The Complicated History of the Vasectomy

A United States Supreme Court decision earlier this year has changed the reproductive and contraceptive landscape across the nation. Anecdotally, many urology practices have noted a substantial increase in the number of patients seeking vasectomy since the June 2022 Supreme Court decision. A recent study assessing the volume of Google searches for "vasectomy" showed that such searches peaked on June 25, 2022, corresponding to the highest search rate within the past 5 years and a fourfold increase in the average rate throughout that timeframe.¹ Given this renewed interest in vasectomy, a brief review of the history of the procedure is timely.

A comprehensive review of the history of vasectomy was published by Sheynkin in Urologic Clinics of North America in 2009 and remains a definitive review of this topic.² The pertinent highlights of this history from that chapter summarized below in this article cannot ignore some of the misguided beliefs regarding potential unfounded medical benefits thought to be associated with the procedure nor the problematic association of vasectomy to eugenic movements of the early 20^th century. However, vasectomy has overcome this history to become a safe and effective form of permanent birth control for men.

The first reported vasectomy was performed on a dog in 1823 by Sir Astley Cooper.³ He found that this did not result in atrophy of the testicle as occurred with occlusion of the testicular artery. Castration had been recognized as a method of improving symptoms from benign prostatic hypertrophy in the 19^th century,⁴ and the first vasectomies performed in humans were also done with the goal of improving voiding. Felix Guyon made reference to vasectomy as an alternative to castration for inducing prostate atrophy in 1885,⁵ and Karl Gustav Lennander in Sweden similarly suggested that vasectomy could be an alternative to castration.⁶ Reginald Harrison reported in 1900 on over 100 vasectomies done for the purpose of addressing BPH symptoms.⁷ The effects of vasectomy on voiding symptoms were unsurprisingly disappointing, and the procedure fell out of favor as a treatment for BPH. With the development of new surgical treatments for prostate enlargement, bilateral vasectomy at the time of such intervention to prevent epididymitis did become commonplace until improved surgical techniques and more effective antibiotics made this unnecessary.^8,9

Another unfounded purported medical benefit for vasectomy promoted in the early 20^th century was the return of youthful vigor, or "rejuvenation". Eugen Steinach was the most prominent promoter of this concept and popularized vasectomy for this purpose ¹⁰. Vasectomy was performed on thousands of men with the express goal of reversing the effects of aging, including some famous men such as W.B. Yeats and Sigmund Freud.¹¹ Unsurprisingly, vasectomy fell out of favor for rejuvenation when scientific data failed to confirm its effect to be anything other than placebo, and the discovery of testosterone and its potential benefits offered a more likely target in this area.¹²

Harry Sharp, MD

The role of vasectomy in limiting reproduction by certain segments of the population remains an extremely problematic element in the history of this surgical procedure. A.J. Ochsner in Chicago reported on the first vasectomies in the United States in 1897, and he suggested a role for sterilizing habitual criminals and "chronic inebriates, imbeciles, perverts and paupers".¹³ Harry Sharp, the chief physician at the Indiana State Reformatory, published on his experience performing vasectomies on inmates,¹⁴ and in 1907 the Governor of Indiana signed a law authorizing the involuntary sterilization of criminals and others deemed undesirable to procreate.¹⁵ Involuntary eugenic sterilization in those with certain conditions or guilty of particular crimes spread throughout the United States in the first half of the 20^th century but had ceased by the 1960s.

It wasn't until after the Second World War that vasectomy took on its modern role as a voluntary means of birth control and family planning. It was utilized first to a great degree in the developing world. India in particular enthusiastically embraced vasectomy as a means of population control beginning in 1954,¹⁶ and the number of men receiving vasectomies in the mid-1970s increased by millions, often aided by incentives and recruitment.¹⁷ In the United States, vasectomy began to be promoted for family planning in the 1950s, and in the mid-1960s, approximately 40,000 were being performed annually.¹⁸ By 2015, 527,476 vasectomies were estimated to have been completed that year in the United States.¹⁹ With the spike in interest in vasectomy since the Supreme Court decision earlier this year, it remains to be seen if unprecedented rates of vasectomy will occur this year or be sustained in the coming years.

As Sheynkin's thorough review in Urologic Clinics has made clear, vasectomy has evolved over the past two centuries from a procedure done with goals very divergent from reproduction prevention to a commonly performed and desired means of safe and effective permanent sterility.

References

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2. Sheynkin YR. History of vasectomy. Urologic Clinics. 2009 Aug 1;36(3):285-94
3. Cooper A.: Observation on the structure and diseases of the testis. 1830. Longman, London
4. Ricketts B.M.: Surgery of the prostate, pancreas, diaphragm, spleen, thyroid and hydrocephalus: a historical review. 1904. Lancet ClinCincinnati
5. Alyea E.P.: Vaso-ligation: a preventive of epididymitis before and after prostatectomy. J Urol 1928; 19: pp. 65-80
6. Gallant A.E.: Sterilization of the unfit by vasectomy. Med Times 1915; 43: pp. 39
7. Harrison R.: Remarks on vasectomy relative to enlarged prostate and bladder atony. Lancet 1900; 155: pp. 1275-1276
8. Meltzer M.: Bilateral vasectomy for prevention of epididymitis in prostatism. NY State J Med 1928; 28: pp. 1290-1292
9. Wagenaar J.: Vasectomy in prostatic surgery. Eur Urol 1975; 1: pp. 275-277
10. Steinach Eugen: Verjüngung durch experimentelle neubelebung der alternden pubertätsdrüse. Archiv für Entwicklungsmechanik der Organismen 1920; 46: pp. 557-610 German
11. Wyndham D.: Versemaking and lovemaking: W.B. Yeats "strange second puberty." Norman Haire and Steinach rejuvenation operation. J Hist Behav Sci 2003; 39: pp. 25-50
12. Schultheiss, Dirk; Engel, Rainer M. (1 November 2003). G. Frank Lydston (1858–1923) revisited: androgen therapy by testicular implantation in the early twentieth century, World Journal of Urology. 21 (5): 356–363
13. Ochsner A.J.: Surgical treatment of habitual criminals. JAMA 1899; 32: pp. 867-868
14. Sharp H.C.: Vasectomy as a means of preventing procreation in defectives. JAMA 1909; 53: pp. 1897-1902
15. Reilly P.: Involuntary sterilization in the United States: a surgical solution. Q Rev Biol 1987; 62: pp. 153-170
16. Sharma, Sanjay (April–June 2014). "A Study of Male Sterilization with No Scalpel Vasectomy" (PDF). JK Science. 16 (2): 67
17. Liskin L., Pile J.M., Quillin W.F.: Vasectomy: safe and simple. Population Reports Series D 1983; 4: pp. 61-100
18. Davis J.E., Hulka J.F.: Elective vasectomy by American urologists in 1967. Fertil Steril 1970; 21: pp. 615-621
19. Ostrowski, Kevin A., et al. "Evaluation of vasectomy trends in the United States." Urology 118 (2018): 76-79

Author

David R. Paolone, M.D.
Associate Professor
Department of Urology
University of Wisconsin School of Medicine and Public Health