A few minutes of surgery for a lifetime of regret?—regret after vasectomy: prevalence and contributing factors
Original Article

A few minutes of surgery for a lifetime of regret?—regret after vasectomy: prevalence and contributing factors

Arthur Galano1, Xavier Tillou1 ORCID logo, Antoine Clergeau2, Paul Neuville3, Thibaut Waeckel1

1Urology and Transplantation Department, CHU de Caen Normandie, Caen, France; 2Department of Biology, Reproductive Biology Unit, CHU de Caen Normandie, Caen, France; 3Department of Urology, University of Lyon, Lyon, France

Contributions: (I) Conception and design: A Galano, T Waeckel; (II) Administrative support: X Tillou, P Neuville; (III) Provision of study materials or patients: A Clergeau, T Waeckel; (IV) Collection and assembly of data: A Galano; (V) Data analysis and interpretation: T Waeckel, X Tillou; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.

Correspondence to: Xavier Tillou, MD, PhD. Urology and Transplantation Department, CHU de Caen Normandie, Avenue de Côte de Nacre, 14033 Caen, France. Email: xavtillou@gmail.com.

Background: Contraception has consistently been a significant concern for couples, facilitating autonomy in family planning, a highly desired aspect for many. This responsibility predominantly falls on women, who often perceive it as burdensome. In this context, vasectomy, a straightforward, expedient, and dependable procedure, has gained popularity in France and other countries. This emerging trend necessitates an examination of the ethical considerations surrounding potential patient regret. This study aimed to assess the prevalence of regret among patients treated at our center and to analyze the factors contributing to this sentiment.

Methods: After exclusions, a retrospective chart review was conducted on 274 patients who underwent vasectomy at our center between January 1, 2014, and December 31, 2022. The patients participated in semi-structured telephone interviews to assess their sociodemographic data and motivations.

Results: The overall rate of regret was low at 2.2% (n=6). The primary reasons for regret included a change in partner (n=4), post-vasectomy pain syndrome (n=1), and reconsideration of parenthood (n=1). Men whose decision to undergo vasectomy was initiated by their partner were significantly more likely to experience regret (66.7% vs. 22.8%, P=0.03). Age, number of children, and socioeconomic status were not significantly associated with regret.

Conclusions: Although regret among men following vasectomy is relatively rare, it appears to be influenced by the decision-making process, which includes personal relationships. These findings emphasize the need to ensure autonomous decision-making.

Keywords: Contraception; vasectomy; regret

Submitted Sep 06, 2025. Accepted for publication Dec 08, 2025. Published online Feb 11, 2026.

doi: 10.21037/tau-2025-676

Highlight box

Key findings

• This monocentric French study of 274 men who underwent vasectomy (median follow-up, 38 months) found a very low regret rate of 2.2%. The main reason was a change of partner (n=4). The only significant predictor of regret was when the decision was initiated by the partner rather than by the man himself (66.7% vs. 22.8%, P=0.03). Age, number of children, and socioeconomic status were not associated. No participant used their cryopreserved sperm.

What is known and what is new?

• International studies report regret rates of approximately 6–7%, often associated with younger age, absence of children, or changes in marital status. Vasectomy is increasingly common worldwide, including in France, where it has recently surpassed tubal ligation. Although considered safe and effective, its limited reversibility raises ethical concerns.

• This study demonstrates a substantially lower regret rate in a French cohort, likely influenced by legal requirements enforcing reflection periods and informed consent. Regret was not associated with demographic factors but with decision-making autonomy: regret was more frequent when the choice was driven by the partner rather than the patient. This aspect remains underreported in the literature.

What is the implication, and what should change now?

• These results reinforce the need for counseling protocols prioritizing men’s autonomy and informed choice. Physicians should ensure that the request originates from the patient, avoiding partner influence. Routine sperm cryopreservation may be unnecessary, given its negligible use. The principle of “my body, my choice” should extend to male contraception, ensuring an ethically sound, patient-centered practice.

Introduction

The capacity to choose a contraceptive method, whether collaboratively within a partnership or independently, constitutes a critical public health issue in modern society. This capability not only facilitates family planning by mitigating the occurrence of unintended pregnancies but also augments women’s autonomy and sexual freedom. Given the heterogeneity in individuals’ lives, expectations, and needs, individualized contraceptive decisions should be tailored to diverse reproductive intentions without becoming onerous (1,2).

Historically, the responsibility for contraception within couples has predominantly been perceived as a women’s issue (1), with women often bearing this responsibility and the associated cognitive and physical burdens through the use of combined oral contraceptive pills, intrauterine devices (IUDs), hormonal implants, and other methods (3,4). Male contraception is frequently and erroneously confined to the use of condoms. Other available methods, such as withdrawal, male hormonal contraceptives, and thermal contraception, are less prevalent, less well-known, less reliable, and more restrictive (2). The World Health Organization (WHO) endorses only three male contraceptive methods: the male condom, vasectomy, and withdrawal (4). Nonetheless, the potential for post-vasectomy regret—albeit infrequent—presents ethical and clinical considerations that remain insufficiently explored.

In recent years, a notable shift has been observed, as evidenced by the increased adoption of a straightforward, reliable, and effective surgical procedure in the country: vas deferens ligation, also known as vasectomy (5-9). This significant rise in vasectomy procedures necessitates consideration of one of its implications: its theoretical irreversibility (8). Although this irreversibility is anticipated and desired, it compels urologists to address the ethical issues of potential regret among patients. In women, the regret rate is known to be around 10% according to a 2022 report (10). The literature on this topic is limited and does not fully reflect the practices in France. This study aimed to evaluate the prevalence of regret among patients in a retrospective, monocentric cohort and to analyze the factors that may contribute to this sentiment. We present this article in accordance with the STROBE reporting checklist (available at https://tau.amegroups.com/article/view/10.21037/tau-2025-676/rc).

Methods

A retrospective chart review was conducted based on the surgical schedule to identify male patients who underwent surgery entitled “vasectomy” between January 1, 2014, and December 31, 2022, at the CHU de Caen Normandie (n=419). From this cohort, duplicates and surgeries not performed for various reasons (e.g., patient cancellation, lack of written consent, no-show, and scheduling issues) were excluded (n=69) (inclusion flow chart Figure 1). Data extraction was facilitated using Blocprod v5.8 software, which was employed at our center. The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. The study was approved by the Institutional Ethics Committee of CHU de Caen Normandie (No. 2024051119284900000100000479). Informed oral consent was taken from all the patients at the beginning of each interview.

Figure 1 Inclusion flow chart.

A 16-item questionnaire (Appendix 1) was collaboratively designed and approved to facilitate the collection of data regarding marital status, number of offspring, factors considered for surgery, local or general anesthesia, and socio-professional status of each patient at the time of surgery. For question 2, regarding the length of the relationship, the question remained open to patient interpretation without a time threshold. The 2020 Classification of Professions and Socio-professional Categories (PCS 2020) (11) was used to categorize socio-professional status. Data were collected through a phone-based survey after obtaining oral consent and explaining the study’s objectives. A single interviewer contacted the patients between February 11, 2023, and February 5, 2024, for a single interview. Patients who did not respond after three contact attempts during the recruitment period were classified as lost to follow-up.

Statistical analysis

Data were compiled and anonymized using Excel software (Microsoft®), and statistical analyses were performed using GraphPad Prism version 9.4.0 for Windows. The Mann-Whitney U test and analysis of variance (ANOVA) were used to compare continuous variables. The Chi-squared test was used to analyze the differences between qualitative variables. Statistical significance was set at P<0.05.

Results

Among the 350 patients eligible for the screening process, 75 were classified as lost to follow-up (change or wrong phone number, not responding to phone calls), and one declined to participate, resulting in a total of 274 patients and an overall response rate of 78.3% (Figure 1). A significant increase in the number of vasectomies performed at our center during the period of interest was observed, rising from 3 in 2014 to 130 in 2022, which constitutes a 43-fold increase (Figure 2).

Figure 2 Number of vasectomies performed at our center during the period of interest. T, trimester.

The mean age of the patients who underwent vasectomy was 39.3 years, with an age range of 22–61 (interquartile range, 35–43) years. The majority of patients were in a relationship (n=267, 97.4%), with 262 individuals reporting long-term relationships (95.6%) and five indicating short-term relationships (1.8%), as self-reported. On average, patients had 2.4 children prior to vasectomy, with a median of two. Sperm preservation via cryoconservation at the Study and Conservation of Human Sperm Center was undertaken by 31 patients (11.3%); however, none utilized the preserved sperm. Additionally, 98.2% (n=269) of the patients were informed about the potentially irreversible nature of this procedure. The predominant motivation for undergoing this surgical procedure was to alleviate the contraceptive burden on their partner, as reported by 139 men (50.7%). For 31 patients (11.3%), the primary objective was to conclude their parenthood plans. Both motivations were present in 92 patients (33.6%). Other reasons were less common and more anecdotal: five patients (1.8%) expressed a desire to assume responsibility for family planning, three patients (1.09%) sought a vasectomy due to a traumatic event during pregnancy (postpartum hemorrhage, fetal malformation), and two patients (0.72%) aimed to prevent the transmission of a genetic mutation they carried (BRCA2 and tuberous sclerosis complex) (Table 1). Beginning in 2016, patients who were either single or did not disclose being in a relationship were recorded, with one patient in both 2016 and 2018, four patients in 2020, two patients in 2021, and three patients in 2022 (Table 2).

Table 1

Sociodemographic and clinical profile of participants

Characteristics Values (N=274)
Age (years), median [Q1–Q3] 39 [35–43]
Marital status, n (%)
   Long-term relationship 262 (95.6)
   Short-term relationship 5 (1.8)
   Single 7 (2.6)
Number of children, n (%)
   0 13 (4.7)
   1 17 (6.2)
   2 133 (48.5)
   3 83 (30.4)
   4 21 (7.6)
   ≥5 8 (2.6)
Cryopreservation, n (%)
   Realization 31 (11.3)
   Use 0 (0.0)
Initial consideration, n (%)
   By the patient 133 (48.5)
   By the partner 65 (23.7)
   Mutual discussion 76 (27.8)
Motivation, n (%)
   Burden of the contraception for the partner 139 (50.73)
   Personal choice to not have (more) children 31 (11.31)
   Both 92 (33.57)
   Take responsibility for contraception 5 (1.82)
   Traumatic event during past pregnancy 3 (1.09)
   Avoid passing on a genetic mutation 2 (0.72)
   Other 2 (0.72)

Table 2

Characteristics of patients at the time of vasectomy experiencing vs. not experiencing vasectomy regret

Characteristics Regret (n=6, 2.2%) Absence of regret (n=268, 97.81%) P
Number of children 2 [2–3.25] 2 [2–3] 0.94
Childless 0 (0.0) 13 (2.3) >0.99
In a relationship 5 (83.3) 257 (95.9) 0.24
Discussion initiated by the partner 4 (66.7) 61 (22.8) 0.03
Reflection before 1st consultation 4 [2.5–10.5] 4 [2–12] 0.98
Consultation alone 5 (83.3) 213 (79.5) >0.99
Social circle with prior experience 3 (50.0) 85 (31.7) 0.39
Age (years) 39.5 [36.75–43.75] 39 [35–43] 0.71
Patient-reported experience (score out of 10) 8.5 [6.75–10] 9 [8–10] 0.58
Salaried executive 4 (66.7) 73 (27.3) 0.05
Follow-up (months) 46 [36.5–70.25] 44 [32–61] 0.65
Vasovasostomy 2 (33.3) 1 (0.4) 0.001

Data are presented as median [Q1–Q3] or n (%).

The mean follow-up period was 43.1 months, with a median follow-up of 38 months. Within the study population, a regret percentage of 2.2% (n=6) was documented. Of these individuals, three underwent vaso-vasostomy: two due to feelings of regret and one due to the desire for another child, although this individual expressed the intention to undergo another vasectomy. The interventions were conducted at 7, 20, and 23 months after the initial vasectomy. Most patients underwent the procedure under general anesthesia (n=177, 64.6%), while spinal anesthesia was administered to 64 patients (23.3%) and local anesthesia was used for 33 patients (12%). Regarding regret, subgroup analysis did not find any significant difference in terms of childlessness or number of children between men who regret their vasectomy and those who do not (respectively 0 vs. 2 feeling of regret, P=0.94). The number of vaso-vasostomies was higher in the regret group (n=2; 33%) than in the absence of regret group (n=1; 0.4%) (P=0.001). The feeling of regret was higher when the discussion about vasectomy was initiated by the partner (regret: n=4, 66.7%; absence of regret: n=61, 22.8%; P=0.03). The length of the deliberation period prior to the initial consultation, presence of a companion during the consultation, acquaintance with individuals who had previously undergone the procedure, age at the time of the procedure, overall perception of the care provided, and socio-professional status did not significantly influence the development of feelings of regret. Furthermore, cryopreservation appears to have no discernible effects. The mean follow-up duration for men experiencing regret (46 months) did not differ from that of men who did not regret their intervention (44 months; P=0.65). The primary causes of regret included a change of partner (n=4), post-vasectomy pain syndrome (n=1) (de novo chronic testicular pain with normal checkup), and a change of mind regarding the procedure (n=1).

All men who expressed regret regarding their decision were engaged in committed relationships and had between two and four children each. None had preserved their sperm, despite being informed of the procedure’s challenging reversible nature. Their motivations included alleviating their partner from the burden of contraception (n=4), concluding their parenthood aspirations (n=1), or experiencing a traumatic event during pregnancy (n=1). The duration until the onset of regret (time between vasectomy and regret) ranged from 2 weeks to 39 months, with an average of 15.3 months and a median of 12 months (Table 2).

Discussion

Male sterilization, achieved through the interruption of the vas deferens, has been practiced globally for many years (2,12) and has been officially sanctioned in our country since the enactment of the law on July 4, 2001 (13). Interest in this procedure has been increasing among men (14,15), as evidenced by the 2024 EpiPHARE report, which documents a fifteenfold increase in the number of vasectomies performed between 2010 and 2022 (5), reaching more than 30,000 procedures in 2022. In comparison, its female counterpart, tubal ligation, has only been surpassed in frequency by vasectomy since 2021, despite the former’s significantly more invasive nature (8,16,17). Tubal ligation necessitates general anesthesia and coelioscopy, which can lead to both short- and long-term digestive complications. These results reflect a sociocultural shift, as male sterilization gains acceptance in a context historically dominated by female-centered contraceptive methods.

The significant increase in vasectomy procedures in France is corroborated by data from our center. This trend appears to be influenced by the advantages associated with vasectomy: it is a straightforward, rapid, and minimally invasive procedure, devoid of contraindications or severe complications, and can be performed on an outpatient basis (9,18,19). Additionally, a shift in societal norms may also contribute to this rise (2,20,21). Specifically, there is a growing tendency among men to exert greater control over their fertility and share the responsibility for gender equality. Notably, the prevalence of regret among men who undergo this procedure is low. A small percentage of men expressed regret, primarily when the decision to undergo a vasectomy was suggested by their partner rather than initiated by the men themselves. Factors such as being childless, single, or young did not appear to predict feelings of regret. Most men made their decisions considering their partner’s comfort, aligning with the notion that men are increasingly willing to share the responsibility of contraception (21). This evolution was partially predicted and analyzed in studies on knowledge of decisional regret in healthcare (22,23). The limited recourse (24) and lack of sperm preservation may be attributed to the careful deliberation involved in their decision-making process and the effective information and counseling provided to them. These findings, coupled with the cost of cryopreservation (25), underscore the need for a systematic proposal of this treatment option.

The findings of this study diverge from those reported in the existing literature. A regret prevalence of 6–7% is more commonly cited (2,26), with factors such as patient age, fatherhood, and marital status identified as significant contributors. These discrepancies may be attributed to the fact that previous studies do not adequately reflect practices within our country, where this procedure is subject to stringent legal regulation. Such regulations result in delays between the initial consultation and the procedure, ranging from four months to a year, thereby discouraging individuals who are not fully certain of their decision and filtering out those who might act impulsively. Recent studies corroborate these assertions (26-28) and have yielded similar findings. Recent political developments globally, particularly in the United States with the restrictions on abortions as seen in Dobbs v. Jackson (29), underscore the importance of examining this subject. Helping men to participate in contraception within couples will help overcome the difficulties women face in accessing contraception or abortion.

While the primary limitation of this study is its retrospective and monocentric design, its comprehensiveness, as demonstrated by a response rate of nearly 80%, and the investigation of numerous factors not previously addressed in the literature, enhance the robustness of our findings. The potential for recall bias was mitigated through the semi-structured nature of telephone interviews and the use of closed-ended questions whenever feasible. Notably, these results are uniquely based on the population of our country. The results of this study could be valid in our country and be influenced by the cultural background. Consequently, these findings necessitate a reconsideration of existing practices concerning stereotypes and biases regarding men seeking vasectomy. Another limitation was the number of lost follow-ups, mainly due to changes in address or phone number. The question of the influence of the results of our study on these patients remains. We can summarize these limitations by listing the potential biases: social desirability bias in phone interviews, selection bias from exclusion criteria, and information bias from self-reported regret.

Conclusions

Vasectomy is a straightforward, rapid, and effective procedure offered to men seeking a reliable method of family planning. However, its increasing popularity should not overshadow the ethical principle of non-maleficence, particularly concerning the sterilization of individuals who may later regret their decision in 2% of cases. This study identifies the primary predictive factor of regret as a decision initiated by the partner rather than by the individual. Our findings underscore the need for ethical counseling protocols that focus on male autonomy, informed consent, and the psychological implications of sterilization. This finding resonates with the feminist movement’s slogan, “My body, My choice”, which is appropriately applied in the context of abortion access laws. This principle should extend beyond feminist causes to a broader humanist perspective, encompassing men who wish to actively participate in their contraceptive choices. This is supported by the lack of significant differences in other characteristics. It is crucial that personal biases, beliefs, and concerns about making incorrect decisions are not projected onto patients, potentially leading to the refusal of the procedure. Respect for patient autonomy, regardless of gender, remains a cornerstone of ethical medical practice, particularly in difficult reversible procedures, such as sterilization.

Acknowledgments

None.

Footnote

Reporting Checklist: The authors have completed the STROBE reporting checklist. Available at https://tau.amegroups.com/article/view/10.21037/tau-2025-676/rc

Data Sharing Statement: Available at https://tau.amegroups.com/article/view/10.21037/tau-2025-676/dss

Peer Review File: Available at https://tau.amegroups.com/article/view/10.21037/tau-2025-676/prf

Funding: None.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tau.amegroups.com/article/view/10.21037/tau-2025-676/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. The study was approved by the Institutional Ethics Committee of CHU de Caen Normandie (No. 2024051119284900000100000479). Informed oral consent was taken from all the patients at the beginning of each interview.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

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Cite this article as: Galano A, Tillou X, Clergeau A, Neuville P, Waeckel T. A few minutes of surgery for a lifetime of regret?—regret after vasectomy: prevalence and contributing factors. Transl Androl Urol 2026;15(2):51. doi: 10.21037/tau-2025-676

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