Vasectomy, a male contraceptive option that is rarely seen

Vasectomy is 99 percent effective in preventing pregnancy. However, socio-cultural problems make male contraception less popular.

KOMPAS/JUMARTO YULIANUS

Family Planning (KB) Long Term Contraceptive Method (MKJP) service car in Banjarmasin, South Kalimantan, February 2023.

Vasectomy has long been introduced as one of the long-term contraceptive methods for men. However, its usage rate in Indonesia has never reached 1 percent and tends to keep decreasing. Social and cultural issues, as well as limited healthcare resources and facilities, make it difficult for vasectomy to develop.

The options for modern contraception for men are indeed limited, with only condoms and vasectomies available. Although vasectomies have a very high success rate in preventing pregnancy, in reality, this effective contraceptive method has not been widely considered by prospective acceptors, healthcare workers, the government, or donor agencies.

Vasectomy or also called male surgical method (MOP) is a type of modern, non-hormonal and long-term contraception in men. Vasectomy is a sterilization procedure for men which is carried out by cutting and tying the left and right sperm ducts (vas deferens) which carry sperm from the testicles to the penis. This operation is performed by a trained surgeon, urologist or general practitioner.

Cutting the duct makes it so that the sperm cannot mix with the semen or seminal fluid. Therefore, when men undergo vasectomy and experience ejaculation, their semen no longer contains sperm. Consequently, during sexual intercourse, husbands cannot fertilize their wives' eggs, resulting in no pregnancy.

Also read: Vasectomy activities will be encouraged

The popular method of vasectomy in Indonesia and the world, as quoted from the website of the National Population and Family Planning Agency (BKKBN) on November 18, 2019, is non-scalpel vasectomy. This procedure is chosen due to its minimal risks and complications. In addition to being safe, the process is also relatively short.

Swelling, discomfort, or bleeding may occur during and after the procedure. After the surgery, men who have undergone a vasectomy are expected to abstain from ejaculation for seven days, and avoid heavy work for several days.

KOMPAS/AGUS SUSANTO

Residents pass by a mural depicting various contraceptives in KB Village, Bintara Jaya, Bekasi City, West Java, Monday (13/2/2023).

After undergoing vasectomy surgery, it does not immediately function effectively. Therefore, they are still advised to use additional contraception for at least three months and undergo sperm analysis examination in the third month after surgery to ensure that their semen does not contain sperm.

The success rate of vasectomy in preventing pregnancy reaches 99 percent. This means that only less than 1 out of 100 women become pregnant after their male partner undergoes vasectomy procedure for a year.

Despite vasectomy being a permanent procedure, there are options to reverse it and restore the flow of sperm as it was before being cut and tied off. The effectiveness of the procedure, known as vasovasostomy, in restoring male fertility, can reportedly reach 80-90 percent if performed by an experienced microsurgeon, according to Yale Medicine.

However, vasovasostomy is even less popular in Indonesia. The vasovasostomy procedure is more complex, challenging, and takes longer compared to vasectomy surgery. Vasovasostomy not only involves reconnecting the previously cut sperm duct, but also ensuring that there is sperm in the duct.

Husband and wife have equal positions and the same responsibilities in matters of reproductive health.

Therefore, every couple that will undergo vasectomy needs to think about it carefully. Vasectomy has lifelong impacts, so do not use emotions to make the decision.

It's not just a women's thing

Although its effectiveness in preventing pregnancy is very high, vasectomy has not become the choice of many prospective male acceptors. This method, due to cultural considerations and societal norms, is often seen as a last resort for fertile couples who no longer wish to have children.

Guidelines for Contraception and Family Planning Services, Ministry of Health, 2021 states that all men can undergo vasectomies safely after they receive counseling and sign an informed consent form (informed consent).

KOMPAS/JUMARTO YULIANUS

Officials implanted long-term contraception devices on family planning acceptors using the Kubah Basirih religious tourist site in Basirih Village, West Banjarmasin, Banjarmasin City, South Kalimantan, in May 2023.

Men who can undergo vasectomy are those who already have more than two children or have at least two children with the youngest child being over 2 years old. Men who have a wife in the reproductive age range or suffer from sickle cell disease (an inherited disorder that makes red blood cells shaped like a sickle) can also undergo vasectomy.

In fact, men who are at high risk of being infected with sexually transmitted infections or have been infected with the human immunodeficiency virus (HIV), whether they are undergoing antiretroviral treatment or not, can also have a vasectomy.

From the aspect of gender equality, vasectomy is viewed as an effort by men to take over the burden of women and bear the risk of contraceptive use that has so far been focused on women. However, husbands and wives have equal standing and the same responsibilities in reproductive health issues.

Despite that, many social-cultural issues hinder the smooth implementation of vasectomy in men. Many myths and misunderstandings arise related to vasectomy, such as the issue of vasectomy causing a decrease in male libido, making husbands unable to ejaculate, triggering impotence, and equating vasectomy with castration. These rumors spread faster than accurate information about vasectomy.

Also read: Doctors in China Refuse to Perform Vasectomies

In addition, as a permanent and long-term contraceptive, the opportunity to restore the cut sperm duct becomes more limited. This condition often involves the extended family of couples who will undergo vasectomy in the decision-making process.

Various fundamental questions are often asked, such as what will happen if a married couple who have undergone vasectomy want to have children again, either because they want to have more offspring or because their previous child died?

KOMPAS/ADRYAN YOGA PARAMADWYA

Parents accompany their children on swings at Tebet Eco Park, South Jakarta, Friday (12/4/2024).

Or, what if the married couple later divorces, whether it's a live divorce or a death divorce, and the man wants to remarry? Doesn't the new wife have the right to have offspring from the man as well? There are also concerns in the community about men who have undergone vasectomy becoming "indulgent" because they feel they can no longer impregnate women.

On the other hand, religious beliefs also play a major role in making vasectomies unpopular in Indonesia. At least, the Indonesian Council of Ulama (MUI) has issued four fatwas declaring vasectomies as forbidden, in 1979, 1983, 2009, and 2012.

The issue of air pollution is not a new one. The community has been living under the threat of air pollution for a long time, and there is no shortage of research providing evidence of the harms it can cause. However, these facts have not yet been enough to lead to significant efforts to control air pollution, and residents increasingly suffer in the face of it. In the MUI Fatwa of 2012, it was stated that vasectomy is forbidden unless carried out for purposes that do not violate religious rules, do not result in permanent infertility, can be reversed to restore normal reproductive function, and do not pose any danger to the person undergoing the procedure. Additionally, MUI also urged that vasectomy should not be included in family planning programs or permanent contraception methods.

However, as Muhyiddin wrote in the Al Ahkam Journal of Islamic Legal Thought, April 2014, changes in vasectomy law which became permissible with certain conditions have in fact not increased the number of male acceptors who undergo vasectomies. This situation could be because the latest fatwa has not been widely disseminated and there are still many clerics and other Islamic organizations that still prohibit vasectomies for a number of reasons.

Low prevalence

Various socio-cultural and technical problems with vasectomies make the prevalence of men in Indonesia undergoing vasectomies very low. World Contraceptive Use 2022 data compiled by the United Nations Department of Economic and Social Affairs (UNDESA) shows that the prevalence of vasectomies in Indonesia in 2018 was only 0.3 percent.

Meanwhile, the prevalence of tubectomy or sterilization in women has reached 1.9 percent, which is six times more than men who undergo vasectomy. The highest prevalence of vasectomy in Indonesia occurred in 1994 at 0.7 percent.

Also read: Men need to use contraception, not just women

Meanwhile, the 2023 Health Statistics Profile published by the Central Statistics Agency states that the percentage of couples aged 15-49 years who use contraception using the vasectomy method in 2023 is only 0.21 percent. Those who chose vasectomy were the smallest compared to other types of contraception, including male condoms at 2.44 percent.

Meanwhile, the percentage of other contraception users, which were used by women, included tubectomy at 3.46 percent, spiral or IUD (intra uterine device) 8.94 percent, and injections at 53.34 percent. Apart from that, 18.74 percent of them used pills and 10.75 percent of them used implants. There are also 1.43 percent who use the periodic abstinence method, which is a traditional method for preventing pregnancy.

This situation makes the involvement of men in Indonesia in reproductive health, especially related to contraceptive use, still a major challenge. If social-cultural issues make vasectomy difficult to develop, there are still other contraceptives for men that can be promoted, namely condoms.

However, the campaign for using condoms in Indonesia always causes problems despite the fact that the contraceptive is sold freely in minimarkets. Myths and suggestions about the comfort of condoms also hinder efforts to encourage the use of this contraceptive.

Amidst all of these issues, what is certain is the continued increase in cases of sexually transmitted diseases in Indonesia, from syphilis to HIV-AIDS. Sadly, these diseases are often suffered by those in the productive age group who are greatly needed to build the nation. Lack of awareness also leads them to transmit the diseases to their spouses, further multiplying the number of sufferers.

Also read: TNI Involved in Socialization of Male Contraception

Therefore, there is no other way than to raise awareness and concern among the community, government and health workers regarding development issues reproductive health and sexuality. Reproductive health is not only a matter for women, but men can also be actively involved because men who are reproductively healthy will bring health and happiness to their wives and families.