Vasectomy in Israel: motivations, satisfaction, regret, and healthcare counseling

Introduction

Vasectomy is widely recognized as the safest and most cost-effective method of permanent male sterilization (1). It is a commonly utilized long-acting contraceptive technique and is among the most frequently performed urological procedures worldwide (2). Typically performed in an outpatient setting under local anesthesia, the procedure requires approximately 15–30 minutes to complete (3). Its technical simplicity, combined with a high success rate exceeding 99%, has contributed to its global adoption. Current estimates suggest that between 42 million and 60 million men globally, representing approximately 5% of married couples of reproductive age, utilize vasectomy as their primary method of contraception (4).

Despite its safety and efficacy, many men considering vasectomy report significant anxiety (5,6). This apprehension often stems from concerns regarding possible adverse effects on sexual function, including erectile dysfunction, reduced orgasmic sensation, and decreased libido. Nevertheless, empirical evidence indicates that vasectomy does not impair sexual performance (7) and is associated with only minor complications, such as transient pain and localized bruising (8). Psychological distress related to the procedure is commonly attributed to fear of pain and uncertainty surrounding the surgical process (9). Moreover, preoperative anxiety has been correlated with increased postoperative pain in various surgical disciplines, underscoring the importance of addressing anxiety in the perioperative period (10,11).

In Israel, vasectomy remains relatively uncommon compared with many Western countries, reflecting a unique intersection of cultural, religious, and societal factors. Israeli society is strongly pronatalist, with high social value placed on parenthood, which may reduce demand for permanent contraception. In addition, within Orthodox Judaism, male sterilization is generally considered religiously prohibited, and similar reservations toward permanent sterilization exist in parts of the Muslim population. These religious norms, together with cultural perceptions linking fertility to masculinity and the preference for non-permanent contraceptive methods, likely contribute to the relatively low uptake of vasectomy. According to a 2015 United Nations report, 71.3% of married or in-union women in Israel utilized some form of contraception, although the specific prevalence of vasectomy was not delineated (12).

Extensive literature has examined vasectomy in terms of decision-making processes, motivations, satisfaction, and subsequent regret. Common motivations include completion of desired family size, preference for a permanent contraceptive method, and partner influence. Demographic characteristics associated with vasectomy uptake include older age, marital status, higher socioeconomic status, and greater number of children. In contrast, lower rates of vasectomy are observed among immigrant populations and individuals with certain religious affiliations (13,14).

Overall satisfaction with the procedure is high. Both men and their partners frequently report positive experiences, with many expressing willingness to recommend the procedure to others. For instance, one study reported that 93% of men and 96% of their partners would choose vasectomy again. Furthermore, sexual satisfaction is generally maintained or even enhanced, particularly among female partners. Nonetheless, a minority of men report post-procedural regret, with prevalence rates ranging from 4% to 10% depending on the population studied. Regret is more prevalent among younger men and those without children, although it remains infrequent even within these subgroups (15-18).

The decision to undergo vasectomy is often influenced by spousal involvement, apprehension regarding pain, and misperceptions about the procedure’s reversibility. Comprehensive preoperative counseling that emphasizes the permanent nature of the procedure, while acknowledging that reversal may be technically feasible but is not guaranteed, and that regret can occur, is essential to ensure truly informed consent and to minimize future dissatisfaction (9,13,18).

To our knowledge, no peer-reviewed studies have systematically examined Israeli men’s motivations for vasectomy or their subsequent satisfaction and regret, particularly as shaped by Israel’s cultural, religious, and legal milieu. Addressing this gap is essential to inform culturally sensitive counseling, optimize peri- and post-procedural care, and guide evidence-based policy and resource allocation. Accordingly, this study aims to delineate determinants of uptake, satisfaction, and regret within the Israeli context and to identify modifiable factors that could improve patient-centered outcomes. We present this article in accordance with the SURGE reporting checklist (available at https://tau.amegroups.com/article/view/10.21037/tau-2026-1-0054/rc).

Methods

We conducted a quantitative cross-sectional survey in 2024 among men who underwent no-scalpel vasectomy at Assuta Medical Centre, Haifa, using a structured 14-item questionnaire (see Appendix 1). The questionnaire was investigator-developed specifically for the purposes of this study and was not externally validated, which is acknowledged as a study limitation. The survey collected data on demographics, timing and initiation of the decision to undergo vasectomy, medical consultation and counselling process, preoperative concerns, postoperative symptoms, satisfaction, and regret.

Clinical workflow and patient pathway

Men who contacted our office expressing interest in vasectomy received standardized telephone counseling by a urologist or trained staff member. This counselling included explanation of the procedure, effectiveness, potential risks and complications, reversibility considerations, and alternative contraceptive options. Following counselling, some men scheduled an appointment for the procedure, whereas others requested additional time to consider the decision and later contacted the office to arrange surgery.

Timing of patient approach and recruitment

All men who underwent vasectomy during the study period were approached remotely by telephone 4–6 months after the procedure by one of the investigators. During this call, patients were informed about the study and asked whether they agreed to receive the questionnaire. Only men who provided verbal consent were sent the questionnaire for self-completion.

Ethical consideration

The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. The study was approved by the Institutional Review Board of Assuta Medical Centre (No. 0036-25-ASMC). Informed consent was obtained from all participants.

Statistical analysis

Data were analyzed using descriptive statistics. Categorical variables are presented as absolute frequencies and percentages, and continuous variables as means with standard deviations (or medians with ranges, as appropriate). Because several questionnaire items permitted the selection of more than one response, the corresponding percentages were calculated relative to the total number of respondents (n=35) and therefore may sum to more than 100%. No formal hypothesis testing was performed, given the descriptive, single-center design and modest sample size.

Results

Demographic characteristics

Among the study participants (n=35), the majority were married (n=23, 65.7%), with nine participants (25.7%) being divorced, two (5.7%) in a committed relationship, and one (2.9%) single. Regarding offspring, the most frequently reported family sizes were three children (n=13, 37.1%) and two children (n=12, 34.3%). A minority had four or more children, and one participant reported having no children.

Educational attainment varied among the cohort: 12 participants (34.3%) held a bachelor’s degree, 10 (28.6%) had a master’s degree or higher, seven (20.0%) had completed high school, and six (17.1%) held a vocational certificate.

The most common occupational field was technology and high-tech (n=19, 54.3%), followed by self-employed or artistic professions (n=4, 11.4%), education and therapeutic roles (n=4, 11.4%), administrative or office work (n=3, 8.6%), healthcare professions (n=3, 8.6%), and service, commerce, or other occupations (n=2 each, 5.7%) (Figure 1).

Figure 1 Occupational distribution among vasectomy participants (n=35). Bar chart illustrating the various occupational fields reported by participants who underwent vasectomy.

Motivations for undergoing vasectomy

Participants reported a range of motivating factors, with many citing multiple reasons. The most prevalent reasons included avoidance of female contraceptive methods (n=28, 80.0%), the desire for permanent contraception (n=23, 65.7%), perceived simplicity and safety of the procedure (n=15, 42.9%), high contraceptive efficacy (n=13, 37.1%), and completion of family planning (n=11, 31.4%). Additional motivators included enhanced sexual freedom (n=9, 25.7%), the partner’s request (n=9, 25.7%), the partner’s refusal to use female contraceptives (n=8, 22.9%), financial considerations (n=2, 5.7%), and personal or partner-related medical indications (n=1, 2.9%) (Figure 2).

Figure 2 Bar chart presenting the main reasons selected by participants (n=35) for choosing vasectomy. Each bar reflects the number of respondents who indicated a specific reason, and the corresponding percentage is displayed next to each bar. Participants could select multiple reasons.

Initiation of vasectomy conversations and couple decision-making

In more than half of the cases (n=19, 54.2%), the decision to undergo vasectomy was initiated by the male partner. In 22.9% of cases (n=8), the decision was made jointly with the partner, and in another 22.9% it was initiated by the partner alone (Figure 3).

Figure 3 Initiation of vasectomy decision-making categorized by the source of discussion initiation: male partner, joint decision with partner, or partner alone. Percentages and absolute frequencies are displayed.

Preoperative considerations and medical consultation

When asked about the time taken to reach the decision, 14 participants (40.0%) reported deliberating for more than three months. Eight participants (22.9%) made the decision within one month, another eight (22.9%) did not deliberate at all, and five (14.3%) considered the decision for one to three months (Figure 4).

Figure 4 Duration of deliberation prior to vasectomy, categorized by participants who considered the decision for several months, several years, or only a few days. Frequencies and percentages are presented.

Notably, 62.8% (n=22) did not seek any medical consultation with primary care or other physicians prior to the procedure. Among those who did, nine consulted a family physician and four consulted a gynecologist; however, only three participants received a direct medical recommendation to proceed with the vasectomy.

Preoperative concerns

Concerns related to the procedure were common. Fear of sexual function impairment was the most frequently cited preoperative concern (n=27, 77.1%). Concerns about medical complications were reported by 19 participants (54.3%), pain by 11 (31.4%), irreversibility by 10 (28.6%), and postoperative recovery by eight (22.9%). Only five participants (14.3%) reported no concerns prior to the procedure (Figure 5).

Figure 5 Preoperative concerns among vasectomy recipients, categorized by type of concern: sexual function impairment, medical complications, pain, irreversibility, postoperative recovery, and absence of concerns. Frequencies and percentages are provided.

Partner involvement

The degree of partner involvement varied. Eighteen participants (51.4%) reported high involvement (score of 5), ten (28.6%) reported moderate involvement (scores of 3–4), and seven (20.0%) reported no involvement (score of 1). In terms of the partner’s concern about the procedure, most participants reported low levels of concern (scores of 1–2), while seven (20.0%) indicated high concern (scores of 4–5). Regarding physical presence, 23 participants (65.7%) reported that their partner was not present at any stage of the procedure, whereas 12 (34.3%) reported partner presence. Nineteen participants (54.3%) stated that their partner’s opinion influenced the final decision.

Satisfaction and regret

Satisfaction with the procedure was notably high. Twenty-six participants (74.3%) reported complete satisfaction (score of 5), six (17.1%) indicated general satisfaction (score of 4), and three (8.6%) were neutral (score of 3) (Figure 6). All participants reported no regret following the procedure, and 91.4% (n=32) stated that they would recommend vasectomy to others. The three who were hesitant to recommend cited concerns regarding the procedure’s irreversibility.

Figure 6 Post-vasectomy satisfaction levels categorized by self-reported satisfaction scores: complete, general, and neutral. Data are presented as absolute numbers and percentages.

Postoperative symptoms

Postoperative symptoms were reported by 21 participants (60.0%). The most common complaint was testicular discomfort (n=17, 48.6%), followed by testicular pain (n=6, 17.1%), swelling (n=3, 8.6%), and bruising or hematoma (n=3, 8.6%). Fourteen participants (40.0%) reported no symptoms after the procedure (Figure 7).

Figure 7 Postoperative symptoms following vasectomy, categorized by type: testicular discomfort, pain, swelling, bruising or hematoma, and absence of symptoms. Data include absolute counts and percentages.

These findings suggest that although mild postoperative symptoms are relatively common, they are generally self-limiting in nature.

Return to normal daily and sexual activities after procedure-related pain or discomfort

Return to normal activity was generally rapid. Seventeen participants (48.6%) resumed routine activities within three days, 10 (28.6%) within three to seven days, five (14.3%) within one to two weeks, and three (8.6%) took more than two weeks to recover (Figure 8A).

Figure 8 The time to resumption of routine daily activities (A) and sexual activity (B) after vasectomy, both classified into identical intervals: within 3 days, 3–7 days, 1–2 weeks, and more than 2 weeks.

Regarding sexual activity, 14 participants (40.0%) resumed intercourse within one to two weeks, 11 (31.4%) after more than two weeks, six (17.1%) within three to seven days, and four (11.4%) within the first three days (Figure 8B).

Discussion

In this cohort of 35 Israeli men who underwent no-scalpel vasectomy, we observed a predominance of married participants with two to three children, reflecting the typical demographic profile of vasectomy recipients in Western settings. The majority held at least a bachelor’s degree and were employed in technology and high-tech sectors, consistent with higher socioeconomic status being associated with vasectomy uptake (13,14).

Participants cited avoidance of female contraceptive methods (80.0%) and the desire for permanent contraception (65.7%) as their principal motivations. These findings mirror international reports in which permanent family planning and partnerrelated considerations frequently drive vasectomy decisions (15,16). Simplicity and safety of the procedure, high efficacy, and family‑completion motives were also prominent, underscoring that both practical and lifestyle factors contribute to men’s contraceptive choices.

Decision-making was predominantly initiated by the male partner (54.2%), though joint decisions (22.9%) and partner‑initiated discussions (22.9%) were also common. Over half of participants reported that their partner’s opinion influenced the final decision, highlighting the importance of couple dynamics in contraceptive counseling. Notably, more than one‑third of partners were physically present during the procedure, suggesting that partner support may alleviate procedural anxiety.

Despite prevalent preoperative concerns, most commonly fear of sexual dysfunction (77.1%) and medical complications (54.3%), only 37.1% of men sought medical consultation prior to vasectomy, and among those, few received proactive recommendations to proceed. These findings suggest gaps in awareness and provider-level counseling within Israeli healthcare compared with some Western settings, where vasectomy is commonly provided in primary care; in the United States, for example, family physicians perform up to 35% of vasectomies (19). The discordance between high anxiety and low engagement with clinicians represents a missed opportunity for preprocedural education and shared decision-making. Given that preoperative anxiety is associated with greater postoperative pain across surgical disciplines (10,11), targeted preoperative counseling may mitigate fears and improve postoperative recovery.

Postoperatively, transient symptoms were reported by 60.0% of participants—most commonly testicular discomfort—yet these events were mild and self-limiting. Nearly half (48.6%) resumed routine activities within three days, and 40.0% resumed sexual activity within 1–2 weeks, indicating rapid functional recovery. Satisfaction was uniformly high: 91.4% of men expressed complete or general satisfaction, 100% reported no regret, and over 90% would recommend vasectomy to peers. These rates exceed or match those reported in other populations, where regret rates of 4–10% have been documented, particularly among younger or childless men (15-18). The absence of regret in our study may reflect thorough family-completion, effective expectation management, or cultural factors unique to this Israeli cohort.

Limitations

This analysis includes its single-center design and modest sample size, which may limit generalizability. The study population was restricted to men actively seeking vasectomy and therefore does not capture men who face societal, cultural, or access-related barriers to considering the procedure. Self-selection bias is possible, as men with more favorable attitudes toward vasectomy may have been more inclined to participate. In addition, the cohort may overrepresent individuals with higher educational attainment and employment in high-technology sectors, which could further limit the applicability of these findings to broader and more diverse populations.

Conclusions

In this single-center cohort of Israeli men undergoing no-scalpel vasectomy, the procedure was safe, recovery was rapid, and satisfaction was high (91.4%), with no reported regret. Decisions were often male-initiated but substantially shaped by partner involvement, underscoring the value of couple-centered counseling. Despite prevalent preoperative fears, chiefly sexual dysfunction and complications, few men sought medical consultation and even fewer received proactive referrals, revealing a clear gap in provider-level counseling relative to Western primary-care models. Standardized, multidisciplinary counseling pathways, anchored in primary care explicitly covering risks, irreversibility, and psychosocial considerations are likely to reduce anxiety, improve postoperative experiences, and support informed choice.

Acknowledgments

We would like to thank the patients for giving their time to fill the questionnaires.

Footnote

Reporting Checklist: The authors have completed the SURGE reporting checklist. Available at https://tau.amegroups.com/article/view/10.21037/tau-2026-1-0054/rc

Data Sharing Statement: Available at https://tau.amegroups.com/article/view/10.21037/tau-2026-1-0054/dss

Peer Review File: Available at https://tau.amegroups.com/article/view/10.21037/tau-2026-1-0054/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-2026-1-0054/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 Review Board of Assuta Medical Centre (No. 0036-25-ASMC). Informed consent was obtained from all participants.

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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