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Canadian Journal of Human Sexuality. 1999 Fall; 8(3):195-198.Two-thirds of the women in the 1998 Canadian Contraception Study are familiar with sterilization as a method of birth control, and they generally think highly of this method. Among women who have been sterilized or whose partners have undergone vasectomy, rates of satisfaction are very high. The rate of sterilization, 23% overall, includes 10% of women who have had the operation, and 14% of their partners. The increasing use of male sterilization is appropriate, given the low morbidity attached to this procedure. This operation should continue to increase in prevalence, as 75% of women who have decided on future sterilization wish their partner to have the operation. (author's)
AMERICAN JOURNAL OF PUBLIC HEALTH. 1999 Jan; 89(1):92-4.The prevalence of vasectomy increased in the US from protecting approximately 5% of contracepting married women to about 19% by the early 1990s. However, 2 studies published in 1993 noting a potential link between vasectomy and prostate cancer, publications refuting the association and the US National Institutes of Health's recommendation to not change vasectomy practice, subsequent debate in the professional literature, and negative publicity in the national media may have influenced the acceptance and practice of vasectomy in the US. The authors conducted national probability surveys of urology, general surgery, and family practices in 1992 and 1996 to assess the effect of the controversy upon the acceptance and practice of vasectomy in the US. 10.3 vasectomies per 1000 men aged 25-49 years were performed in 1991, compared to 9.9/1000 in 1995. Neither the estimated total number of vasectomies performed nor the population rate changed significantly between 1991 and 1995. 31% and 28% of all physician practices provided vasectomy in 1991 and 1995, respectively, a nonstatistically significant change over the 4 years.
Family Planning Perspectives. 1993 May-Jun; 25(3):133-5.As many as 500,000 US men are believed to have had a vasectomy in 1991, and at least four million US couples of reproductive age depend upon the method. About 42 million couples worldwide also rely upon vasectomy for contraception. Concern arose in the family planning community in February 1993 when two studies published in the Journal of the American Medical Association reported that vasectomized men are at higher risk of developing prostate cancer compared to nonvasectomized men. Prostate cancer is the second most common cause of cancer death among American men. Vasectomy, however, is among the safest, most effective, and most acceptable of contraceptive methods. A link between vasectomy and prostate cancer could therefore have a serious negative impact upon vasectomy practice and upon overall contraceptive practice in the US. The National Institutes of Health convened a panel of experts in March 1993 to assess the likelihood of a relationship between vasectomy and prostate cancer and to make recommendations about any changes in vasectomy practice which may be needed. The panel concluded that there was insufficient basis for recommending a change in clinical and public health practice at that time, but that the debate must be resolved. To that end, epidemiologic and basic biological research are needed. The author reviews the background of the debate, early questions, and recent developments, and discusses future research.
FAMILY PLANNING WORLD. 1993 Sep-Oct; 3(5):12-3.Vasectomy has a shaky reputation in the US, but 500,000 men nonetheless undergo the procedure annually in the country. 15% of US men over age 40 are vasectomized. Dr. Edward Giovannucci of the Harvard School of Public Health in a study of 10,000 vasectomized men and 38,000 nonvasectomized men found the rate of prostate cancer in vasectomized men to be 113 per 22,000 compared to 70 per 22,000 among men who were not vasectomized. Controversy ensued its publication in the Journal of the American Medical Association and an expert panel at the National Institutes of Health was quick to pronounce that the new findings warranted no change in vasectomy procedures or counseling. The controversy continues. Giovannucci's detractors argue that the study is simply a dangerous attack on an already underused contraceptive method and that the report is fueled more by hunger for media attention than by sound science. Supporters counter that the findings are being carelessly dismissed to protect vasectomy in the US.
American Journal of Public Health. 1985 Jan; 75(1):73-5.In this study of 1600 men ages 25-50 from semirural Guatemala, 3/4 had heard of vasectomy. Among these, 54% approved of it. However, the survey reveals a widespread lack of knowledge regarding the procedure, as well as negative perceptions or doublts about its effect on sexual performance, ability to do hard work, health, and manhood. 1/4 of the respondents who knew of vasectomy and who desired no more children expressed interest in having the operation, a finding which raises questions as to the potential (unrecognized) demand for vasectomy in other developing countries. (author's modified)
In: Hsia YE, Hirschhorn K, et. al., ed. Counseling in genetics. New York, Alan R. Liss, 1979. 189-222.American contraceptive patterns have shown consistent acceptance and progressive improvement in its usage. Efficacious methods which offer maximum contraceptive protection are highly favored by all strata of the American population. The 4 methods which the writer examines from a clinical and psychological viewpoint are sterilization, artificial insemination, abortion and selective sex predetermination processes. The increased popularity of sterilization by males and females is accounted for by its development into a simpler surgical procedure, few unpleasant side effects, shifts in smaller family size planning, and easing of medical and legal age restrictions. Vasectomy and tubal ligation are reviewed in terms of positive and negative reactions to the procedures with particular emphasis about psychological adjustment common to both procedures. Artificial insemination with a donor's semen is used primarily when the husband is infertile or when the husband or both parents are carriers of genetic defects. This method is preferred when parents are dissatisfied with adoption procedures, selection process in terms of infant conception is desired, knowledge of pregnancy 1st hand is wanted and when faith in the donor is strong. Abortion and prenatal diagnosis are seen as means of selective reproduction and biological control in family planning decisions. Legal change about abortion has accompanied a decline of public opposition as seen in tables which chart America's public opinion from 1962 to 1975. Psychological aspects of selecting abortion and prenatal diagnosis include the concern parents have over health of the child, security of the family , fairness to the unborn child, to the living children and to themselves. The writer establishes the need for counseling and emotional support when stress, depression and self doubts associated with each procedure is apparent. Technology involved in sex determination is seen by the author as having a future radical impact on sex ratios of developing nations where a greater cultural emphasis is on having sons. From a psychological point of view, sex determination will alleviate the disappointment some parents feel about the sex of the child as well as encourage fertility.
[Unpublished] 1982. Presented at the Conference on Vasectomy, Colombo, Sri Lanka, October 4-7, 1982. 13 p.There are 2 general types of barriers to vasectomy acceptance, cultural and individual. Cultural barriers include: 1) the idea that contraception should be the woman's responsibility, 2) that vasectomy represents a tampering with the natural processes of reproduction and this conflicts with many religions, 3) there is confusion over the legal status of vasectomy even though very few countries actually prohibit it, 4) the idea that men, due to their higher status in many societies, should not be exposed to unnecessary risks, 5) the idea that men who are not capable of reproducing have no worth in society, and 6) that men may need to be able to reproduce at a future date since in many societies only men are permitted to remarry. Research on psychological barriers to vasectomy is based on followup studies of vasectomized men and shows that negative male attitudes toward vasectomy stem from negative perceptions about the nature of consequences of the operation. Some men feel that vasectomy is like castration, that it is painful, has demasculinizing effects, causes a loss of vitality, and is irreversible. The population must be educated in order to overcome these barriers. Any communication program must include: 1) identifying existing sources of motivation for vasectomy, 2) increasing awareness of vasectomy through mass media and interpersonal channels, 3) increasing awareness through wider availability of the operation, and 4) improving the public attitude by publicizing client satisfaction with the operation. Men should be encouraged to seek vasectomy for the intrinsic benefits of the operation.
[Unpublished] 1982. Presented at the Conference on Vasectomy, Colombo, Sri Lanka, October 4-7, 1982. 6 p.This report attempts to synthesize Italy's experience regarding mobilizing and influencing public opinion for vasectomy acceptances in terms of basic policies and initiatives which may be extended to other countries and cultures. On the basis of Italy's experience, it is believed that no uniform approach can be applied to the different leading groups of a given country. Each religious and political group should be approached with specific arguments. With religious groups and leaders and the political parties directly influenced by them, the focus should be on the importance of family planning in general, and of vasectomy in particular, for the stability of the family and for a strengthening of affective ties between the spouses and between parents and children. The argument with nationalist groups and leaders should be that the key to military and international power is quality, not quantity, and technological advancement rather than sheer numbers. The basic arguments with Marxists, feminists and other radicals should concentrate on human rights and women's health. Finally, the argument that birth control is crucial for economic development, social advancement, reduction of unemployment and poverty can be effectively used with "mild" liberals and "mild" conservatives. The support of the media is necessary in any effort aimed at influencing public opinion. Personal contacts with influential journalists should be pursued. The popular strata should be primarily approached at the emotional level with the use of initiatives that can capture their imagination and messages which can effectively motivate them to surgical contraception. Much good work has already been done with medical and paramedical personnel, but better results might be obtained through motivational psychology. Capability and proficiency in vasectomy and sterilization procedures should be rewarded and honored in order to make them an object of professional competition among both medical and paramedical personnel. Special career advantages should be attached to proficiency in this area. Public and professional opinion may be influenced by transforming legal actions into national cases. Public and professional opinion may be influenced by transforming legal actions into national cases. The initiatives taken before and after the trial of the gynecologist Diorgio Conciani, incriminated by the Public Attorney of Lucca for having performed about 80 vasectomies on Italian citizens from many towns of Italy who had formally requested the procedure, by the Italian Association for Voluntary Sterilization may be usefully adapted to other countries. At the medical level some physicians in Milan, Rome, Venice, and Naples agreed to perform both male and female sterilizations. At the legal level the Association formed a legal council of defense.