"In 2014, I was doing 1 to 2 vasectomies per month, in 2021, around 25"

• On the occasion of the release this week of the comic strip

  Les Contraceptés

  , a survey by two journalists on male contraception,

  20 Minutes

  is examining this still taboo subject.

• If vasectomy is starting to interest more men in France, this surgical operation for permanent contraception remains confidential.

• Vincent Hupertan, specialist in this technique for ten years, explains how this operation takes place and what can be expected.

When you start to bring up the subject, in general, men make faces.

Vasectomy, this surgical operation which allows permanent male contraception, scares many.

However, more and more French people are interested and are taking the plunge.

According to our MoiJeune * survey, 22% of men aged 18 to 30 would be ready to undergo a vasectomy.

The urologist Vincent Hupertan, specialist for ten years of this operation, explains to

the techniques, the risks… and the brakes which make that the vasectomy, if it is made known, remains confidential.

Why is France so late compared to other countries on male contraception?

Today, in all countries of the world, the most common male contraception is vasectomy.

In France, the first bioethics law, in 1994, prohibited it.

It was not until 2001 that it was authorized and its legal framework clarified.

While we did not exceed 1,000 vasectomies per year in the 2000s, we rose to nearly 10,000 in 2018.

In France, we talk about equality between men and women, but that remains an illusion.

There is also a lack of information.

Are we talking about vasectomy at school, at university, at family planning?

Today, people come to me through the Internet, the media, word of mouth.

I have a patient for a vasectomy because his best friend has done it before.

Do you have the impression that the “contraceptive burden” is a topic that is starting to gain traction in public opinion?

Yes, the context is more conducive to this change.

We have a society that refuses chemicals, turns to organic.

We are also in post-MeToo.

And some do not want to have children.

Is this translating into increased demand for vasectomies?

In 2014, I was doing one or two a month.

In 2021, I'm around 25 a month.

And this is confirmed at the national level: from 2017 to 2018, we went from 4,800 to nearly 10,000 operations!

There is an emerging societal demand from men.

About 80% of my patients tell me: "I had two children, my wife took the pill until she was 40, now it's up to me".

Exactly, isn't there a generation gap on vasectomy?

In Quebec, one in three men has had a vasectomy, in New Zealand, 19%.

These examples show that contraceptive equality arrives at a certain stage in the life of a couple: around age 40, if the couple is stable and in terms of parenthood, their goals have been achieved.

I note, however, an increase in demand from young people under 25.

When the patient is 18, I say, "I don't think that's the age to make such a drastic decision."

But at 24, we discuss.

How does a vasectomy work?

The idea is to prevent sperm from going from the testes, a tight-flow factory that doesn't store, to the seminal vesicles behind the prostate.

After the operation, 5% of the sperm volume is lost.

But otherwise, nothing changes.

The man ejaculates in the same way, he has the same orgasms, and obviously nothing changes on the testosterone side.

Usually, the use of postoperative pain medication is limited to the first two or three days, if at all.

In contrast, 1% of men can experience chronic pain.

This is post-vasectomy syndrome, which occurs after three months and will go away over time.

But we have neither an explanation nor an ideal solution.

Are there different techniques?

Yes, two.

If the principle of vasectomy remains the same - interrupting the vas deferens - it is the way of looking for the channels that changes.

There is the classic way, by an open surgery of the scrotum [the envelope containing the testicles].

The operation is most often performed under a brief general anesthesia on an outpatient basis.

There is another technique, called "vasectomy without scalpel", in which a small incision of a few millimeters is made to limit the surgical risks and in particular bleeding.

Described in the 1970s in China, it was exported to the United States and has become the reference technique in many countries.

It is performed in vasectomy centers, under local anesthesia.

What are the main obstacles?

First, ignorance.

Misconceptions of castration type, drop in testosterone, absence of ejaculation… And the fact that this is definitive blocks many men.

There is also the financial aspect.

Social Security reimburses around 60 euros for the operation.

But that does not cover the actual costs.

In 2017, it was calculated that in reality there was a net loss of 136 euros per operation for the hospital.

In the private sector, doctors overrun fees that not everyone can afford.

Some mutuals reimburse all or part.

Is a vasectomy always irreversible?

In France, the law provides for two consultations four months apart, for a period of reflection.

We stress the difficulty of going back and the possibility of keeping your gametes in a Cecos.

In countries like the United States, where 500,000 vasectomies are performed per year, 6% of these men change their mind.

The teams, trained, have a success rate of 90% in the event of vasovasostomy [operation to become fertile again].

Which I also get, but I do one every 3-6 months!

What about other contraceptive techniques?

Much hope was aroused by the discovery in India of Risug (Reversible Inhibition of Sperm under Guidance). It is reversible, since this time we will not cut the canal, but inject a gel so that the sperm are ineffective. This contraceptive can last up to thirteen years and we can cancel the effect of the molecule with a second injection so that the man becomes fertile again. But we've been waiting for the results of a clinical trial for years ...

As for the hormonal methods (weekly injection) and thermal (heating briefs or ring), they remain complicated. Knowing that there is a physical inequality between men and women: A woman who takes the pill no longer fertile quickly, and as soon as she stops, she can get pregnant in the next cycle. For the man, it is very different, it is necessary to wait 3 to 6 months so that it is sure to be infertile. As long as it is necessary to keep a method of female contraception. On the other hand, for both techniques, there are contraindications and they are limited in time: eighteen months for hormones and four years for the thermal method.

* Study #MoiJeune 20 Minutes - OpinionWay, carried out online from October 12 and 13 with a representative sample of

Health

Single-dose, effective 13-year-old male contraceptive could be on the market as early as 2020

Society

Fifty years of the Neuwirth law: What about male contraception?

• Society

• Health

• Sexuality

• gender equality

• Contraception