Grace Shih

Vasectomy: the other (better) form of sterilization.

Male sterilization (vasectomy) is the most effective form and only long-acting form of contraception available to men in the United States. Compared to female sterilization, it is more efficacious, more cost-effective, and has lower rates of complications. Despite these advantages, in the United States, vasectomy is utilized at less than half the rate of female sterilization. In addition, vasectomy is least utilized among black and Latino populations, groups with the highest rates of female sterilization. This review provides an overview of vasectomy use and techniques, and explores reasons for the disparity in vasectomy utilization in the United States.

Racial and Ethnic Disparities in Contraceptive Method Choice in California

CONTEXT Unintended pregnancy, an important public health issue, disproportionately affects minority populations. Yet, the independent associations of race, ethnicity and other characteristics with contraceptive choice have not been well studied. METHODS Racial and ethnic disparities in contraceptive use among 3,277 women aged 18-44 and at risk for unintended pregnancy were assessed using 2006-2008 data from of the California Womens Health Survey. Sequential logistic regression analyses were used to examine the independent and cumulative associations of racial, ethnic, demographic and socioeconomic characteristics with method choice. RESULTS Differences in contraceptive use persisted in analyses controlling for demographic and socioeconomic characteristics. Blacks and foreign-born Asians were less likely than whites to use high-efficacy reversible methods-that is, hormonals or IUDs (odds ratio, 0.5 for each). No differences by race or ethnicity were found specifically for IUD use in the full model. Blacks and U.S.-born Hispanics were more likely than whites to choose female sterilization (1.9 and 1.7, respectively), while foreign-born Asians had reduced odds of such use (0.4). Finally, blacks and foreign-born Asians were less likely than whites to rely on male sterilization (0.3 and 0.1, respectively). CONCLUSIONS Socioeconomic factors did not explain the disparities in method choice among racial and ethnic groups. Intervention programs that focus on improving contraceptive choice among black and, particularly, Asian populations need to be developed, as such programs have the potential to reduce the number of unintended pregnancies that occur among these high-risk groups.

“We never thought of a vasectomy”: a qualitative study of men and women's counseling around sterilization

BACKGROUND Sterilization is the most commonly used method of contraception in the United States; however, little is known about how providers counsel about these procedures or the information patients desire. In this study, we explore male and female experiences of sterilization counseling and their perspectives on ideal sterilization counseling. STUDY DESIGN In-depth individual and group interviews were conducted with 37 heterosexual couples between the ages of 25 and 55 years. Each couple had reached their desired family size. Interviews were recorded and transcribed using NVivo software and analyzed using modified grounded theory. RESULTS Men and women differed in their experiences of sterilization counseling. Women commonly received counseling on female sterilization but not vasectomy, while men rarely discussed either form of sterilization with their providers. Both men and women desired more information about sterilization. CONCLUSIONS Contraceptive counseling of couples who have completed childbearing does not routinely include men or the option of vasectomy, despite the advantages of this method with respect to safety, efficacy and cost. Family planning and primary care providers have an important role in ensuring that couples are aware of all their options and can make an informed decision about their contraception.

He's a real man: a qualitative study of the social context of couples' vasectomy decisions among a racially diverse population.

Vasectomy has advantages with respect to safety and cost when compared with female sterilization. The reasons underlying the overall low use of vasectomy, particularly among Black and Latinos, have not been adequately explored. The goals of this study were to (a) explore the social context of vasectomy decisions and (b) generate hypotheses about the social factors contributing to differences in vasectomy use by race/ethnicity. Fourteen group and nine couples interviews were conducted. Participants were 37 heterosexual couples aged 25 to 55 years who had reached their desired family size and self-identified as Black, Latino, or White. Participants discussed reasons that men and women would or would not select male sterilization. Reasons to select vasectomy included a desire to care for their current family, sharing contraceptive responsibility, and infidelity. Reasons not to select vasectomy included negative associations with the term sterilization, loss of manhood, and permanence. Misconceptions about vasectomy included misunderstandings about the vasectomy procedure and adverse postvasectomy sexual function. In addition, Black and Latino participants cited perceived ease of reversibility of female sterilization and lack of support around vasectomy as reasons not to choose it. Improving communication and social support for vasectomy, particularly among Black and Latino communities, may improve vasectomy utilization. Misconceptions regarding female and male sterilization should be targeted in counseling sessions to ensure men, women, and couples are making informed contraceptive decisions.

Acceptability of a transdermal gel-based male hormonal contraceptive in a randomized controlled trial, ,

OBJECTIVE Fifty percent of pregnancies in the United States are unintended despite numerous contraceptive methods available to women. The only male contraceptive methods, vasectomy and condoms, are used by 10% and 16% of couples, respectively. Prior studies have shown efficacy of male hormonal contraceptives in development, but few have evaluated patient acceptability and potential use if commercially available. The objective of this study is to determine if a transdermal gel-based male hormonal contraceptive regimen, containing testosterone and Nestorone® gels, would be acceptable to study participants as a primary contraceptive method. STUDY DESIGN As part of a three-arm, 6-month, double-blind, randomized controlled trial of testosterone and nestorone gels at two academic medical centers, subjects completed a questionnaire to assess the acceptability of the regimen. Of the 99 men randomized, 79 provided data for analysis. RESULTS Overall, 56% (44/79) of men were satisfied or extremely satisfied with this gel-based method of contraception, and 51% (40/79) reported that they would recommend this method to others. One third of subjects (26/79) reported that they would use this as their primary method of contraception if it were commercially available today. However, men with concerns about sexually transmitted disease were significantly less satisfied than men without such concerns (p=0.03). CONCLUSIONS A majority of the men who volunteered to participate in this trial of an experimental male hormonal contraceptive were satisfied with this transdermal male hormonal contraceptive. If commercially available, a combination of topical nesterone and testosterone gels could provide a reversible, effective method of contraception that is appealing to men. IMPLICATIONS A substantial portion of men report they would use this transdermal male contraceptive regimen if commercially available. This method would provide a novel, reversible method of contraception for men, whose current choices are limited to condoms and vasectomy.

Bringing men to the table: sterilization can be for him or for her.

Sterilization, male and female combined, is the most common use of contraception in the United States. Despite the lower risk, higher cost-efficacy, and high efficacy of vasectomy compared with female sterilization, more US women rely on female sterilization than male sterilization. Reasons for low use of vasectomy include lack of knowledge and misconceptions about the procedure, lack of access, provider bias, and patient preferences. This article will provide a basic overview of male and female sterilization, an exploration of vasectomy barriers, and ways obstetrician-gynecologists can increase vasectomy uptake including regular recommendation of vasectomy to patients in long-term committed relationships considering sterilization.

Reversing the United States sterilization paradox by increasing vasectomy utilization

This editorial discusses how vasectomy is a more cost-effective and efficacious option than female sterilization but utilized far less frequently. It explains that shifting the balance of sterilization utilization to favor vasectomy over female sterilization will require a multifaceted approach including: provider willingness and ability to offer the service and increasing mens awareness acceptance and selection of the procedure. It also stresses that an integral step involves increasing the number of providers trained in the simple no-scalpel vasectomy (NSV) procedure. Copyright

Minimizing Pain During Vasectomy: The Mini-Needle Anesthetic Technique

PURPOSE We describe pain scores for a modified anesthesia technique for no-scalpel vasectomy using a 1-inch 30 gauge mini-needle. MATERIALS AND METHODS A prospective study was performed in 277 patients who received anesthesia using a 3 cc syringe filled with approximately 2 cc 2% lidocaine without epinephrine and a 1-inch 30 gauge needle. Local anesthesia was given directly to the vas at the expected surgical site on each side. RESULTS Mean +/- SD pain intensity score on the 10 cm visual analog scale was 1.5 +/- 1.6 (95% CI 1.3-1.7) during the anesthesia and 0.6 +/- 1.0 (95% CI 0.5-0.7) during the procedure. Patients experienced less pain during anesthesia and the procedure than they expected before vasectomy (average 3.1 +/- 1.8, 95% CI 2.8-3.3). CONCLUSIONS The mini-needle technique provides excellent anesthesia for no-scalpel vasectomy. It compares favorably to the standard vasal block and other anesthetic alternatives with the additional benefit of minimal equipment and less anesthesia.

Putting the man in contraceptive mandate.

ARHP Commentary ― Thinking (Re)Productively Putting the man in contraceptive mandate Brian T. Nguyen⁎, Grace Shih, David K. Turok Department of Obstetrics and Gynecology, Oregon Health and Sciences University, 3181 Southwest Sam Jackson Park Road, Box L466, Portland, OR 97239, USA Department of Family Medicine, University of Washington, Seattle, WA 98195, USA Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT 84132, USA

Offering the full range of contraceptive options: a survey of interest in vasectomy training in the US family planning community ☆ ☆☆ ★ ★★

OBJECTIVE To assess current practices regarding female and male sterilization counseling and provision, as well as determine interest in providing vasectomy among family planning specialists. METHODS Members of the US-based network of family planning fellowship physicians (current fellows, graduates and faculty) received a Web-based survey from November 2015 through January 2016 regarding current sterilization preferences and practices, as well as interest in obtaining training in vasectomy counseling and procedure. RESULTS Nearly 60% (n=178/302) of family planning fellowship providers responded to the survey. While 62% (111/178) of respondents reported counseling their patients about vasectomy at least most of the time and 57% (102/178) recommended vasectomy over female sterilization, few (8/178; 4 trained in family medicine and 4 trained in obstetrics and gynecology) had performed a vasectomy in the last year. Nearly 90% (158/178) of respondents were somewhat or very interested in receiving training on vasectomy counseling; 58% (103/178) desired procedural training. Desire for training was associated with being male and receiving residency training in family medicine. CONCLUSIONS Few family planning fellowship physicians provide vasectomy, and the majority expressed being at least somewhat interested in receiving further training. IMPLICATIONS Vasectomy is more effective, safer and less expensive than female sterilization but is less common than female sterilization. One barrier to vasectomy access is the low number of vasectomy providers. Creating a structured vasectomy training program through the family planning fellowship may help to increase the number of vasectomy providers.