Modern times: Men and birth control

It's not very often that someone asks a happily married man about his hypothetical next wife. And yet, this is what happened over and over when R. told his male friends that he'd had a vasectomy. Five years wed, 39, father to two kids, he heard a similar line from several people: "But what if you split up?"

His actual wife was insulted by the implication that their marriage is just a temporary holding pen, but she noticed something else, too: "I don't think a woman would hear the same comment if she announced she'd had a tubal ligation."

Even though it takes two to tango a baby into existence, the subject of male fertility is still framed in nervous tones, if it comes up at all. In an Australian study of 1,000 men, 66 percent agreed that men should take responsibility for birth control, but only 11 percent said they would consider a vasectomy, the only option available to the less-gentle sex outside of condoms. Perhaps the reason, as one blogger writes, is fear: "I can think of no one who I would allow to hold a razor-sharp blade to my testicles."

But, in fact, the modern vasectomy is a safe and minimally invasive procedure; a manicure takes long­er, and is probably dirtier. (Risk of infection post-vasectomy is less than one percent.) Those men who reject vasectomy with a spit-take may be unwitting buyers of the convenient idea that halting sperm is an act "against nature." The trophy-wife-ahead jokes come with a subtext: Men need to spread their seed far and wide until the moment of death – that's just their man thing, man – and stymying that impulse is, well, unmanly. This may be why many men writing online about vasectomies (even those in favour) often disavow their agency in the decision: The sensitive "I did it for her" pro-vasectomy guys and the beer-burping, back-slapping "Dude she handcuffed you" fear-of-vasectomy guys swim side by side in the murky waters of the male-birth-control debate.

But men may have to get used to a new level of family-planning responsibility as we enter a new age of male birth control. This spring, a group of physicians announced that the male-birth-control pill is "safe, effective and reversible." The pill is a combination of progestin (a synthetic form of the hormone secreted by women's ovaries) and testosterone that blocks sperm production, similar to the way the female pill prevents ovulation.

Recently, Popular Science magazine reported on more radical inventions: One engineer is developing a radio-controlled implant that could stem sperm-flow with a hand-held device (bringing new urgency to the age-old question "Honey, have you seen the remote?"). "Sperm plugs, sperm dissolvers and heat-inducing gels" are listed as other potential non-hormonal methods in the making.

But how will we talk about these options when we can barely discuss the most effective one we already have? Vasectomy has a failure rate of 1 in 1,000, versus the 30 in 1,000 failure rate of condoms. Fifty thousand Canadian men a year have vasectomies, but these seem to occur in a private realm, ne'er seen nor spoken of, like unicorns.

For Daniel O'Quinn, a professor at the University of Guelph, the decision was easy: He has two kids with his partner and has acted as a sperm donor to friends, resulting in three more children. "I felt I was well represented in the world," he laughs.

Mostly, O'Quinn and his wife had experienced the pleasure of condom-free sex when they made their babies, and they didn't want to go back to latex. Yet, along the way to surgery, he en­­countered much resistance. At the hospital he was referred to after a long consultation with his doctor, the nurse told him to think it over further and come back with a decision at the second visit. He had already made up his mind, he explained, but the policy held that he had to wait, as if it were unfathomable that any man would make a reasoned, unconflicted choice for vasectomy. (Let me pose a Carrie Bradshaw–style question: Is vasectomy the male abortion?) When O'Quinn talks vasectomy, most people are supportive, but a few did ask if he'd been "persuaded." This is a common refrain: "Did your controlling wife make you do it, Castrato?"

Yes, birth control is all about control, but here's a shocker: Most women are eager to pass it on. A colleague of mine who went through two difficult births wants her husband to have a vasectomy. "It feels like my body has played a big role in the relationship. I've taken care of birth control for 13 years. It's his turn now," she says.

Her husband, however, is reluctant; he's not entirely sure that two kids are enough, and he wants to "keep his options open." "He knows I can't go through childbirth again, so I don't know exactly what those options are," says his wife. He may be put off by the undeniable symbolism of the vasectomy: a reduction at the site of male power. Men wonder if their virility will be compromised; if they'll ejaculate again (relax: Sperm accounts for only one percent of ejaculate); if they'll still be male. And to some, it's a more permanent reminder of one's monogamy than a wedding band (and one that's harder to take off: After the first year, successful reversal rates decline steadily).

"Vasectomy figures commitment in really tangible ways. You're not just making a decision about not having kids with a current partner; you're also not going to have kids with a future partner," says O'Quinn. "Vasectomies force guys to confront the future in a way they aren't usually asked to."

There's a more upbeat mythology around vasectomies, too: In the 1920s, Austrian physiologist Eugen Steinach spread the theory that the procedure was a way for men to rejuvenate and restore their sexual vigour. Today's vasectomies come with less lofty claims, but they probably hurt less, too. Instead of scalpels and sutures, the popular 15-minute "non-surgical" procedure involves a skin puncture over the vas deferens. The hole is stretched open and the vas are clamped, cut and cauterized. Perhaps the shorthand for vasectomy should no longer be "snip, snip" but "sizzle, sizzle"; then again, that might be taken by The Keg.

Many post-vasectomy couples report a new, spontaneous sex life. With the lifelong power imbalance around reproduction suddenly equalized, vasectomy has the potential to change the tenor of sex. No longer is sex about the getting or avoiding of a tiny third party. It becomes about you and your partner, and that can be profoundly moving. One of the few references to vasectomy in the arts is a poem by Philip Appleman that describes a new intimacy "after the precision of scalpels": "the purity of loving/for the sake of love." This idea transforms something clinical and political into something hugely romantic. If we think of it that way, sizzle, sizzle.