Alan Perrott: The nut job

By Alan Perrott

We have one of the highest rates in the world and they’re considered ‘the new masculinity’… So why are vasectomies still a taboo subject? Alan Perrott tells his story of the unkindest cut.

Photo / Thinkstock
Photo / Thinkstock

I've never felt more helpless than while lying on a slab, pants around my ankles, with someone poking around in my twig and berries.

I didn't want to move almost as much as I didn't want to be there. And I really, really didn't want to move.

When the poking seemed to have been going on for an awfully long time, I allowed myself to think he might be almost done. But nothing was going to make me look for myself.

Instead, I cleared my throat, hoping that'd keep my voice steady, and squeaked, "How's it going?" I figured that sounded braver than "Please, please, please tell me you're almost done." Or, for that matter, "Help ... "

"Almost finished the first one," said my cheery GP.

"[Expletive deleted]."

All I could do was return to my deep breathing and reread the technical details on the underside of the air-conditioning unit to stop my brain from filling in what I didn't want to see.

Not that it was a mystery - I'd gone in knowing what I was in for, sort of, anyway. A vasectomy is exactly what the pamphlets and websites tell us - it's "minor surgery" - and, aside from the small matter of genital invasion, that's nothing to get het up about.

It's certainly not, as I almost did, something to faint over when all that'd happened was a little preliminary shaving.

That was when I realised I am one of the fainthearted and my kind has no place in rooms such as this with its horrible, blank-walled plainness. I'd had an inkling earlier, when my stomach dropped as I cottoned on to the obvious fact that I was to be sterilised (now that's a term that kicks off some nasty word associations) but I still believe you'd need the imagination of toothpaste not to find the situation grotesque.

And, yes, I know the whole thing can now be reversed (unsterilised?), but slim and none sum up the chances of me going through all of that again. Scissors (!), blood and scrotum have no place in the same sentence, especially not in a sentence about me at a time when I don't have any health problems. And, yes, again, as several helpful women have pointed out, giving birth is far worse but, with all due respect, there's usually a desired outcome and some pretty handy hormones to enjoy once you're done. My minor surgery didn't save, improve, extend or even add to my life, and my reward turned out to be potato chips, a bottle of Coke, a rubbish superhero DVD and a bag of frozen peas between my legs.

Still, I accept it was a good idea. We've got two great little boys at home that we - 99 per cent of the time anyway - love to bits, and that's our bag limit. Keeping it that way would have meant condoms, the pill, or Abbie undergoing not-so-minor surgery. Taking a $490 kick to the nethers that left me walking like John Wayne for nigh on two weeks seemed a fair and reasonable alternative.

But I struggle to imagine any man ever being the one to suggest the procedure. In my case, Abbie's initial push had been gentle, but there was no missing the determination that never slackened even as my procrastination reached Olympic levels. Which can't be a unique response, not from the wide-eyed and dry-mouthed responses I got whenever I raised the issue with mates. I'd say that your average Joe's relationship with his tackle is so locked into the visceral depth of the pleasure/pain spectrum it delivers that it's the last thing he will ever surrender control over. Once you add in tropes around fertility and masculinity, the idea of having your manly totem messed with surgically is always going to be delicate ground.

A 2007 study found that 18 per cent of New Zealand men have had vasectomies, including a quarter of all married men and almost 60 per cent of men aged between 40 and 49 years. If it's one of the highest rates in the world and puts us on a very short list of countries where vasectomies outnumber tubal ligations, it must also be noted that fewer than 1 per cent of men who decide to live childfree get themselves sterilised and the remarkably few (and male-written) scientific investigations into the issue have been driven more by bewilderment than curiosity.

Until Aucklander Dr Gareth Terry published what may be the first positive study in 2011, researchers had stuck tightly to the questions of stigma, post-operative anxieties, sexual implications and self-image. It was all "why would a man do that to himself?" And "who is pressuring us into it?" As Terry says, positive responses were written off as a defence mechanism: "The overall message was that men struggled intensely with the decision ... and often did it unwillingly."

Science, he says, has only been concerned with why men don't get the snip, not why they do - for the record, neither Terry nor my doctor has had one.

But it doesn't stop there - the research to justify keeping your vas deferens intact keeps on coming. Not only have vasectomies been linked to a rare form of dementia, but early last month they were shown to increase our risk of prostate cancer - actually that connection had been made before, this new study was just a whole lot more terminal. For laughs, I also visited an evangelical pro-life website to learn I'm also now at risk of emotional disorders, marital instability and a bloodstream flooded with sperm. Eh?

Dr Terry views my sufferance as part of a new, emerging masculinity, even if he does admit that many of his research subjects had successfully avoided thinking deeply about what they'd done.

Photo / Thinkstock

Still, he found a few common threads; vasectomised men see themselves as taking responsibility, showing commitment and being fair-minded. Essentially this means that once a family is complete, with all the contraceptive juggling that involves, my compadres and I evidently decided it was our turn to step up and end the potential for "surprises". Terry regards this stepping up as the new masculinity, even if he might be playing down the old truism "happy wife, happy life".

But if interviewing 28 former patients is quality research, his knowledge must pale against a man who has personally sterilised about 7000 (not including me) men.

So then, Dr Jonathan Masters, aka the "Vasman", what has 15 years of snipping taught you about the ale attitude to their genitals?

"What a strange question," he says. "Nothing."

Okay, it seems all his patients care about is whether it'll hurt, assurance that their genitals will still work, and why on earth Masters even does such work. Actually, that last question is key. During the 90s, Masters spent four years training as an obstetrics and gynaecology specialist and saw how much of the contraceptive burden women carry by default. To balance things out, he trained in the "non-scalpel" vasectomy technique devloped by Chinese Professor Li Shunqiang in 1974.

"I thought it would be a good idea to be able to offer this service to families as well, it seemed totally logical and it's the reason I still do it."

I suspect he isn't so much uninterested in reflection as focused on enabling men to do what he sees as the right thing; he's even had one done himself. "I'm about dealing with people in a positive way, whether they're doing it for the wife or partner, or for the future of them both, they're doing an honourable thing, a really honourable thing." He includes women in his equation because the overwhelming majority of his patients are in stable relationships.

Not everyone is suitable for his services, though, and he vets all potential patients, mostly by asking "is your family complete?" as often as is needed to uncover any issues - and for anyone wondering, saying that you're 18 and want a vasectomy because it's the only way your girlfriend can get away with having pre-marital sex, as some have, isn't going to get you an appointment. Even then, he estimates about one in 200-odd men end up being turned away on the day because they lack the necessary commitment.

Come game day, Masters adopts a blokey approach with pre-op banter around fishing, travel, family and work. In fact, this "getting to know you" relaxation phase seems to be a highlight of his working week. He also encourages a 10 to 15-minute post-op chat - to avoid the spectacle of men fainting in the corridor as they leave - and, after noticing his offers of coffee, tea or water were being spurned for a "have you got a beer?" he's installed a rather nifty WilliamsWarn personal brewery at reception. There are even plans for a small range of Vasman beers.

"If that sounds frivolous, we are very serious about what we do here, it's all about making the experience a positive one and helping families. I'm not interested in building an empire or anything, one of the reasons I got into this was so that I could have a normal
Monday to Friday week and spend more time with my own family. It's all about family ... "

Which is lovely, except that even if I wasn't the only one at home wearing nappies on my fateful day, I was the only one who needed them to soak up blood. At least I managed to upgrade my painkillers to "plus codeine", which left me feeling quite chipper about my recovery time until the first lot wore off - still ouchy.

I took to sleeping with a cushion between my knees and it was another week before I could sit normally. Then there is the wee issue of how the tiny cut and the even tinier stitch match perfectly with my zipper. Have I said too much?

Otherwise, I'm still working through the etiquette of chafing, an inconvenience that's possibly my fault as I do like a polyester trouser. But there's precious little that I can do about it, short of some serious rearranging and that's never a good look in polite company. All I can do is add a wiggle to my gait and wait for things to sort themselves out.

As for follow-up work, I'm supposed to, erm, provide a, umm, sample in three months to check my sperm count. Further detail is unnecessary aside for two points - I'm still making sperm, the vasectomy only stops them bolting for the door and most men don't bother with the follow-up test despite about one in 500 operations not working.

But right now I'm more concerned with not being among the 1 to 2 per cent of men who have long-term post-operative pain. Some struggle with it so much they approach surgeons like Dr Greg Phillipson to see if a $9000 reversal could help.

Now based in Christchurch, Phillipson conducts about one reversal a week and, as opposed to some doctors, gives his patients a general anaesthetic to help them through the two hours of delicate microsurgery needed to reconnect tubes about 0.3mm wide.

If the general consensus is that most reversals are sought by men opting for a younger dance partner, you also have to factor in couples who have lost a child, or who simply made a bad call, but it's impossible to talk with any authority because this issue has seen even less research than the vasectomy business.

"It's very stressful, very emotional," says Phillipson, "especially as there are no guarantees. Even if you decided you wanted to change your mind now [no thanks!] your chances might be around 90 per cent but in 10 years that could be down to around 50 or 60 per cent."

Apparently, the issue is scarring within the testes, which effects the sperm.

I now know more about this carry-on than I ever wanted or needed to and I'm still left dealing with a stitch where no stitch should be. But I'm willing to deal with that and my measly Coke, chips and movie payoff if it means that the next time I hear the words "almost finished the first one" it's from some guy building my new coastal hideaways in the Bahamas.

- NZ Herald

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