Family Planning in Men

Irwin G. Common Male Genitourinary Issues: Family Planning in Men. FP Essent. 2026;567:23-28.

Case 3. PR is a 32-year-old man who had a vasectomy performed 6 months ago. He did not keep his follow-up appointment for a postvasectomy semen analysis. His female partner has recently been confirmed to have a viable intrauterine pregnancy at 16 weeks’ gestation. He is inquiring about the effectiveness of his procedure.

Globally, male-directed options, namely, condom use and vasectomy, comprise only 16% of contraception used, although many men state a desire to use methods that allow them to share responsibility for contraception.¹ Women also voice a desire to have male-directed contraceptive options, although most also are insufficiently informed about how male contraceptives may work.² Currently, the only methods of male contraception currently available outside of research protocols are condoms as barrier protection and vasectomy, which is generally considered nonreversible.¹

Populations that have less knowledge of sexual health or distrust of the health care system may not have the information necessary to make informed choices about contraceptive options.³ Further, access to counseling about options and contraceptive care may be limited for men of lower socioeconomic status. Less than 25% of public clinics in the nation offer vasectomy.³ In addition, access to condoms may be limited by cost.³

Unnecessary barriers to obtaining contraception should be eliminated.⁴ Genitourinary examination and laboratory testing are not indicated as a precursor to counseling men about contraception options for themselves or educating men about options that exist for female partners.⁴

Vasectomy is a highly reliable male contraception option that is generally considered not to be reversible.⁵ Approximately 7% of all men in the United States have undergone vasectomy, with a reported success rate of up to 99%.^6,7 Vasectomy rates increase with age, with only 0.2% of men ages 18 to 24 years reporting the surgery compared with 14.5% of men ages 45 to 49 years.⁷

Vasectomy is an office-based procedure wherein the vas deferens is removed or cauterized under local anesthesia.⁵ Before the procedure, men should have an interactive consultation with the performing physician to ensure informed consent.^8,9

Men often receive little counseling about contraception during routine health visits, with only 0.8% of those ages 18 to 64 years receiving vasectomy counseling as noted in one study using insurance claim review.¹⁰ Men may not have already established care with a urologist before choosing a vasectomy, and up to 13% of vasectomies are performed by family physicians.^5,10 Family physicians have an important opportunity to provide men with counseling on the full range of contraceptive options to allow for informed decision-making.