Q & A With Doug Stein, MD, Urologist and Star of 'The Vasectomist':

How many vasectomies have you done in your career?
Stein: About 31,000.
How about reverse vasectomies?
Stein: About 1,550. I don't think I've hit 1,600 yet. I do about 1-2 reversals per week. But about 70 vasectomies per week.
What are the most important questions a good urologist should ask a patient?
Stein: My eye goes first to their age and their number of children. Anybody who's in his 20's, whose had fewer than two children ... he and I have to have a nice long chat. But if a guy's 35 and he's got three kids and he's with the mother of his kids, my eye darts next to his medications and prior surgeries.
Why does the number of children someone already has affect whether somebody should get a vasectomy?
Stein: I don't want to do something that someone might regret at a later date. So let's say I have a 22-year-old who registers and he's never had kids and he has no partner. He may be at risk for seeking a vasectomy reversal in the future ... Therefore, I have to caution a guy who's 22 and never had kids that he is making a lifelong decision. A decision which he could regret.
What is the success rate of a vasectomy reversal these days?
Stein: It depends on the interval in years between the vasectomy and the reversal. The longer the interval, the lower the likelihood of both return of sperm to the semen and pregnancy.
How many anticipated births have you prevented as a result of your cutting career?
Stein: It's tough to measure a negative isn't it? I would like to think that it could be one per vasectomy? How many unintended pregnancies am I preventing in the 50-year-old guy who has a 49-year-old wife? If he had never had a vasectomy, what are the chances that he would've gotten her pregnant? Maybe she's got six eggs left in her and they're pretty crummy eggs to boot. On the other hand, if I'm in Kenya, and I'm doing a guy with two kids when the average number of kids might be 7 or 8, with that one vasectomy I might've prevented another six unintended pregnancies. It's really hard to say.
I imagine it's a tough formula to concoct. It would also be interesting to hear how much in unpaid child support payments you're preventing.
Stein: Even with well-to-do people, you'll see unintended pregnancies. What fine fellow hasn't taken his wife to a Christmas party, and they've each had a couple of glasses of champagne. And you know, she's lookin' kind of good and he's lookin' good. And alcohol impairs your judgment. And he says, "Well, I'll pull out." And she says, "Nah, don't worry about it, it's probably not even the right time of month." And bingo -- their kids are 7, 9, 11 and one month. Happens all the time. I think the thing that causes more pregnancies than anything else, the mitigating factor in there, is alcohol.
What is the idea behind World Vasectomy Day?
Stein: The first time I ever heard the expression, I was in Kenya. And Jonathan Stack, who's the director of the documentary called 'The Vasectomist,' he was outside these procedure rooms and there were a whole bunch of guys who had either had their vasectomies or were awaiting their vasectomies. And most of them spoke Luo or Swahili and maybe a little bit of English. I heard outside the door "We support World Vasectomy Day!" I think that's the first time Jonathan thought of it.
What's the ultimate goal?
Stein: What if ... in at least 25 countries, on one day, we could do a thousand vasectomies and devote those 1,000 vasectomies to the principles, values of World Vasectomy Day? Support World Vasectomy Day because it reduces the risk to your partner because of other forms of contraception and unintended pregnancy. Because it's easier for a man to nurture two children instead of 10 children. Because it's quick and simple and you may enjoy sex more. Because we feel responsible for a planet that is approaching 8 billion people with species extinction faster than there's ever been. And who knows what's happening with the climate. There's a whole series of reasons to support vasectomy as a procedure. Male responsibility as a state of mind ... and respect for our planet.
Who are your detractors?
Stein: An active detractor is someone who says perhaps that it's against their belief. Some kind of belief. Even though there's no written rule about it. Certainly strict Roman Catholics would say that vasectomy is not something they should be doing -- even though it doesn't say it in the Bible because there was no vasectomy in the Bible. These are rulings that priests, bishops and popes come to when they're at their ecumenical counsels. And they somehow interpret Holy Scripture or make it up ... That would be the most direct kind of opposition.

There's a very, very small set of men who have post-vasectomy pain syndrome. It occurs in about one out of a thousand guys. Seems to make their life pretty darn miserable. They're a very vocal group out there on the Internet. I'm not exactly sure what their objective is, I mean, do they want to stop vasectomies? That is like stopping people from getting into cars because some people who get into cars get killed or become paraplegics or quadriplegics. Everything involves a risk. Fortunately, that's an extremely rare occurrence, and therefore a very low risk. But it is a problem when it occurs.
How many countries have you traveled to perform vasectomies?
Stein: Three. Because I can't go to a country where I'm not invited ... We go through an organization called No Scalpel Vasectomies International, and that was formed by some Filippino-American doctors who used to run medical surgical missions to The Philippines. And they realized that every year, the lines were longer and longer and longer. The lines were mostly women with little children and pregnant women. And they said, "Wow guys, we're not getting anywhere. They're reproducing faster than our missions can make them healthy." So he started running vasectomy missions back around 2002. And I met him around 2008 or 2009. Then I became an active force in missions to The Philippines around 2010. Since then we expanded to Haiti and Kenya.
Is this pure charity work for you?
Stein: Yeah, but you know, it's fun. Some people spend exorbitant amounts of money to go to Scotland and play golf. I pay money to go to Kenya and do vasectomies. I happen to enjoy doing vasectomies more than I enjoy playing golf.

(We laugh.)
What's the biggest challenge of doing free vasectomies in a third world country?
Stein: Maintaining your enthusiasm when their receptivity is so low. In every country and in every culture, there is a small percentage of guys who will go out of their way to find a vasectomist and have a vasectomy. These few guys (even though it might not be in their culture), they love their wives so much, and nurture their kids so much, that they realize their wives have already contributed enough in having 2-3 kids and being on contraception all these years that they want to get a vasectomy. And they will seek us out -- whether we are in Haiti, Kenya or The Philippines -- they will find us, and they give us so much satisfaction ... and are so appreciative ... that's what feeds our sense of fulfillment.
How people do you turn away outright in the U.S.?
Stein: Turning away is an abrupt scenario. Usually I can talk a guy out of it if I think he's just being ridiculous. A guy who's 22 and has never had sex and just wants to be sure. I'll say, "I don't feel comfortable doing this. I'll tell you what. You get a girlfriend and when you start being sexually active and you need contraception, then you come back to me."
Do you get a lot of referrals from divorce lawyers?
Stein: No. I do vasectomies on divorce lawyers ... My feeling is when somebody with three kids comes up to me and they'll say, "Well, what if something happens to my wife?" I say, "Well, if something happens to your wife then you're the sole parent of three kids. You've got much more reason to have a vasectomy. Because those kids are counting on you and you alone ... In effect, you've just acquired twice as many kids because you're no longer splitting the parenting." I believe being a good parent is far more the measure of a man than being able to fertilize a female.
Do you see the vasectomy getting easier to perform anytime soon -- and with less risk?
Stein: I get so many guys who say "Doc, that was nothing." I'm not sure you can get less than nothing ... I don't foresee it. I'd like to be able to do an online vasectomy where you hold your scrotum up to the screen, but I'm afraid that that's not coming anytime soon.
Doug Stein, MD Doug Stein, MD is the star of the new documentary, The Vasectomist, premiering at the Adelaide Film Festival in Sydney, Australia, on Oct. 18. By his own count, he has performed more vasectomies than any other doctor in the U.S.

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