Childfree reader’s story: The consultation changed my mind

I had the most unexpected experience today. Today I had my consultation, and the doctor convinced me not to have the vasectomy.

The doctor (name on request) is a urologist at Stanford Hospital, who “has extensive experience in performing complex vasectomy reconstructions, sperm retrieval techniques and microsurgical varicocelectomies” according to a webpage describing him. He normally performs closed-ended NSV vasectomies.

I’m 31, childfree, and not in a relationship. I’ve been convinced for the past six years that I do not want to ever have children. I decided a couple of months ago to go ahead with a vasectomy and I’ve been researching it on the net. I’ve had some experience with misinformed doctors in the past so I went in today with the attitude that I’ve got to be informed as possible before I see the doctor, that doctors are tools, and that it’s important to use them effectively to get what I want. Here’s what happened:

I saw my primary care physician a couple of months ago and asked for the referral. She raised her eyebrow at my request to have a vasectomy, given my childfree status, and asked me some basic questions to determine how serious I was. It wasn’t too hard to convince her.

Today I met first with the doctor’s assistant who gave me some basic procedural information. He said he wishes he’d thought twice about having kids. Pressing for clarification, I said, “It’s a lot of work to raise kids,” and he said, “Yeah, especially as a single parent.” Good. I felt it wouldn’t be hard to convince these people that I’m serious.

Next, I saw a doctor-in-training (this is at Stanford Hospital, which is part of a medical school). She asked me more about my history and pressed me further about my reasons for wanting the vasectomy. I laid out all my reasons (there are enough people in this world already, if I have to raise a kid in the future I’ll adopt, etc.) but felt some resistance – it was much harder to convince her. Still, I thought no problem, I need only convince the doctor himself. The interactions were going pretty fast (as they usually do at Stanford), and I was worried that I might not have enough time with the doctor to answer my checklist of questions.

When the doctor came to talk to me, two students were in the room (including the resident I spoke with before). He was relaxed and spent A LOT of time talking with me. It’s a blur in my head right now but I’ll try to capture most of what I can remember. He said right away, “So what brought you to this decision?” I started down my list of reasons, but he kept repeating “What brought you to this decision?” I felt like he was really trying to connect with me. Fine, I laid out my most serious reason, which I hadn’t brought up before this point (my big gun, as it were). He wasn’t convinced.

He started talking about his duty as a doctor to do no harm, and how he always avoids performing surgery on healthy people. He then went into great detail about the risks of PVP syndrome (I was thinking, this is great! I read on this newsgroup how many doctors just seem to skip or gloss over this). He said the incidence is less than 3%, but then he really emphasized, when you get it, YOU DON’T CARE ABOUT THE STATISTICS (I’m emphasizing this with caps to reflect his emphasis). The intern then repeated the same thing. She said, when you get it, you get it 100%. She said there is no standard effective treatment for PVP. The doctor said when they treat a patient with PVP they aim for 60% pain reduction as their goal. The resident piped up with, “enough pain reduction so the patient can return to work.”

The doctor said think about it, these are your testicles. He said he has had problems with his back, but he can find a comfortable position to sit in to avoid the pain. He said how are you going to avoid pain in your testicles? They’re swinging all the time; there’s no way to get them into a comfortable position. He said “What are you going to do, tape them to your thigh or your abdomen?”

Throughout this both of them had a sympathetic tone in their voices and a cooperative attitude. They weren’t trying to scare me; they were educating me.

The doctor said that not any of his vasectomy patients have had PVP yet (knock on wood), but the statistics predict it will happen someday. He said he has had many patients come to him with PVP that had vasectomies elsewhere. He said that when patients don’t respond to pain treatments, they often have parts removed (such as the epididymis), and sometimes it’s so bad the patients have an entire testicle removed! He said the cause of PVP is still unknown.

He said patients will sometimes have pain every time they ejaculate, and they often lose interest in sex, for the simple Pavlovian reason that they associate sex with pain.

I asked about the open-ended procedure as a way to minimize the risk of PVP. Both the resident and the doctor were familiar with it and responded that it increases the chance of failure. At any point in the future, they said, the vas could reconnect enough to make the man fertile again. The doctor also discussed how sperm getting dumped in the body can trigger an autoimmune reaction and cause inflammation.

The doctor spent equal time on how many times he’s seen patients who were adamant that they never want kids and then later came back for reversals. He’s done a lot of reversals. He said they’re really to be avoided: they’re expensive, things don’t always get put back exactly the way they were, and they’re not always effective. He asked me whether I had a happy childhood, whether I wanted to talk to someone about any issues I might be anxious about. I said no thank you, and was amazed at how sincere he was and not patronizing. This guy really didn’t fit my cynical expectations about doctors being too rushed to care about the patient.

I don’t go down without a fight so I spent some time sparring with him about how committed I am to never having kids. He responded to every one of my points, then dropped the bomb: He elected not to perform the surgery on me! I was surprised and thought he was testing my conviction again. I told him I respected his decision but that I would find another doctor because I was determined. He took me seriously and talked some more.

Eventually, he won me over. I kept thinking, “Damn, this guy’s articulate, and caring, and he’s covered every point I’ve read on the Internet about vasectomy.” What I couldn’t get from the Internet was the perspective of someone who has a ton of professional experience with vasectomy, which this guy does.

I finally said, “OK, tell me specifically why aren’t you electing to do the surgery on me. Is it because you think I might change my mind later or because of the risk of PVP?” He said it was mostly former but partly the latter as well.

He even encouraged me to look at newer methods of sterilization, such as hormone therapy. I asked him for more information and he said “The Internet’s a great resource for that, start with Google.” I love this guy!

All in all, I feel really lucky that this doctor took so much of his time to share his considered opinion with me and to take me very seriously. I’m still adamant that I don’t want to have kids, but think having kids is fine for other people. After today I think vasectomy isn’t for me either (I’m not willing to take on the risk of PVP), but it may be fine for other people. Certainly, this doctor thinks it’s okay for other people because he performs them all the time.