of our organs, for example.

Dr. Sophia:
Oh my gosh. Don't get me started.

Touseef Mirza:
Okay. So let's just go there. So as opposed to, so the reason also why we're going through all this detail is to then also recognize what it actually entails if a woman is considering-

Dr. Sophia:
A tubal ligation?

Touseef Mirza:
Or a permanent sterilization.

Dr. Sophia:
Okay. All right. Let's go through it.

Touseef Mirza:
I've been waiting for this one.

Dr. Sophia:
This gets me hot. It does, because a woman has to go through so much more in order to go through a permanent sterilization. It's just not fair. So similar to a man, the concept of a tube. A tube that's connecting the reproductive organ. So for a woman, it's the ovary, or the equivalent for a man is the testes. What creates the sperm for a man is the testes. What creates the ovum or the, or the egg for the woman is the ovary. And for a woman, there's the connection between the ovary and the uterus eventually where we want that egg to land. The connection between that is the fallopian tube. And so for a woman, we would basically do a similar process in the sense of cutting the tube, whether that's a cut and tie, cut and burn.

Touseef Mirza:
The tube between the ovary and the uterus. So the egg never gets to go to the uterus where it could be fertilized.

Dr. Sophia:
Right. And actually for women, fertilization actually happens in the tubes. And then the fertilized egg then continues to travel down until it reaches the uterus, and that's where it will implant. So for a woman, cutting the tubes will stop the transport of the egg and the connection for fertilization to happen. So like a man, a woman still has her eggs, she still creates her eggs in her ovaries. They just don't have a way of making it from the ovary to the uterus. And so for that, that concept is the same. Where it's very different is the fact that a woman typically has to go through general anesthesia, typically has to have incisions on her abdomen. Typically has the risk of actually injuring other organs that are adjacent because-

Touseef Mirza:
You literally have to open her up like through the abdomen.

Dr. Sophia:
Yeah. Whether it's open through an actual incision that opens, whether it's open, you still have an incision that's a smaller incision using a camera. And doing, you know, most commonly we do this a lap as a laparoscopic procedure, but if that fails, then yeah, we may have to open or we do a small incision that's an open incision, generally done like postpartum in order to gain access to the tubes and still be able to cut them, cut them, burn them. However, we end up doing the procedure.

Touseef Mirza:
And then you have all these other organs around.

Dr. Sophia:
What I like to stress is the fact that there are all these other organs around. So a woman's reproductive system is inside of her body. It is next to the bladder, it is next to the bowel, it is right next to the uterus. It is right next to the ovary. There's just so many different components that are very close in terms of that tube. And so in doing a tubal ligation for a woman, you are doing so much more in order to accomplish that than that simple office procedure for a man.

Touseef Mirza:
So when we say so much more, there's so much more, basically incurs higher risk because of all of these aspects.

Dr. Sophia:
Exactly. That is correct. Anyway, we should really talk about what brought us to this. Because I had these patients, so one of them I have been taken care of, and I actually have delivered two of her children. She's currently pregnant, and with a third one with her third. And this is a third pregnancy in the last two and a half years.

Touseef Mirza:
So one after the other.

Dr. Sophia:
So basically back to back to back. Both making both her and her husband extremely fertile. And so she walked into my office, like when she realized that she was pregnant with a third, she was like, Dr. Lubin, I know for a hundred percent solid fact, I do not want any more children. I am done. I'm so done. Like I can't do this anymore. And she happened to be there with her husband. And I said to him, how do you feel about that?

Touseef Mirza:
So, just to clarify, when she said, I don't want more children, she was just like, this is my third and last?

Dr. Sophia:
Yes. Okay. And I turned to her husband and I said, well, how do you feel about that? He says, yeah, absolutely. This is it. We are done. I can't, we don't want any more children. And he was very clear to say, we, and I said, no, I'm very curious. Does that also mean you, do you feel like you don't want any more children? And he said, absolutely. I'm sure I'm clear. I'm a hundred percent on the fact that I don't want any more children. This is actually not just her third pregnancy. This would be her fourth pregnancy. This is her third with me.

Touseef Mirza:
This is her fourth kid.

Dr. Sophia:
This would make her fourth kid. Okay. And so, like I said, I go to the husband and I say, okay, so are you sure that you don't want any more children? And he said, yes, absolutely. I'm done. I don't want any more children. And I said, okay. And this is a woman who's had three previous vaginal births. Okay. So the anticipation is that she should have another vaginal birth if all goes as we expect. So I turned to him and I said, well, would you consider getting a vasectomy? And he says, oh, absolutely not. I don't even know why you brought it up. And I was like, because you just told me you don't want any more children. And he says, yeah, she can get her tubes tied.

Touseef Mirza:
Just simply like that.

Dr. Sophia:
It was very easy. Like it was so matter of fact, it was so like, well, she can get her tubes tied. And I said, but you know that you can actually get a vasectomy, which is a complete outpatient procedure. He says, no, no, no. I'm not gonna do that. It's gonna affect my manhood.

Touseef Mirza:
He literally said that.

Dr. Sophia:
And then when I further went to explain exactly what we just talked about. Literally, it has nothing to do with your manhood. We went through the whole thing, the tube, the semen, the, the sperm, and how they connect and, and what happens. And he was like, well, no, I'm not doing that. And I tried to really grasp and understand from him, like why his number one concern was simply that he thought it was gonna for sure affect his manhood or his virility. Right. And even under guidance and education. And even by explaining to him that it actually has nothing to do with his quote unquote manhood. Nope. Still a woman's issue.

Touseef Mirza:
Do you remember what her reaction was?

Dr. Sophia:
She was like, you see, this is what I'm talking about .

Touseef Mirza:
So she's like, I tried it. It's not working. Okay.

Dr. Sophia:
She was like, I was hoping you would bring, you know, bring some sense into this. And she's like, well, but I know I'm done. And I said, okay. I said, listen, I am happy to do whatever is going to make sense for you and your family. I just wanna make sure that, you know, you understand what your actual options are as a couple. And that a vasectomy is definitely an option in terms of permanent sterilization as you two are in a committed relationship. And quite frankly, it should be an individual's decision, obviously, but as two people who are committed to each other for a lifetime, why should the burden always be on the woman? In my opinion, she's already done a lot for, you know, about bearing her fourth child. Her body has gone through a lot already in order to have a family.

Touseef Mirza:
I think that part of the issue is that because women bear the brunt of childbirth carrying and childbirth, is that maybe the male doesn't feel as responsible and feels, well, that should be her responsibility too. I don't know, like, you know, as you're talking to me and you know, like she did like three vaginal births and the man obviously saw her go through all of that and that he's not going through it. She's going through it. So then maybe it almost feels, well then it's also her responsibility. While it is not because this is 50/50. Yes. Like, you know, the sperm and the egg. This is not just the egg and the egg. So therefore, that type of thinking, we need to rejigger that needs to, we need to change that.

Dr. Sophia:
There needs to be a shift in this. There needs to be a serious shift. Because for me, as a doctor, especially as a obgyn, for me, it's the pleasure of being able to usher in life into this world. But I also see all the complications that can come with it. I also see how, just how hard it is for women. You know, it's a beautiful process, don't get me wrong. However, for some women, it's very taxing. . It's very taxing on their bodies. It's very taxing on them emotionally.

Touseef Mirza:
It's scary.

Dr. Sophia:
Mentally and it's scary, especially in today's day and age. Unfortunately, it should feel less scary. But that's not the case. And so I'm just like mind blown that in loving, committed relationships, that there's still this notion of the whole concept of contraception, whether we're talking permanent sterilization or not, is still the responsibility of the woman.

Touseef Mirza:
Also, just a note here, we're not saying that every situation means permanent sterilization. We're just talking about it today. But obviously there's all sorts of different contraception options, methods that you can use. We're just talking about that. And the reason why I'm also bringing this up is the male does wear a condom.

My point is, that's where he has a responsibility. Right? They put it on their penis. Therefore, if we can, it means that there's a kernel of reality there. That's what I'm trying to say. That there is a responsibility that they feel if we could extend that to also, when we talk about permanent sterilization versus putting all the onus on the women.

Dr. Sophia:
I mean, I have patients who come to me all the time, even the condom situation, where men don't wanna wear their condoms. You know, like it's, it's a burden. They don't wanna have a barrier, especially in those of them who are in committed relationships that feel that they should not have to wear a condom because they are, you know, with their mate. And this is who they've chosen to be with, and they're monogamous. And, you know, it's like the association is, oh, well, the condom is really just to prevent STDs. And so therefore, if I'm going to be with someone that I'm committed to, and I don't have to be worried about STDs, then I shouldn't have to wear a condom anymore.

Touseef Mirza:
And that situation, again, the onus goes back to the woman. And now she has to take the pill.

Dr. Sophia:
Exactly. She still has to do something in order to prevent pregnancy. But for his comfort.

Touseef Mirza:
Now I'm getting hot.

Dr. Sophia:
Are you getting hot? Because this stuff gets me hot. It does, it gets me a little frustrated.

Touseef Mirza:
For the man who said it's going to affect my manhood. Even if you explained it and it still didn't sink in. It means that there's a stereotype, there's a taboo, there's something in terms of conditioning that is hard to pierce. Even if the facts are otherwise, when we say manhood or virility as it pertains, nobody else is gonna know. Right. When they're walking around, nobody knows if they've had a vasectomy or not.

Dr. Sophia:
There's no way to know that a man has had a vasectomy if he doesn't tell you.

Touseef Mirza:
So then how does it really affect your manhood?

Dr. Sophia:
It doesn't, that's the whole point.

Touseef Mirza:
Yes. Oh, okay. I know, babe. I know, babe. I'm not challenging you. I know. I'm on your side here. Okay. Sorry.

Dr. Sophia:
I told you this topic makes me emotional.

Touseef Mirza:
But my point is, when we say manhood, in what way? Like it doesn't even make complete sense. If the facts are the facts, and it actually does not, you're still, you're still having sex. Your sperm is intact in your testicles, therefore you have the hormonal sperm.

Dr. Sophia:
The sperm has nothing to do with your hormones. They're not making your hormones.

Touseef Mirza:
Okay. Yes. And that, and then the second part is when you're walking around, nobody knows whether anybody has had a vasectomy. It's not like it's printed on your forehead. Nobody knows. Okay, so why are we stuck there?

Dr. Sophia:
Girl, if I knew the answer.

Touseef Mirza:
We need to change this up. Like this makes no sense.

Dr. Sophia:
If I only understood and knew the answer to this. And it's interesting because obviously not all men have this concept. I know a guy who actually got a vasectomy when he was, I don't know, 28 years old. He'd already had his two children and was super clear that for him in his life, his goal was to have two kids. And he had them. And that was it. He was like, okay, great. I've had my two kids, even

Touseef Mirza:
At 28.

Dr. Sophia:
At 28, he was so clear he knew, he's like, I had my two kids, now I'm done. And he went and got a vasectomy. And interestingly, having a conversation with him about it, I was like, wow, that you were so young and he's much older now. And he's, I was like, don't you have any regret that you did that? He was like, why would I have regrets? I was clear. I knew that I wanted only two children. And when I got my vasectomy, it actually made me feel freer. Hmm. I felt a sense of freedom. Because I didn't have to worry ever.

Touseef Mirza:
And also, by the way, in that relationship, or in any relationship, let's say even that woman that we were talking about, who has four kids, if the husband says, instead of saying, you know, no, I don't wanna do it because it's gonna affect my manhood, the man says, you know what, let me do that. That's actually really hot. Okay. That if your man does that and says, I'm gonna take that one, you know, let me do that. That's actually so attractive because now the man is being responsible in the relationship.

Dr. Sophia:
Not just that, it just opens up the door for them to have a more open sexual life. Because now the woman who's always, who's always fearing pregnancy, if she doesn't want any more children, like her fear of pregnancy is super high. It's like 10. And so a man who gets a vasectomy, I would think that that opens the door for them to have a more robust sex life with their partner. Because now that has completely melted away the pregnancy anxiety that the woman probably feels.

Touseef Mirza:
And that she has to bear.

Dr. Sophia:
Exactly. The interesting thing is that the conversation is not just with men, it's also with women. Because I feel like many times they feel either scared or like, oh, well, I don't think my man will ever go for that. They don't even bring it up as an option. I definitely think we've been conditioned to believe that contraception and or, and the concept of family planning is on the woman's side.

So because of it, there's like an expectation there for the woman to carry that burden. And I know this because like I said, even when I bring up, well, okay, will your husband then use condoms? And she's like, no. And I'm like, why? So we don't even have to go so far to get a vasectomy. We can just go back to the basics of barrier protection with a condom.

Touseef Mirza:
This whole conversation actually starts with understanding just who is responsible around this, which is the man-

Dr. Sophia:
Around their fertility.

Touseef Mirza:
Around fertility, around sex.

Dr. Sophia:
Around sex, around fertility, around family planning. Yeah. And I think the onus is always put on the woman, and it's just, we have to bring more of this to light that it should, it is a 50/50 in terms of, you know, pregnancy, getting pregnant and that, especially in couples who have that conversation where they are clear that they don't want any more children, then I think a vasectomy conversation should be a bigger conversation. It's for sure a simpler procedure for men. And though it takes away their immediate method for quote unquote fertility, it actually doesn't make them infertile.

Touseef Mirza:
It's crazy that we're even talking about this. Like, you know, we don't really need sperm. Because that's the whole point of a vasectomy. But we need to bring this up because of the manhood issue.

Dr. Sophia:
It doesn't affect their manhood.

Touseef Mirza:
We need to say 10 more times.

Dr. Sophia:
It doesn't affect their manhood.

Touseef Mirza:
It doesn't, but I mean, their-

Dr. Sophia:
Testicles are still working. Like they're supposed to, your testes are unbothered by you and your vasectomy.

Touseef Mirza:
They're doing their thing.

Dr. Sophia:
Their thing, they're still working, they're still functioning. You know what I mean? They are like, your testicles are not affected here. I do wanna bring another story, which actually is another reason why I wanted to have this conversation, because I did have a patient whose partner was all for the vasectomy, and actually is the person who brought it up.

Touseef Mirza:
Hallelujah.

Dr. Sophia:
Right? It is because here I had a patient who had her third C-section and her husband watched.

Touseef Mirza:
So she had three babies.

Dr. Sophia:
She actually had three babies, all three C-sections. And he watched her through all her pregnancies, all of her deliveries. And with the last one, which was particularly more difficult, he said to her, we really shouldn't have any more children. And she said, no, I don't want anymore. And he said, I'm gonna go get a vasectomy. He said, I just don't want you to go through this ever again.

Touseef Mirza:
If you don't want to.

Dr. Sophia:
Well, she was clear that she didn't want to. And he said, I'm not putting any more on you. He literally said that.

Touseef Mirza:
That's amazing.

Dr. Sophia:
And I was like, where is this man? And can he give lectures ? He needs to give seminars, you know, because at the end of the day, that is how we should be caring for our partners. That to me was real respect for her body, respect for the process, respect for their communication, respect for their joint decision, and respect-

Touseef Mirza:
For their committed relationship.

Dr. Sophia:
And respect for their commitment. I was just like, wow, scream from the rooftops. Please.

Touseef Mirza:
He's really embodying what we say in a marriage is that you're a team.

Dr. Sophia:
I was just like, wow, what a breath of fresh air. That he was so clear about not wanting any more children, number one. And then number two, understanding that he just didn't wanna see his wife go through another pregnancy and delivery and the fear around that part of it.

Touseef Mirza:
And so also as, as we're talking about this in terms of the effectiveness of a vasectomy, it's quite effective.

Dr. Sophia:
Oh my gosh. So the effectiveness of a vasectomy, it's like 99.9% effective. It's even more effective than a woman getting her tubes tied.

Touseef Mirza:
Wow.

Dr. Sophia:
Okay. This is like, again, boom, mind blown.

Touseef Mirza:
So it's even more effective to do it than for a woman?

Dr. Sophia:
Yes. It's even more effective than a woman who gets a tubal ligation.

Touseef Mirza:
When we mean by effective basically means if you have a vasectomy, then your chances for the sperm to actually impregnate is like 0.1%.

Dr. Sophia:
It's like, no zero.

Touseef Mirza:
Versus a woman can actually be a little bit higher?

Dr. Sophia:
Much higher. So over a 10 year span, the woman has a higher failure rate after, you know, within the 10 years of her being sterile.

Touseef Mirza:
And then the other question that comes up is, is this sort of like, okay, so I'm going to get a vasectomy, and then what if my life changes in the future? So even if it's called permanent sterilization, is there an option to reverse a vasectomy?

Dr. Sophia:
Yes. A vasectomy can be reversed. And also compared to the woman also has a higher rate of effective reversal, or like the reversal actually being functional depending on the type of procedure that they have. And like we said, even if the reversal is not the option, they still have a way of extracting the sperm from the testies.

Touseef Mirza:
Right, because the sperm is there.

Dr. Sophia:
The sperm is still there. Right, exactly. So just like with a woman, there's the concept of, okay, if we do a tubal ligation, that in the future, if she decides that she does still want to get pregnant, that they would use reproductive technologies in order to extract the egg. It's the same concept. We just extract the sperm. And then you still would have to mix it with the egg and then implant that back into the woman. But we have enough technology out here that nothing has to be quite permanent if it's something that you actually still want in the future. And I get it, like for women, even the concept of sterilization, we don't necessarily encourage, let's say even before the age of 30, in terms of counseling. Granted, a woman can have a sterilization at any age, however, we're less likely to encourage it, or in our counseling. Again, because for a woman, the number one complication with sterilization is regret. They regret that they had the procedure done at an earlier age.

So for example, where I had that 28-year-old male friend of mine who was much older, but at 28 had had the vasectomy and was super clear and never had any regret about it. A woman who's, let's say 28 and has her tubes tied despite, no matter how many children she has, typically has a higher level of regret later on. And so I certainly wouldn't say that it's encouraged. If a woman wants it, we counsel them, we explain to them all of the risk factors, we explain to them the efficacy, et cetera. But certainly a younger woman, it would not be the first thing we would talk about.

Touseef Mirza:
When you say regret is basically in the future, they might regret it because now their motherhood sort of gene sort of kicked in and now they wanna have kids.

Dr. Sophia:
That is correct. So interestingly, for a man who's like, oh, my macho, my manhood, but for a woman, it's like my motherhood. It doesn't take away their feeling of feeling like a woman. That's something else. It doesn't take away their feeling of feeling like they're still sexy or, or have, or womanly or feminine. So having a permanent sterilization doesn't take that away from them, but it takes away that motherhood, that mothering feeling that whether they have it at the time of their decision for sterilization that they may end up having later on in life. And this happens to women all the time who even early who say that they know for sure that they don't want children. They still have a blip. Even if they don't like it, at some point they're like, no, I, I know for sure I don't want any kids. At some point, there's a thought that can enter their mind that's like, hmm, am I fully sure about this? And then even if the answer still is no, there's a point in which they question it again. And I don't know if that's related to hormones or what have you, but there's a point in which social-

Touseef Mirza:
Pressures?

Dr. Sophia:
Social pressures for sure. Yes. You're a good example of someone who could definitely speak on this.

Touseef Mirza:
And you could still have some women that do it. And they're super happy. The best decision they ever made. Absolutely. They stand by it.

Dr. Sophia:
They stand by it. And I would say that the majority are, are a little bit older, over 30. That they've made the decision and they're fully clear, they are super happy with their decision. And likewise for them, they tend to have a feeling of freedom.

Touseef Mirza:
So a question I have is, when it comes to vasectomy, since a man has sperm, you know, maybe their quality of sperm and the quantity of sperm is less as they get older. But can a man basically have a vasectomy anytime in their lives versus a woman? You know, like us, we don't need a tubal ligation after we hit menopause, for example, because we don't have any eggs that are coming out of our ovaries by that time.

Dr. Sophia:
Right. So, unlike women, your body has a clock and it has a full stop at menopause, that full stop is for real. You are not getting pregnant anymore. The possibility of being able to get pregnant is lost because your eggs are basically depleted to a threshold that makes them the only, the very few eggs that you may still have are so non-viable. Basically, every year our bodies naturally get rid of eggs. So we're born with millions. That changes pretty instantly after birth to hundreds of thousands. That changes pretty significantly at puberty. And then with every ovulation, we're losing, you know, like 10,000 eggs. So by the time we hit menopause, the few thousands of eggs that are left are not the best of the bunch. They're the most fragile. So even just the ovulation process alone can kill those eggs. Can, can make those eggs not viable.

Touseef Mirza:
So therefore, for a woman in menopause, we don't even have to talk about

Dr. Sophia:
We don't have to talk about sterilization. Whereas for men, they have sperm that can impregnate a woman forever. Well into their seventies and eighties. Now, the quality of that sperm certainly changes, but it doesn't change the fact that they still have tons of sperm, because men basically are regenerating sperm. Every three months they get a new batch.

Touseef Mirza:
Well, we just got our batch when we were born.

Dr. Sophia:
That's it. Done.

Touseef Mirza:
So in terms of moving forward, like when certain situations happen like this in your office, when you talk to, to males, like is there anything you feel that you can tell them that helps them really consider if they're looking for permanent action between the, the woman and the man of how to really consider it? If there's an issue around manhood? Or do you feel we're really at the beginning steps here and we need to address it more often to get there?

Dr. Sophia:
To be fair, I really think that we're at the early steps of this conversation. What I do typically is I really encourage when I have the conversation, oftentimes it's only with the woman I am. I'm often just talking to a woman in my office who's like, I really don't want any more children. And I say, okay, well, are you in a committed relationship? Because also a woman can make this decision for herself, whether she's in a committed relationship or not, she can make this decision. If she knows she doesn't want any more children, then by all means go through the process to, to feel secure for yourself. So this is not to take anything off the table for a woman. It's also tough, instead to introduce the concept that if you are in a team, you're in a partnership, that that conversation can be opened up and be a much more robust conversation regarding who has to take on the responsibility of future family planning.

And that it doesn't all have to fall on the woman. And that conversation first starts with the woman. And if she's like, well, I don't know. And I say, well, bring your husband in, bring your partner in, you know, let's have a conversation together. And then if that still, you know, like that one couple I had where a man was like, absolutely not. I'm like, why don't you at least get a consultation from a urologist? I'm just glad we're actually opening up and talking about this because I think more men need to understand that a vasectomy is an option. And the way that shows how much you care for your partner.

Touseef Mirza:
And to know the facts.

Dr. Sophia:
And just yeah, know the facts.

Touseef Mirza:
I mean, I think this episode is really good for women to hear and for men to hear. So we all get it straight. Because I also think, you know, as a woman, I didn't know all the things that we talked about, you know, so that we're all talking about the same thing here. This is biology, we're not making this up, right? This is how this thing actually works and what actually happens in a vasectomy. So we can potentially start to look at it in a more objective way versus, versus the conditioned way.

Dr. Sophia:
Women and men. I hope listening to today's podcast just encourages you to continue to embrace your body, embrace yourself. Thank you so much for joining us here on the Dr. Sophia ObGyn podcast. See you later.

This is General Medical Information based on my professional opinion and experience. For specific medical advice, please refer to your physician. Until next time, embrace your body. Embrace yourself.