Introduction

On June 24 2022, the United States (U.S.) Supreme Court ruled abortion unconstitutional in Dobbs v. Women’s Health Organization, an unprecedented hearing which resulted in the overturning of two landmark rulings that previously protected abortion as a human right under the fourteenth amendment; Roe v. Wade and Planned Parenthood of Southeastern Pa. v. Casey [1,2,3]. The decision issued in Dobbs ultimately gave states decisive power over abortion access and restrictions. Following the U.S. Supreme Court’s radical decision, several states were free to enact trigger laws, leading to the immediate ban of abortion within their borders. Since the radical court ruling in 2022, 14 states have outlawed abortion, with another 10 states restricting access [4]. Fig. 1 demonstrates states with abortion bans and restrictions in effect at the time of this review. These restrictions have not only resulted in significant boundaries to safe abortion care, but also dramatic alterations in the legal, social, and medical climate surrounding reproductive rights in the U.S.

Fig. 1
figure 1

U.S. Map of States with Abortion Bans and Restrictions (as of September 2024).

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Total abortion bans carry significant public health concerns regarding maternal health. Restrictive abortion laws will result in limited abortion care education and training, forcing patients to seek unsafe alternatives. Because of this, pregnancy-related deaths are estimated to rise up to 21% in states instituting complete abortion bans, with an even greater impact in the non-Hispanic black population [5, 6]. The public’s response to these staggering figures resulted in a rise in interest in permanent sterilization for both women and men, in the form of tubal ligation and vasectomy, respectively [7, 8].

Tubal ligation is a widely accepted form of permanent sterilization for women who no longer desire the ability to conceive. Although globally regarded as an effective mode of contraception, this is an invasive abdominal surgery requiring general anesthesia, and recanalization has been reported up to twenty years after the procedure [9]. Vasectomy, on the other hand, is a minimally-invasive procedure for male sterilization that can be performed in the office under local anesthesia, negating the need for general anesthetic, with efficacy rates reported as high as 99%, making it an attractive option for permanent sterilization in couples who do not desire future conception [10,11,12].

Shortly after the nationwide shift in abortion access, urologists reported anecdotal increases in vasectomy consultations and procedures [13, 14]. Subsequently, several peer-reviewed studies emerged quantifying these trends across different geographic and social populations [7, 8, 15,16,17,18,19,20,21,22,23]. This article aims to review the recent literature that has emerged regarding vasectomy trends since the Dobbs decision, exploring trends in both vasectomy interest and utilization, and highlighting the evolving role of vasectomists in maintaining the contraceptive health of U.S. couples in the post-Dobbs era.

Methods

A literature review was conducted in August 2024 using PubMed and Medline to identify all articles referencing vasectomy interest, consultation rates, and procedural trends following the Dobbs ruling. The literature search covered studies available on PubMed between June 2022 and August 2024. The keywords “vasectomy” and “Dobbs” were utilized. All studies investigating vasectomy trends, whether in interest, consultation, and procedural completion, published during the time period, were included. A total of five studies were identified quantifying search trends and public interest in vasectomy post-Dobbs. Additionally, five publications evaluating vasectomy consultation and procedural trends post-Dobbs were included, including three primary publications from single center institutions. One additional study characterizing social media (SoMe) themes on the video-based platform, Tik Tok, was included as it directly referenced videos posted in the post-Dobbs era.

Trends in Public Interest in Vasectomy

Jamie Ducharme proclaimed that “Vasectomies Are Going Viral…” in his piece in TIME magazine from May 2022, highlighting public interest in vasectomies following the leak of the Dobbs draft [13]. In his article, Ducharme cited google search trends to substantiate his argument, demonstrating a rise in both “vasectomy” and “tubal ligation” searches immediately following the draft leak. In the current technological era, Google Trends is an increasingly utilized tool that can gauge public interest and awareness in specific topics, providing insight into current search patterns across a variety of sociodemographic groups.

In the post-Dobbs era, Google Trends proved beneficial in assessing the public’s reaction to the ruling. Ghomeshi et al. demonstrated a 121% increase in searches related to “vasectomy” during the week following the leak of the Dobbs decision as compared to the week prior [7]. In the months following the Dobbs hearing, a similar trend was observed. Across all forms of male and female contraception, there was a significant increase in Google searches, with searches peaking 24–72 h after the verdict was delivered. In the ten days following the decision, there was an overall seven-times increase in “vasectomy” as compared to pre Dobbs [8]. Subsequent longitudinal studies demonstrated a sustained heightened interest in vasectomy, with greater increases in states with stricter abortion laws [23]. Patel et al. similarly found that public interest was highest in states with stricter abortion laws, such as Oklahoma, Utah, and Idaho [20]. However, these states also were found to have significantly lower ratios of urologists to adult men, highlighting the potential future strain on the urological community in these regions. Moving forward, it will be important to continue monitoring these trends in interest in sterilization in order to help predict regional and demographic urologic needs and ensure work force and resources are allocated accordingly.

In terms of motivation for pursuing vasectomy, a recent study reviewing content on the video-based SoMe platform Tik Tok provides some insight [24]. Tzelves et al. reviewed the top 100 videos posted with the hastag “#vasectomy” since December 2023, and found 9% of videos specifically referenced the Dobbs ruling. Other reasons for undergoing vasectomy that were documented included 12% of videos mentioning women’s rights, and 5% of videos that felt vasectomy was safer compared to tubal ligation. Fortunately, 61% documented a positive experience during the vasectomy process. Future studies of SoMe trends may help identify areas of disinformation, and help physicians provide more adequate counseling pre-procedurally.

Vasectomy Trends by Region

Historically, permanent contraception has more heavily burdened female partners. Data from the 2002 National Survey of Family Growth suggests that 16% of women undergo tubal ligation as compared to only 6% of men undergoing vasectomy in the U.S [25]. Furthermore, vasectomy rates in the U.S. were previously noted to be decreasing across all geographic locations between 2007–2015 [26]. Prior to the Dobbs decision, vasectomy rates varied by geographic region, with the highest proportion being performed in the North Central (0.66%) and Western (0.61%) regions of the country, and lowest in the Northeast (0.41%) [26]. In order to meet patient need for reliable permanent contraception, various initiatives were considered to improve vasectomy utilization rates, including qualitative research into patient-related barriers to seeking vasectomy, enriched training opportunities for providers, and widespread utilization of the minimally invasive “no-scalpel” approach [27]. However, when the decision of Dobbs was announced, urologists recognized the substantial impact this might have on vasectomy volume.

Nationwide, vasectomy trends were noted to have increased by approximately 20% in the U.S. in the seven months post-Dobbs as compared to the seven months prior, as estimated by claims data [19]. This trend was persistent in subgroup analysis across different age, race and ethnic groups, except in men aged 40–60 years old, who had a downtrending rate in vasectomy consultation. However, this data set did not explore state-specific trends which is of particular interest given the large variation in abortion control amongst states. States with reported post-Dobbs vasectomy trends have been summarized in Table 1.

Table 1 Primary Publications Reporting on Trends in Vasectomy Consultations Post-Dobbs.
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The first published data regarding vasectomy trends emerged from a quaternary care center in Ohio. On June 24 2022, hours after the Dobbs decision, the Ohio Senate moved to enact the Human Rights and Heartbeat Protection Act, which would ban abortion statewide after six weeks gestational age [28]. Single institutional data from Ohio after the introduction of this bill demonstrated a 22.4% increase in vasectomy consultations in the three months (July-August 2022) following the Dobbs decision as compared to the same time period the year prior (July–August 2021) [15]. These consultations were not merely patients seeking information, as this study also demonstrated an increase in procedural volume as well, with the number of vasectomies completed per month rising to 218/month from 124/month. Of note, due to the subsequent November 2023 ratification of Issue 1, abortion is legal in the state of Ohio at the time of this review.

Interestingly, analysis of vasectomy volume in states electing to preserve abortion rights demonstrated similar trends. For example, the state of Michigan moved to preserve abortion right shortly after the Dobbs decision through a temporary injunction which banned the enforcement of the 1931 abortion ban. Even so, Zhu et al. found a 150% rise in vasectomy consultation and 160% increase in vasectomy volume at their Michigan-based institution in the six months following the Dobbs decision [17]. On the other hand, studies from the state of California, which protected the right to abortion and expanded coverage for contraception including vasectomy with the Contraceptive Equity Act of 2022, found a rising vasectomy consultation rate that did not reach statistical significance [18, 29]. This discrepancy may be explained in part by the already higher rates of vasectomy on the west coast, or due to patient reassurance of preserved abortion rights given the generally liberal political climate of California [26].

Post- Dobbs variations in state-specific utilization of vasectomy were also pronounced in the military health system (MHS) cohort. Pierson et al. reported an overall increase in vasectomy utilization in patients in the MHS, with an accentuated spike in vasectomy utilization in Texas, a state with immediate triggering of laws banning abortion, as compared to Virginia, a state which took no legislative action against abortion in the immediate post-Dobbs era [16]. While altogether these studies suggest a nationwide rise in vasectomy use, with higher rates in more restrictive states, future studies are needed to directly correlate legal limitations of abortion with vasectomy utilization.

Vasectomy Trends by Patient Age

Prior to Dobbs, average vasectomy age was reported to be approximately 36–37 years old [30]. Furthermore, increasing age is associated with higher likelihood of seeking vasectomy [31]. After the issuance of the Dobbs decision, investigators theorized that the average age for men seeking vasectomy may decrease. The median age of men undergoing vasectomy in the post-Dobbs era, compared to the pre-Dobbs cohort, can be found in Table 1. Bole et al. found the median age for patients seeking vasectomy to be significantly lower in the post-Dobbs period, with a substantial rise in men under 30 seeking consultation of vasectomy [15]. A similar trend towards younger age at time of vasectomy was observed in an MHS cohort [16]. Although not statistically significant, there was also an increase in vasectomy utilization in men age 18–24 seeking vasectomy in Michigan [17]. As time passes from the initial issuance of the Dobbs decision, longitudinal studies investigating regret and reversal rates in these men who sought vasectomy at a younger age as a result of the ruling may yield crucial insight into motivational factors driving these trends.

Vasectomy Trends By Child/Partner Status

Earlier data from pre-Dobbs demonstrates a direct correlation between likelihood of vasectomy and number of children, with up to 84% of men undergoing vasectomy having at least two children at the time of their procedure [31]. Prior to the Dobbs ruling, it was estimated that approximately 3-4% of men undergoing vasectomy were childless [32]. However, in the post-Dobbs era, multiple researchers identified an increase in the proportion of childless men seeking vasectomy consultation, with some studies reporting that up to 19% of men seeking vasectomy consultation in the post-Dobbs era to be childless [15, 17, 18]. The reported rates of partnerless vasectomy consultation in the Post-Dobbs era are summarized in Table 1. In a one-year extended study, Nguyen et al. found that men undergoing vasectomy in the post-Dobbs era had significantly fewer children than pre Dobbs [18]. This data suggests a changing paradigm in the country’s contraceptive patterns in couples who do not wish to conceive with the reversal of Roe v. Wade, with more male engagement and participation in contraceptive practices [22].

The impact of partner status on vasectomy rates was also explored in several studies. These findings are summarized in Table 1. A majority of studies reported an increase in vasectomies in single men [16,17,18]. One study, however, failed to find an association between marital status and vasectomy rates. The authors theorize this discrepancy could be partly explained by a desire amongst single men to maintain reproductive autonomy in light of restrictive abortion laws [15]. Female partner tubal ligation rates could also contribute to lower rates of vasectomy in married men, which were not reported. Thus, future studies capturing detailed female partner data are needed to further delineate the true association between vasectomy rates and marital status.

Conclusion

In light of heightened uncertainty surrounding safe abortion access following the issuance of the Dobbs decision, researchers across the U.S. are seeing a significant shift in male participation in contraceptive planning. This is evidenced by increased public interest in vasectomy online, and rising rates of vasectomy consultation visits across the country. Furthermore, younger, unmarried, and childless men appear to be seeking vasectomy at higher rates as compared to pre-Dobbs. These data point towards a changing paradigm in contraceptive patterns within the U.S. However, longitudinal studies are needed to determine the sustainability of these patterns, specifically with regards to long-term satisfaction and vasectomy reversal rates in this cohort of young men who sought vasectomy shortly after the Dobbs decision. Nonetheless, further awareness and understanding these societal shifts is crucial for all healthcare providers, as they highlight the potential population-level ramifications of changing access to reproductive care.