Then there's the stigma that goes along with getting a -- sshhh -- vasectomy.
"There's still a macho image that guys don't get vasectomies," says doctor Mark Johnson of the Jefferson County Department of Health and Environment. "There's a sense of loss of manhood involved."
Today, however -- and especially in Jefferson County -- a scalpel-free vasectomy is a little less involved. Instead of cutting the patient, a doctor merely punctures the scrotum, spreads the skin thin and, using a clamp, cauterizes the vas. No blood, no stitches, and the irritation is, all things considered, minimal. "It heals on its own," Johnson says.
Bruised egos are another story. But that, too, is about to change, thanks in part to Jeffco's it's-cool-to-get-it-cut social marketing campaign that could be coming soon to a bar near you.
Last spring, the Association for Voluntary Surgical Contraception, an international group that provides reproductive-health services, offered the Colorado Department of Public Health and Environment a chance to teach some of its doctors how to perform the scalpel-free vasectomy. State health officials chose Jefferson County as the experimental county, since the facility still offers its own clinical services and employs its own doctors. (Many other counties switched to managed care in the early '90s.) The state gave the Jefferson County Health Department $2,000 for start-up costs, and in November, a certified proctor from AVSC visited Johnson and his fellow doctors.
County officials like the idea, since they were concerned about the rising rate of unplanned births. Nationwide, 50 to 60 percent of all full-term pregnancies are unplanned, according to Nancy Braden, a spokeswoman at the Jefferson County Health Department. The total number of unplanned pregnancies is even higher, since abortions aren't factored into the total. In Jefferson County, however, only 29.5 percent of pregnancies are unplanned. But it's those pregnancies, Johnson reminds, that "put a tremendous social strain" on the population.
In February, the department publicly announced its plans to offer the new, "low-cost" service. Although Johnson says some people were concerned that this was a sterilize-the-poor project, he says the insinuation is unfounded. "I was really surprised at the...controversy...this created. I see this as just another tool in family planning."
Currently, as with all clinical services provided by the county, the cost of the procedure is set to a sliding scale based on income. Higher wage-earners pay the full $100, while some are asked to pay just $50. Johnson says the county may set just one price for all men, however, at $75. The going rate for vasectomies at other locations is about $300 to $400, he adds.
Twenty men called the health department initially, ready to be sterilized. Johnson says that of every two men who call to arrange an appointment, only one has actually been showing up. The first ten vasectomies were performed between November and February. Another twenty men have now scheduled appointments, but since there is a thirty-day waiting period, Johnson doesn't know how many will follow through. "I don't want them to wake up a week later and say, 'Boy, I wish I really wouldn't have done that,'" he says.
The onus of permanent birth control is usually on the woman, he says. Last year, according to the National Center for Health Statistics, 540,000 American women underwent tubal ligation, as opposed to just 400,000 men who had vasectomies. Tubal ligations (which the Jeffco health department doesn't perform) are considered "major surgery," whereas vasectomies -- especially scalpel-free -- are not, and Johnson says vasectomies are the truest, safest solution. "This isn't putting chemicals or hormones into a body," he says. "This is stopping the sperm from coming out." Nevertheless, he says, men fidget for as many excuses as they can. "Guys traditionally have scared feelings about having anything done down there," he adds, pointing as evidence to comments he has heard on KOA radio's Sports Zoo. Anytime the DJs mention the word "vasectomy," lots of people phone in with comments, most of which are for laughs, he says. "It's something societal about that part of a male's anatomy that always makes for funny, interesting conversation."
To help change these fears, Johnson recently applied for a $15,000 grant from AVSC to begin a social marketing campaign to remove the vasectomy-equals-castration belief maintained in male circles. In other cities around the country, doctors have issued removable tattoos for their patients and outside the clinics. The tattoos are designed much like a sailor tattoo with a heart and anchor, with the word "Vasectomy" printed across the front.
In 1998, the Pinellas County Health Department in Florida became the first county department to try out a new marketing campaign. Along with the removable tattoos, the department distributed free beer coasters to 125 bars in the county. Red coasters sported a large "V" and a heart with the words "Make my next one a vasectomy." The coasters included a phone number for the local health department. Johnson heard the campaign was a success and is considering doing the same thing here. "Apparently, it does stimulate conversation."
Elise Lubell, director of health promotion and lifestyle management for the county, still hasn't decided if the coasters will find their way into county watering holes ("I don't know if that would fit in Colorado"), but she says the tone of the marketing campaign will certainly "stay away from the fear appeal." The tattoos, however, are a go. "We just haven't figured out the distribution route."
She's also looking into radio, print and television advertising, as well as some public-service announcements, and says the campaign will target both genders -- not just males. "We would aim something at wives to encourage their husbands." Finally, she says the campaign will advertise not only in English, but also in Spanish. "We don't want to target just one audience, but we want to reach as many people as possible."
All yucks aside, Johnson wants the true message to come out about vasectomies: "Your body continues to look and act as it always has," he says. "All you're doing is cutting a pipe."
