Question 46


Why Good Doctors Refuse To Perform Vasectomies

 Very few men understand the stakes involved in a vasectomy. 

That vasectomy is an act of hostility, whether conscious or unconscious, is not my own idea but the idea of the famous psychologist Milton Erickson, who said precisely the same thing. He added that the "rational sounding" reasons such as prudent avoidance of childbearing, helping one's wife to avoid the risks of sterilization, or rationalizations simply camouflage the real and ugly reality. I have confirmed this through the years in clinical practice. One man confided to me, in a written testimony entitled "Can Manhood Be Lost?", that it was only when I brought up the long-term sequelae of vasectomy in front of his wife that for the first time years of resentment could escape to the surface, and he could express his anger at having been humiliated as a man through the experience of a vasectomy. And lest anyone think that this is an odd or idiosyncratic reaction peculiar to one individual only, be assured that it is not. This particular man was only lucky enough to be in a position to be consciously able -- because in the setting of a real conversion -- to admit the anger, shame, and self-loathing that the sin of vasectomy had engendered in him. It was the beginning of a real healing between him and his wife, something that usually is not possible in our society because the sin, fault, or injury is most often not consciously admitted. 

Vasectomized men experience unhappiness, because unless they can admit the existential, spiritual and bodily injury, they have to live in a life where they have rejected part of their own identity. Depression, sexual dysfunction, all kinds of hyper-masculine and hyper-macho acting out often takes place, and very many of these men cannot avoid expressing their anger. Still, they most often do not know the source of this anger unless they are fortunate enough, as my patient was, to learn the source and be able to repair (not "reverse") the damage. It remains true that many men undergo repair (again not "reversal"), not so much to achieve a pregnancy as to repair their manhood and restore their sense of themselves as men. If this cannot be done, then one can only expect an increased chance of infidelity, as his masculinity is propped up through the illusory acceptance of the act of adultery. There is an increased chance of divorce, as the man after a time cannot stand to be with the woman who required the loss of his manhood as a condition of their continued marriage relationship. 

For the same reasons, vasectomy often influences in an adverse way a man's relationship with his existing children. When the very source of a man's procreative powers is attacked or assaulted as it is with vasectomy -- no man should believe that vasectomies are anything less than this kind of self-violence – then he comes to loathe not only that source but the life that was generated from that source. This makes sense because the vasectomy has forced an illegitimate equation whereby either he is worthy or his procreative powers are, but not both! He will often resolve this difficulty by rejecting and loathing the idea of more children, which spills over to a rejection, at least in part, of his existing children as well. I have had personal experience with this in my practice, in a situation where two daughters born before their father's vasectomy learned that they were not valued and were rejected, and suffered all kinds of damaging mental and psychological anguish in their lives. They falsely concluded that they were in competition for their father's love. 

Finally, vasectomy has numerous health consequences at the purely physical level. Many men have chronic pain after the operation, which only is resolved with the repair. The occlusion of the tube causes spermatic "blowouts" or granulomas, and the abnormal immunologic reaction to spermatozoa suddenly and abnormally appearing in the bloodstream is an autoimmune reaction that can cause arthritis and autoimmune disease. Likewise, prostate cancer, probably chronic prostatitis, and heart disease (despite what you may read, this tendency towards heart complications has never been disproved) are all increased in frequency. 

After vasectomy wives suffer health complications too. The literature suggests increased rates of hysterectomies, abnormal menstrual bleeding, and even allergic reactions among women whose husbands have had vasectomies.

But perhaps the saddest thing is the closing off of a man's horizons to life, and to the joys that come with that. All of the complications in a marriage cannot compare with the joy of a new child, one's own child! 

Dominic M. Pedulla MD, FACC, CNFPMC, ABVM, ACPh
Associate Clinical Professor of Medicine, OU Health Sciences Center 
Medical Director, The Oklahoma Vein and Endovascular Center 
President, The Edith Stein Foundation