Epidemiological profile, contraceptive knowledge, and reasons for undergoing vasectomy at a university hospitalABSTRACT
Introduction: Vasectomy is a definitive male contraceptive method recognized for its safety, effectiveness, and low cost. Nevertheless, male participation in contraception remains limited, particularly when compared with female contraceptive methods. In Brazil, data regarding the sociodemographic profile of men undergoing vasectomy and their knowledge of other contraceptive methods remain scarce, especially within the context of the Brazilian Unified Health System (SUS).
Objective: To evaluate the epidemiological profile of patients undergoing vasectomy at a university hospital, as well as their knowledge of other contraceptive methods and the reasons leading to the choice of the procedure.
Methods: This was an observational, retrospective, cross-sectional study conducted through the review of medical records of patients who underwent vasectomy at a university hospital. Sociodemographic and clinical data, as well as information regarding knowledge of contraceptive methods and reasons for undergoing vasectomy, were collected from preoperative records.
Results: A total of 181 patients were included, with a mean age of 39.4 ± 6.6 years. Most participants were married (72.4%) and had a mean of 2.1 children. The predominant educational level was high school education (55.2%). Most patients (86.2%) reported knowing at least one contraceptive method, with a mean of 2.8 ± 1.7 known methods. The main reason for undergoing vasectomy was completion of family planning (66.9%). No statistically significant association was observed between educational level and knowledge of contraceptive methods or the reason for vasectomy. Younger patients tended to report knowledge of a greater number of contraceptive methods, although this correlation was weak.
Conclusion: Patients undergoing vasectomy presented an epidemiological profile similar to that described in the international literature, with the decision predominantly based on completion of family planning. Despite the widespread availability of the procedure, male knowledge regarding other contraceptive methods remained limited, regardless of educational level, which underscores the importance of structured preoperative counseling and strategies aimed at male contraceptive education within SUS.
Keywords:
Vasectomy; Contraception; Family Planning; Health Knowledge, Attitudes, and Practice; Epidemiology
RESUMO
Introdução: A vasectomia é um método contraceptivo masculino definitivo reconhecido por sua segurança, eficácia e baixo custo. Apesar dessas características, a participação masculina na contracepção permanece limitada, especialmente em comparação aos métodos femininos. No Brasil, ainda são escassos os dados sobre o perfil sociodemográfico dos homens submetidos à vasectomia e sobre seu conhecimento a respeito de outros métodos contraceptivos, particularmente no âmbito do Sistema Único de Saúde. Objetivo: Avaliar o perfil epidemiológico de pacientes submetidos à vasectomia em um hospital universitário, bem como o conhecimento sobre outros métodos contraceptivos e os motivos que levaram à escolha do procedimento.
Métodos: Estudo observacional, retrospectivo e transversal, realizado por meio da análise de prontuários médicos de pacientes submetidos à vasectomia em hospital universitário. Foram coletados dados sociodemográficos, clínicos e informações relacionadas ao conhecimento sobre métodos anticoncepcionais e aos motivos para a realização da vasectomia, a partir de registros pré-operatórios.
Resultados: Foram incluídos 181 pacientes, com idade média de 39,4 ± 6,6 anos. A maioria era casada (72,4%) e apresentava média de 2,1 filhos. O nível de escolaridade predominante foi ensino médio (55,2%). A maioria dos pacientes (86,2%) relatou conhecer ao menos um método contraceptivo, com média de 2,8 ± 1,7 métodos conhecidos. O principal motivo para a realização da vasectomia foi o planejamento familiar completo (66,9%). Não houve associação estatisticamente significativa entre escolaridade e conhecimento sobre métodos contraceptivos ou motivo da vasectomia. Pacientes mais jovens tenderam a relatar maior número de métodos conhecidos, embora essa correlação tenha sido fraca.
Conclusão: Os pacientes submetidos à vasectomia apresentaram perfil epidemiológico semelhante ao descrito na literatura internacional, com decisão predominantemente baseada na conclusão do planejamento familiar. Apesar da ampla difusão do procedimento, o conhecimento masculino sobre outros métodos contraceptivos mostrou-se limitado, independentemente do nível de escolaridade, reforçando a importância de uma orientação pré-operatória estruturada e de estratégias voltadas à educação contraceptiva masculina no contexto do Sistema Único de Saúde.
Palavras-chave:
Vasectomia; Anticoncepção; Contracepção; Conhecimento, Atitudes e Prática em Saúde; Epidemiologia
INTRODUCTION
Vasectomy is a definitive male contraceptive method widely recognized for its safety, effectiveness, and low cost, representing an effective option for family planning. Nevertheless, male participation in contraception remains limited, particularly when compared with female contraceptive methods. Cultural factors, misinformation, and barriers to health care access contribute to this discrepancy, especially in low- and middle-income countries.
Currently, vasectomy has an estimated failure rate of 0.10%-0.15%. In the United States, approximately 500,000 men undergo the procedure annually, corresponding to a prevalence of nearly 6% among men of reproductive age1. In Brazil, public health system data indicate that 51,692 vasectomies were performed in 2022, a number that remains modest compared with the use of female contraceptive methods2.
The main indications for vasectomy include the desire for permanent contraception, reduction of risks associated with female contraceptive methods, and socioeconomic factors. In addition, vasectomy may be considered in individuals with known hereditary conditions as a strategy to prevent genetic transmission to future generations3,4.
In the Brazilian context, family planning legislation was updated through Law No. 14,443/2022, which reduced the minimum age requirement for vasectomy from 25 to 21 years in individuals with full civil capacity and eliminated the requirement for spousal authorization. These changes were intended to expand access to family planning and strengthen reproductive autonomy.
Despite the widespread adoption of vasectomy as a safe, effective contraceptive method, the sociodemographic profile of men who choose this procedure and their level of knowledge regarding other contraceptive methods remain poorly explored in Brazil, particularly within the Brazilian Unified Health System (SUS). Therefore, the present study aimed to evaluate the epidemiological profile of patients undergoing vasectomy at a university hospital, with emphasis on knowledge of other contraceptive methods and the reasons leading to the choice of the procedure.
METHODS
This was an observational, retrospective, cross-sectional study conducted through the review of medical records of patients who underwent vasectomy at a tertiary hospital between January and June 2024. All patients who underwent the procedure during the study period were included, considering exclusively the information recorded during the preoperative assessment.
Sociodemographic variables (age, marital status, educational level, and ethnicity), clinical variables (comorbidities and number of children), and information related to knowledge of contraceptive methods and self-reported reasons for undergoing vasectomy were evaluated. Patients with incomplete data for variables of interest were excluded only from the corresponding specific analyses and were otherwise retained in the overall sample whenever possible.
Knowledge regarding contraceptive methods was assessed based on information documented in medical records during the preoperative evaluation. Knowledge was defined as reporting familiarity with at least one contraceptive method. The number of known contraceptive methods was quantified according to the available records, without the use of a standardized instrument or validated questionnaire.
Statistical analysis was performed using Python version 3.12 with the pandas and scipy packages. Categorical variables were described as absolute and relative frequencies, whereas continuous variables were expressed as mean ± SD, as well as median (IQR) when appropriate. Associations between categorical variables were assessed using Pearson’s chi-square test or Fisher’s exact test, as indicated. Correlations between continuous or ordinal variables were evaluated using Spearman’s correlation coefficient. A significance level of 5% was adopted.
The study was conducted in accordance with the ethical principles of the Declaration of Helsinki and was approved by the institutional human research ethics committee under CAAE 84711124.7.0000.0096 (approval number: 7,331,260).
RESULTS
The analyzed sample consisted of 181 men who underwent vasectomy, with a mean age of 39.4 ± 6.6 years, ranging from 26 to 57 years, and a median age of 39 years. The most prevalent age group was 30-39 years (47.0%), followed by 40-49 years (41.4%) (Figure 1).
Most patients were married (72.4%), followed by single (19.3%), divorced (6.1%), and separated individuals (2.2%). Regarding educational level, 55.2% had completed high school education, 28.2% had higher education, 10.5% had elementary education, and 6.1% had postgraduate education. With respect to ethnicity, White individuals predominated (51.9%), followed by Brown individuals (33.7%), Black individuals (7.7%), Asian individuals (1.7%), and Indigenous individuals (0.6%), whereas 4.4% of records lacked this information. The mean number of children was 2.1 ± 1.1, with both the median and mode corresponding to two children. Most patients had no comorbidities (80.1%). Among those with recorded comorbidities, systemic arterial hypertension was the most frequent (11.6%), followed by dyslipidemia (5.5%) and diabetes mellitus (3.9%) (Table 1).
Regarding knowledge of contraceptive methods, 86.2% of patients reported knowing at least one method, whereas 13.8% reported no knowledge of contraceptive methods (Table 1). Among patients with complete information regarding known methods, the mean number of reported contraceptive methods was 2.8 ± 1.7, with a median of three methods, ranging from one to nine (Figure 2). The main reason reported for undergoing vasectomy was completion of family planning (66.9%), followed by the desire to avoid contraceptive use by the partner (14.9%), the intention to spare the partner from tubal ligation (7.7%), partner-related health problems (6.6%), and other less frequent reasons (3.9%) (Figure 3).
Distribution of the number of contraceptive methods known by patients undergoing vasectomy.
No statistically significant association was observed between educational level and knowledge of contraceptive methods, nor between educational level and the reported reason for undergoing vasectomy. Across all educational levels, completion of family planning was the predominant reason for choosing the procedure (Table 2). Younger patients tended to report a greater number of known contraceptive methods, although this correlation was weak (Figure 4).
DISCUSSION
The epidemiological profile of patients undergoing vasectomy observed in the present study is consistent with that described in the international literature, with a predominance of individuals between 30 and 40 years of age, a mean of two children, and, in most cases, involvement in a stable relationship1. Prior studies have also identified having completed desired family size as one of the most frequent and decisive factors associated with the procedure, reinforcing vasectomy as a choice linked to completion of family planning5. Although the present sample originated from a single center within SUS, the findings demonstrate that the epidemiological pattern of these patients is comparable to that reported in high-income countries, regardless of differences in health care access and health system organization.
Regarding educational level, few Brazilian studies have evaluated its influence on the decision to undergo vasectomy. Current evidence suggests that educational level is indirectly associated with number of children and access to information, but not necessarily as a determining factor for choosing the procedure1. In the present study, no statistically significant association was observed between educational level and knowledge of contraceptive methods, nor between educational level and the reported reason for undergoing vasectomy. These findings suggest the decision to undergo vasectomy is more closely related to a pragmatic approach centered on completion of family planning than to formal educational attainment.
Knowledge regarding other male and female contraceptive methods remains poorly explored in the literature, and it is often assumed that patients and their partners already possess adequate information at the time of surgical decision-making. However, previous studies have demonstrated that such knowledge may remain limited, even among populations with higher educational and socioeconomic status. In a previous study, only approximately half of the patients demonstrated a high level of contraceptive knowledge, mainly associated with educational level and income6. Furthermore, knowledge alone did not appear to be a determining factor for adherence to vasectomy, acting more as a source of interest than as a decisive element in method selection6,7. The findings of the present study support this observation, indicating that limited male knowledge regarding contraceptive methods is a consistent phenomenon observed both in developed countries and in the setting of a universal public health system.
With respect to the reasons for undergoing vasectomy, discussions since the 1980s have highlighted the procedure as a safer and more definitive family planning strategy4. Vasectomy has a lower risk of surgical complications compared with tubal ligation and avoids the adverse effects associated with female hormonal contraceptive methods3,8. In the present study, most patients reported completion of family planning as the primary reason for undergoing vasectomy, although a relevant proportion mentioned the intention to avoid continued contraceptive use by their partner or to spare the partner from a more invasive surgical procedure. These findings suggest that, even after the consolidation of vasectomy as a safe and effective contraceptive method, male contraceptive responsibility still frequently occurs only after exhaustion of female contraceptive options rather than as a primary male-centered decision.
Younger patients tended to report knowledge of a greater number of contraceptive methods, although this correlation was weak. Previous studies suggest that this finding may be related to greater access to information among younger individuals, which, paradoxically, may also generate more doubts and insecurities regarding available contraceptive methods6,9. This pattern may reflect a generational shift in access to information that has not yet translated into a more active male role in contraception.
The limitations of this study include its retrospective design and the use of data derived from self-administered preoperative questionnaires, which may introduce information bias and limit the depth of contraceptive knowledge assessment. In addition, the absence of a validated instrument to measure knowledge regarding contraceptive methods restricts direct comparison with other studies and may have influenced interpretation of the responses.
CONCLUSION
Vasectomy is a definitive, safe, and widely adopted contraceptive method; however, the profile of patients who choose this procedure and the factors influencing this decision remain poorly investigated in the Brazilian context. The findings of the present study demonstrate that patients undergoing vasectomy present an epidemiological profile similar to that described in the international literature, with the decision predominantly based on completion of family planning. Nevertheless, male knowledge regarding other contraceptive methods remains limited, including among individuals with higher educational attainment, reinforcing the need for a more structured preoperative counseling approach. Expanding male contraceptive education may contribute to more informed decision-making and to a more active male role in family planning.
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