Permanent contraception for premenopausal women typically involves abdominal surgery to ligate or occlude the fallopian tubes. While overall safe, this is still a procedure with inherent risks such as pain, transfusion risk, infection, damage to abdominal strictures and risks of general anesthesia [7].

In contrast, permanent contraception for men via vasectomy involves a straightforward minimally invasive procedure in the scrotum [8]. Despite the fact that vasectomy is less invasive and safer, tubal ligation has historically accounted for the majority of surgeries performed for permanent contraception in the United States [8, 9]. Approximately 16% of women undergo tubal ligation as a sterilization technique compared with only 6% of men who undergo vasectomy [10]. In fact, one study even demonstrated a decrease in the number of vasectomies performed from 2007 to 2015 in the United States across all ages and geographic locations [11].

While women appear to have historically taken on more responsibility regarding the decision to avoid future offspring, the overturning of Roe v. Wade in June 2022 has changed the landscape of family planning for male partners as well. Multiple news organizations covered stories about non-published reports of more men seeking vasectomies all across the country [4,5,6]. We hypothesized that increased discussion around reproductive rights and a strong desire by some couples to avoid legal jeopardy may have contributed to assertive decision making among single and partnered individuals, some of whom may have already considered pursuing elective sterilization but had not yet found the impetus to do so.

In this manuscript, we report clinical data from a high-volume academic medical institution showing a significant increase in vasectomy procedural volumes following Dobbs (Fig. 1). While the overall increase in procedural volume includes patients who had initiated consultation prior to the ruling, the legal decision may have prompted many to actually schedule vasectomy rather than putting it off. Within the short interval after this decision, our hospital network also experienced a rise in new vasectomy consultation requests of 35.0% and vasectomy consultation visits of 22.4% compared to the same time period the year prior. Interestingly the rate of men who actually attended their appointment was lower in 2022, showing that some men ultimately did not feel compelled to pursue vasectomy after initial fact-searching. However, when examining the preliminary 3-month follow-up period after consultation in the July–August cohorts, we found that men were proceeding with the vasectomy procedure at a similar rate, indicating that patients who came to appointments were truly interested in acting.

There were multiple other notable findings in our analysis. After Roe v Wade was overturned in June 2022, men seeking vasectomy were significantly younger (35 vs 38 years, p = 0.01) and far more likely to be under the age of 30 (23.9% vs 10.3%, p = 0.005). The median age of men undergoing vasectomy has previously been described at approximately 37 or 36 years of age depending on urban versus rural location [12]. This surge of younger men choosing to undergo permanent contraception half a decade earlier than historical rates should not be dismissed as expected change over time. The immediacy with which this change was seen indicates that the Post-Dobbs generation has already been significantly affected by the legal climate and the population-based consequences of this decision will continue to be seen in multiple ways for decades to come.

Interestingly there was no change in the proportion of single or married men pursuing vasectomy pre and post Roe v Wade overturning. However, there was a significant increase in childless men pursuing vasectomy after the legal ruling. We hypothesize that both single and partnered men who have decided not to have further offspring now feel it necessary to take reproductive autonomy into their own hands. The invasiveness of female permanent contraception may have some bearing on this decision, but changes in the rates of tubal ligation for women Post-Dobbs have yet to be described.

Prior studies have described racial and ethnic differences in men seeking vasectomy in the United States [10]. Consistent with the published literature, we also found that the majority of men in our study self-identified as white for both years. There was a significantly higher percentage of white men seeking vasectomy after Roe v Wade was overturned, and a significant decrease in African American men (Table 1). The reasons for this are likely multifactorial in nature, and could include uneven access to healthcare, and differing perceptions of the reproductive legal climate. However, larger numbers would be needed in order to accurately assess for these factors.

One limitation of our study is the short duration of follow-up for the July/August 2022 cohort. In order to minimize the risk of bias in interpreting results such as surgical scheduling, we compared the 3-month vasectomy completion rate in both the 2021 and 2022 cohorts and found these to be similar. In addition, our procedural volume also reflects the increase in consultation, which further strengthens the conclusion that vasectomy interest rose post-Dobbs. Another limitation is the single-institutional nature of our study. However, as our institution is a large quaternary referral center including a network of 13 community hospitals serving our racially diverse region in both urban and rural settings, the database used is likely representative of the greater population. It is also important to note that this study was carried out in Ohio, a state that activated a “heartbeat bill” (Ohio Revised Code, 2919.195) very soon after Roe v Wade was overturned. At the time of writing this manuscript, an Ohio state judge temporarily blocked this law from taking effect based on a challenge from the Ohio American Civil Liberties Union and further deliberations are pending. A strength of our study is that comparison of the same months (July–August) in two different years limits the inherent variability in surgery consultation and scheduling, as patients consider multiple factors when making medical appointments that are unrelated to the legal landscape [4]. One unique factor that has affected elective medical appointment scheduling over recent years is the COVID-19 pandemic, and it is important to note that during the July–August 2021 time period compared, there was no active national or Ohio-wide surge in cases which would have decreased our volumes. Further study regarding vasectomy consultation and scheduling across the country should be encouraged and is ongoing at our institution.