The number of men in France getting a vasectomy – a minor operation to cut the tubes that carry sperm – has rocketed in the past decade, but the procedure remains far less common here than in many other countries. Vasectomies were illegal in France until 2001 and, despite growing interest, lingering reservations continue to put patients and doctors off.
The first time Justin asked a French doctor about getting a vasectomy, he got an answer he wasn’t expecting.
“He said, ‘we don’t really do that in France’. And I said, ‘what do you mean you don’t do that in France’, and he’s like, ‘well, you need to be ready and fertile for your second wife’. And I just was floored. Like, are you kidding me?”
Justin, an American teacher who lives in Paris, already had two children at the time and his wife was pregnant with their third.
“So I went home to my wife that night and said: ‘I guess I can’t get a vasectomy here because I need to be prepared for my next wife who wants to have children’.”
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'Form of mutilation'
Vincent Hupertan, a urologist in Paris who’s been performing vasectomies since 2011, sighs when he hears the story.
“The description is cartoonish – and it’s entirely accurate, unfortunately,” he tells RFI.
“I get the feeling that doctors place the blame for refusing vasectomies on men themselves – ‘you’re not sure about it, you haven’t thought it through’, as if they weren’t capable of making their own decisions about their life.
“It’s a very humiliating attitude, paternalistic to the extreme. Unfortunately, I hear it a lot.”
Much of the mistrust goes back to the French law’s position on vasectomies.
As surgeons were developing the modern procedure in the 1930s, prosecutors in Bordeaux put a doctor on trial for performing vasectomies on some 15 men. Although his patients were willing, he was convicted of castration – removal of the testicles, even though vasectomy leaves them intact – and served a year in prison.
“That frightened doctors, because there was now a legal precedent classing vasectomies as a form of mutilation. So generations of doctors hammered that home,” says Hupertan.
“Us urologists, we all came out of medical schools where our superiors told us: ‘Don’t touch men’.”
Generational shift
The law was revised in 2001 to make voluntary sterilisation legal for both men and women.
By the end of that decade, fewer than 2,000 men a year were getting vasectomies in France. It’s only in recent years that numbers have shown a significant rise – increasing more than fifteenfold from 1,940 vasectomies in 2010 to 30,288 in 2022, according to a recent study by France’s public health service.
“It’s not just me – all urologists are noticing that demand is increasing everywhere,” says Hupertan.
He puts the change down to generational shifts. “People in their 40s now who were 20 [when the law changed] have grown up with this idea of equality between men and women,” he says.
“So these are men invested in their relationships and their children... Men are invested in equality at the heart of the family. That’s why they’re taking responsibility.”
'No-brainer'
Justin describes his own decision to get a vasectomy as “a no-brainer”.
“For us, with three kids – three boys – at this point, we just knew that we’re happy with where we are,” he says.
His wife wasn’t keen to go back to taking the contraceptive pill, which had given her side effects.
“And so this idea that the onus is placed on the woman to have to go back on birth control as opposed to the men doing something, taking action and having a vasectomy, to me was just like... There was no question in my mind that that’s what I was going to do.”
In the United States, where Justin grew up, an estimated 500,000 men get vasectomies every year.
“Of my close friend group in high school, those who have had children and are done having children, all of them have had vasectomies,” he says.
He was expecting as routine a process as they’d gone through in the US. But from start to finish, getting a vasectomy in France will have taken him eight months.
Mandatory wait
Justin first spoke to RFI in February, two weeks before he was booked to have the procedure. Even after finding a specialist to do it, it had been a long wait.
“I saw this doctor back in October, whatever it was. I legitimately had to sign a document to say... I was required to take a four-month waiting period so that I had an opportunity to be able to change my mind and I needed to really think about it,” he recounted.
This “reflection period” – four months minimum – is written into French law as a condition for sterilisation, male or female.
“Meanwhile for plastic surgery, for example, the mandatory period is 15 days,” points out Hupertan. “It’s outdated.”
Together with other members of the French Urology Association, he’s pushing lawmakers to shorten the wait time.
He and his colleagues believe France’s rules are due an overhaul in other respects too, starting with getting vasectomies better covered by health insurance.
Given that the procedure is both elective and low risk, France’s national insurance pays for only a small fraction of the cost. The rest is left to private insurers – most of which won’t cover the full cost, according to Hupertan – and patients themselves.
Finally, urologists want to make it possible to get a vasectomy in doctors’ offices, not just hospitals.
Surgical procedure
“They treat this like an operation, for sure,” says Justin when RFI next catches up with him, about a week after his vasectomy.
“I was taken back and laid down on the operating table. And more people start to come in... When there were six people in the room, I remember being like, ‘this is just a vasectomy, right, this is all we’re here to do?’”
He was given a general anaesthetic for the procedure, which typically lasts less than half an hour.
“Which again is not something that my friends went through when they got this done in the United States,” he points out. “They all just do local anaesthesia, and they’re completely awake during the process.”
Hupertan, who practices a less invasive technique that doesn’t involving cutting the skin, says he only ever uses local anaesthesia and recommends other doctors do the same.
He believes performing vasectomies as a simple outpatient procedure would help normalise them in France.
“What surprises me is that in 2024 we’re still talking about vasectomy like a revolution,” he says, with a trace of exasperation.
“When in fact – just look at the rest of the world, it’s been done for ages and we know it’s safe, it doesn’t harm your sex life, it doesn’t give you cancer, you’re no less virile – on the contrary.”
'Behind the times'
Justin shares his frustration.
“I want doctors to be more comfortable and proactive in discussing it with patients,” he tells RFI, noting that none of the professionals he spoke to even told him there was a less invasive option.
Eight days after his procedure, he was still recovering.
“Some soreness, a little bit uncomfortable,” he reported. “I haven’t gone for any runs or anything and I don’t plan to for a little while, but otherwise it’s been pretty good.”
He won’t find out whether the procedure was effective for another three months, when a doctor will check a semen sample to be sure it no longer contains sperm.
“And then at that point I should be hopefully good,” he says.
“Unless of course I need to impregnate a younger wife in the future – then I would have to return to have it reversed.”
This story appeared on the Spotlight in France podcast, episode 108.
