When couples decide they don’t want any more biological children – or any children at all – the topic of contraceptive surgery tends to come up, especially for heterosexual couples. But the decision can be weighty. Is it the best option? Is a permanent solution really what they want? And which person should undergo the surgery? A vasectomy takes just about 20 minutes to do in a clinic, requires only local anesthesia, and is minimally invasive and quicker to heal. It typically costs about $1,000 in the US without insurance. By contrast, the procedures available to those with a uterus are more complicated. Tubal ligation and bilateral salpingectomy, the removal of both fallopian tubes – which is now more commonly recommended – require general anesthesia, involve multiple incisions and often laparoscopy, and have lengthier healing times. They also generally cost more than a vasectomy – some candidates report out-of-pocket quotes in the $15,000–$30,000 range. Yet surveys show that there are fewer men getting vasectomies than women undergoing sterilization procedures. In the most recent comprehensive data, the National Center for Health Statistics reported that 27% of contraceptive-using women relied on female sterilization as their mode of birth control from 2017 to 2019, a bigger proportion than those using the pill (21%). But just 8% relied on male sterilization for birth control. Vasectomy rates have been in decline in the US for some time, though there has been a recent bump in consultations since the rollback of Roe v Wade, especially in younger and childless men. There are no definitive answers when it comes to this disparity. One possible factor is that women tend to be more in contact with the healthcare system than men, especially men of minority groups, says Kari Braaten, an assistant professor of obstetrics and gynecology at Harvard Medical School. “Vasectomy users are much more likely to be white and high income than any other group,” Braaten says. The NCHS report also notes that sterilization was over three times more likely in women without a high school diploma or GED compared to women with a bachelor’s degree or higher. “Security in your contraception is highly needed among those who may have both a less stable relationship and less stable access to the healthcare system,” Braaten says. But there is little research on the motivations behind these procedures. In one study from 2019 focused on low-income women with male partners, many participants said that their partners didn’t want to get vasectomies because they wanted options if, for example, their wives died or in case of divorce. Some participants’ partners felt like a vasectomy would compromise their manhood, or were scared of lingering pain or lowered libido and testosterone. Pain is a real but relatively rare complication, and “there are no changes in terms of testosterone production or libido” after a vasectomy, says Leon Telis, a urologist and the director of the men’s health program at Mount Sinai Hospital. We spoke to heterosexual couples about the highly personal and complex decision to undergo sterilization surgery. Deborah, 35, and William E, 36 Redwood City, California How long have you been together? We began dating in 2016, and were married in 2018. Do you have kids? One daughter, born in 2020. Who underwent a sterilizing procedure? Deborah got a bilateral salpingectomy in May 2024. Deborah: When we started trying to conceive we had some trouble, but I got pregnant in 2020. It was a high-risk pregnancy because of my type 1 diabetes, but for the most part it was uneventful. But fast forward to having her, and I pretty quickly felt this really deep depression. I had to go back to the hospital twice for postpartum complications, and both were near-death experiences. The first time, my heart was failing and they diagnosed me with postpartum pre-eclampsia, and the second time I was bleeding intensely and they had to surgically insert a balloon into my uterus to get it to stop. It took me a couple years to get out of the postpartum depression. I still struggle sometimes. We each have a sibling, so we both thought we’d have another kid. But after we had her I was thinking, “Oh, gosh, I don’t know if I can do this again.” And Will felt strongly about not going through this ever again. So I brought up the idea of a vasectomy. William: On places like Reddit a lot of people were saying that issues like pain were underrepresented and not talked about. As a man, you have a sense that you don’t mess with things down there – that made me feel a little vulnerable. I was fine with using other contraception, like condoms. I guess you could say I have a little bit of a more of a conservative approach to risk, so I just wasn’t sure if it was worth it. Deborah: Ultimately he didn’t want to go through with it. Then I was on and off different forms of birth control, but every single time either my mood would be terrible, my skin would get worse or I’d relapse into postpartum depression. It affected our relationship, and my relationship with my child. It just wasn’t working for me. So it felt like a bilateral salpingectomy was a really good option. I got the consultation at the end of March and scheduled the surgery for June. William: I wasn’t comfortable with her getting a procedure either. Almost losing her during our child’s birth was one of the most stressful points of my life. But she was pretty adamant about it. Deborah: I felt pretty confident. I’ve had surgeries before, I had faith that it would go well, and I’m pretty strong when it comes to pain and healing. Having a child was nothing like I expected – it was really hard, our relationship suffered, and bonding with my daughter didn’t come easily. Bilateral salpingectomy just felt like what I needed to do. It was a way to close a really hard chapter in our lives and put all that bad stuff behind us. Jacqueline, 21, and Jefferson, 23 Athens, Greece How long have you been together? We’ve been dating since 2021. Do you have kids? No Who underwent a sterilizing procedure? Jefferson got a vasectomy in April 2024. Jefferson: On the very first day that we met we talked about not wanting kids at all. I’ve known this since I was about 16 years old. Jacqueline: I’ve also known since high school. Back in April I was getting my wisdom teeth out back in Colorado, where we are from, and they recommended that I stop birth control because it can interfere with the clotting. I had been on birth control for six years straight. I’ve probably tried 10 different types, but it makes a lot of health issues that I have worse. It made me feel like I was a walking corpse, and I had been wanting to stop anyway. Jefferson: I’ve wanted a vasectomy for as long as I could get one. I tried as an 18-year-old, but it was so unlikely for anyone to agree that I didn’t earnestly try to get one until Jacqueline wanted to be off birth control. That really was the catalyst. We didn’t want to risk it with condoms, and we don’t have the spare cash to deal with an unwanted pregnancy. We looked to a permanent solution we could both be happy with. Jacqueline: We actually looked into sterilization procedures for women first because I wanted more of that security with sterilization, for myself. But they’re a lot more invasive – plus, doctors are way less willing to do those on very young women, even less than they are to do vasectomies on very young men. The recovery time was too long, and it was about four times more expensive than the vasectomy. Jefferson: When we were in Colorado, I contacted five different doctors. They all made me fill out different reports and give reasons for my wanting the procedure. Four out of five said that I was too young, and took issue with the fact that I don’t already have kids. They were like, “you’re going to change your mind.” Finally one doctor took my reasons seriously – he saw that I had clearly been thinking about this for a long time and effectively said: “I’ll perform this as long as you don’t sue me later on saying you made a mistake.” I got really lucky. Jazmine, 28, and Jimmy, 29* Hampton Roads, Virginia How long have you been together? Married since 2017. Do you have kids? Three kids. Who underwent a sterilizing procedure? Jazmine got a bilateral salpingectomy in February 2024. Jazmine: When I was pregnant with our third child in late 2022, it was 100% that he was going to get a vasectomy. He wasn’t unwilling to do it. I was the one who was unwilling to be put under anesthesia at the time. Each of the three pregnancies were miserable. We were miserable. I wasn’t willing to go back on hormonal birth control because that was horrible. Jimmy: She was seriously sick during those pregnancies. We also had some pretty dramatic deliveries. Our first child was stillborn at 36 weeks. When she was 22, 23 weeks pregnant with our second child, she had a benign dermoid cyst on her ovary and had to get surgery. Our last child came out three weeks early, not breathing, not crying. I can’t even begin to explain how terrifying that is. Jazmine: I didn’t want to do any of that again. He didn’t want me to do any of that again. So we set up a vasectomy consultation. Jimmy: We hit some roadblocks in getting the vasectomy. I would have had to wait six months and travel all the way to Richmond for just the consultation. Then I got fired and had a lapse in my medical coverage, so I had to cancel the appointment. It looked like it would be at least a year-long wait before I could get a vasectomy. During this time, she’s recovering from being pregnant. We wanted serious, lasting contraception that wasn’t hormonal birth control. Since abortion isn’t legal throughout the US, the fear of getting pregnant was putting a huge damper on our sex lives. Jazmine: I couldn’t enjoy simple things like feeling horny, because feeling horny meant that you wanted to go have sex, and having sex meant the possibility of getting pregnant. I was having an aversion to our physical relationship. Getting my tubes removed just made more sense. I already had access to an OB-GYN because I had recently been pregnant – all the resources were readily available for me to ask questions and get my appointments. After educating myself on what the surgery was, and thinking about the freedom that would come with knowing you can’t naturally get pregnant no matter what, I wanted it. [After a bilateral salpingectomy it is possible to get pregnant via IVF.] Plus, even if Jimmy had easily gotten his vasectomy, there’s still a waiting period afterward where you have to get a checkup to confirm that it worked. Even if he got a vasectomy, the anxiety and “what ifs” of getting pregnant would still be there. I don’t want to be pregnant again for anybody – no matter if he dies, if we formally divorce or if I get sexually assaulted. Speaking as a survivor, these things happen. So I got the surgery in February. Jimmy will still get sterilized once we’re logistically in a place for him to do that. Jimmy: Jazmine and I are not traditionally monogamous, and I don’t want more kids. We had talked before about having four or five kids, but after what we’ve been through, we’re both done. Jazmine: Since I’ve healed, I can lean into enjoying myself again. I don’t have to worry or do ovulation math, I don’t have to do all those things that take you out of the moment. Now we get to connect in that way and also be the best parents that we can possibly be to the two kids that we have knowing we will never have another one. I wouldn’t trade that for anything. Randa, 36, and Weldon P, 38 Denver, Colorado How long have you been together? Married since 2006. Do you have kids? Four kids between the ages of nine and 15. Who underwent a sterilizing procedure? Weldon got a vasectomy in October 2023. Weldon: We always wanted four kids. I saw the stress that her body went through with that first labor – it lasted 24 hours and all I could do was hold her hand. Starting from then, I started thinking: “How can I belly up to the table and help shoulder some of the responsibility?” Randa: He would always say: “After we’re done having kids, I’ll get a vasectomy.” I never really had to ask him, so I really appreciated that. Weldon: Our youngest is nine years old. So it’s been nine years that I’ve been putting it off, because of the fear, I suppose. But Randa had been on birth control since she was 18. With my employer and my insurance, birth control is free. But the vasectomy we would have to pay for. Randa: Being on the pill was really easy and I was happy to continue – it wasn’t making me sick or causing side-effects. But at the beginning of October, I went to get my prescription renewed. My doctor said that she didn’t like me being on the pill for too long, and that maybe it’s time to start thinking about other options. I told Weldon I could do something else, like get an IUD. But he immediately said: “No, I’ve been talking about a vasectomy for a long time, let’s just go ahead and do it.” The next day we got an appointment, and the procedure took place on Halloween of last year. He jokes that it truly made it the scariest day of the year. It felt very sudden. I was worried it would hurt him. We also talked a lot about emotional side-effects, and whether he was really ready. I thought, if I needed to, I could get my tubes tied – because it’s easier, almost, to think of yourself going through something painful than signing your spouse up for something painful. He didn’t entertain that at all. He said: “This is my turn, I’ll take care of it.” But even so, the finality of not having any more kids – there was a little sadness there. Weldon: Getting the procedure done has definitely brought some relief. Originally, I had some thoughts of: “Does this make me less masculine?” because we think of masculinity with having lots of kids, right? Women, with menopause, they always know that there’s a finite window. But for a man, there’s no window, and we don’t usually ever have to think about that. But now it has no bearing in my mind. I’m not any less successful or attractive. I’m still a husband. I’m still a dad. Interviews have been edited for length and clarity. *Names have been changed.