I must admit that the letter shocked me. Its headline, "Sterilisation," adopted a tone which is more familiar in modern China than in SE1. But having produced, between us, five children in three marriages, I and my wife did not need Parson Malthus to tell us it was time to stop.
The precise subject of vasectomy had arisen over lunch with friends one day, when our host forcefully informed us that he'd had the operation a couple of years ago, gone back to work the next day and never looked back. Since my wife had already bled for modern reproduction by having a most unwelcome caesarian section when our first child was born, it now seemed to be my turn.
Courage, however, is more easily exercised on behalf of another and it took my wife to research the practicalities. Because our lunch host was himself a considerable authority on Britain's health system, we were not inclined to dispute his testimony that a snip on the NHS would involve both a lengthy wait and a damaging diversion of resources from elderly people awaiting hip replacements. In any case, a private snip needn't mean Harley Street. In Britain, there are two or three charities which provide the service. A quick internet search turned up Marie Stopes International (MSI), which has clinics all over the world and 60,000 British snips to its credit. MSI, it seemed, would take care of the entire proceedings for a modest ?180. Since official government figures say that it costs an average of ?332 to deliver a vasectomy on the NHS, it was clear that in using this service we would be performing a service to the nation.
There wasn't much by way of formality. Read the four-page leaflet, fill in the form, send your deposit and make an appointment at a convenient clinic. Because we were spending most of August last year in west Wales, I opted for the Swansea centre, just in case I didn't feel like being at work the very next day.
The leaflet was reassurance itself. The operation was "safe, simple and effective... the worldwide recommended family planning method for men who want a permanent solution to their contraceptive needs." A diagram illustrated the procedure: an incision of "less than one centimetre in the scrotum" through which the tubes which carry sperm to the ejaculatory liquid would be cut and cauterised. "Does it hurt?" the pamphlet asked. Foolish thought. There would be a local anaesthetic of the type dentists deliver every day, although, like dentists, "we cannot guarantee you will feel no discomfort." Afterwards there might be "a dull ache which can be relieved by taking paracetamol." And the risks? "Vasectomy is very safe and long-term effects are extremely rare." Although there was (and is) talk of a link between vasectomy and prostate cancer, "there is no conclusive evidence." It would take a real sissy to say no to this.
The operation, the pamphlet continued, should not be considered reversible (although in the hands of the right surgeon it mostly is), but it would not adversely affect my sex life or my ability, after just four weeks, to take part in violent games. "Many couples find greater sexual freedom once the risk of unwanted pregnancy has been removed," the heirs of Marie Stopes whispered, and no doubt the founder herself would have approved. After a sexless first marriage, Marie Stopes came to the closing stages of her second marriage with a written agreement from her husband that she could expend her sexual energies upon a series of younger men. This detail was absent from the official pamphlet, but you can read all about it at MSI's website (www.mariestopes.org.uk), where the story is retold to celebrate the fact that readers of the Guardian selected Stopes as their woman of the millennium. You can also read the comments of Tim Black, MSI's chief executive, that the vasectomy is "a very minor operation that takes about five minutes to complete." Other press releases set out details of MSI's advertising campaigns for more vasectomy and Geri Halliwell's ambassadorial role.
Had I known that I was up against the Spice Girls and the Guardian's Millennium Woman, perhaps I would have made my excuses and not turned up. But I felt quite relaxed when I arrived at the clinic, which turned out to be a Swansea general practice. The jolly nurse who greeted me was, surely, someone I had seen in Carry On Nursing; any moment now she'd bathe me in a shower of double entendres. Instead, she sat me down and asked me to confirm how many children I had fathered. Guilty as charged. "You've obviously made your mind up about this," she said. Counselling session over.
Having been instructed not to arrive in loose fitting boxer shorts, but in briefs, I removed those and lay on the couch. Now the doctor joined the nurse and explained that there would be a modestly uncomfortable local anaesthetic, followed by the operation. I should inform him if the situation approached agony.
The nurse talked about her religious convictions and her social life. The doctor joined in, telling me about his fondness for sea diving and explaining the difficulties he was having in re-surfacing his drive. "No molten tarmacadam today, though, eh?" I quipped. The smell of burning had meanwhile become strong and persistent, and the physical sensation that of an electrician rooting through a hole in the ceiling for recalcitrant wires. Somehow things didn't seem to be going to plan. The nurse's accounts of her evangelical convictions became more florid, but less distracting. After 40 minutes, I was told to re-hoist the briefs and to "take it a little easy for a couple of days" and everything would be fine.
The next morning I was black and blue across my entire groin area, bleeding spasmodically and walking like an extra from a John Wayne film. It was a fortnight before I felt anything like normal, and I waited for a subdued but nagging pain to subside.
I also waited for certification that I was now infertile. After the specified 12 weeks I started to fill the plastic sample jars with ejaculatory fluid for testing at the lab near Regent's Park. On Christmas Eve, I had a letter: the sperm were still at large. They would need another series of samples. I was upset.
What was really bothering me, I think, was the sense that an operation which many men plainly find unproblematic had become such a trouble for me. Why was this? Five months after the operation, I still had pain every day. I thought back to a Friday afternoon in Swansea and reflected upon the laying of tarmacadam and about what they used to call "Friday afternoon cars" in the dog days of British Leyland.
I sent off more samples. By March, another letter -still the sperm were defiant. I telephoned MSI to say that I was concerned that the operation had not been well-conducted, that I was not feeling well and that I would like to see a specialist in London to discuss the matter. An appointment was made.
I arrived at Marie Stopes House itself, in Whitfield Street, west London, where Millennium Woman set up her family planning clinic in 1925. At first I didn't realise that I had been booked in at the start of an afternoon devoted to the breaching of more male vas deferens, but because the doctor turned up 90 minutes late, there was plenty of time for conversation in the small, nervously packed waiting room.
There were three couples and me. "You first then, mate," says a man in a leather jacket. "Don't use up all the blades." "It don't hurt," says a woman on the opposite set of chairs, looking as if she were fresh from snapping telegraph poles across her knee.
"You know anyone's actually done this, mate?" inquires leather jacket.
"Well, actually, yes," I say. "I've had it done myself."
"So, why you here then?"
"Because it didn't work."
The silence that followed was charged. "Whaddya mean, didn't work?"
"Well, I had the operation last summer, and I've still got positive samples. But I've come here today because I've also been in a bit of pain."
"Pain, whaddya mean? They say it's no problem."
"Look here," says the telegraph pole-snapper, "I don't think you should be coming in here upsetting all these people," glancing at her petrified husband.
"He asked me why I was here," I say. "I told him."
Silence resumed.
Eventually, the consultant urologist turned up. He looked at my "notes"-the form I had originally filled in, with boxes marked to record the results of my prodigious supply of samples. I asked him if he knew anything about the doctor who had done the operation. "Can't read his name," he said. I described the intermittent pain in my right testis. "There is a risk of chronic pain after vasectomy," said the consultant. "Some people experience pain for their whole lives, but the numbers are very small, 0.1 per cent."
"Why does your literature not make this clear?"
"Because the risk is so small, we are not required to state it."
"What about the fertility issue: what is your conclusion?"
"It appears that the operation has not been successful. You still have one more sample to complete, but it does not look very hopeful."
"What are my options?"
"You can have another operation, under general anaesthetic."
"What effect will that have on the pain?"
"It's unlikely to make it better, but it's difficult to say."
As I grumbled back down Whitfield Street, I was not feeling too warm towards the author of Married Love and Wise Parenthood. I would do something I'd never done in my life: I would seek a second opinion.
A general practitioner friend inquired on the consultant urology circuit and referred me to Mr Chinegwundoh at The London Independent Hospital. He told me, and put in writing, that he tells his vasectomy patients that the incidence of chronic testicular pain is 4 per cent. He confirmed that I would probably need a second operation to become infertile.
The only thing I knew for certain was that I was not going to trust a surgeon to undo the problems caused by surgery. Perhaps I should sue, but where would that get me, other than an unknowable distance down the path of vengeance? I resolved to live with it. To moan silently, and brood.
The brooding moved in two directions. One was the peevish mood which thought ill of an organisation which campaigns so hard for its birth control mission that it puts dubious sales gloss on medical evidence. On the other hand, I couldn't complain too much. Compared with the dangers women face from sex and reproduction, vasectomy is hardly a big deal. Over half a million women a year still die in childbirth or as a result of some complication in pregnancy. Even in thriving, Blairite Britain, female sterilisations, of which there are about 50,000 a year, involves a risk of fatality, chiefly through the effect of anaesthetic. Although there is a man on the internet setting up Men Against Vasectomy (having coughed up $185,000 in fees to deal with the aftermath of his own operation), there is not really any good evidence for claims that vasectomy raises the risk of genital cancer or other ailments.
What there is, however, is a clear risk of chronic pain. In my case this is still intermittent and irritating rather than debilitating. If I had known this risk, I would probably still have had the operation. But why is it so difficult for medical people to understand that most patients prefer to be fully informed?
Men are to blame, too, preferring the maximum in jokes and the minimum in useful conversation about these matters. If you doubt this, look at the men's health websites-vasectomy is simply not an issue. And how often is it discussed even in the ubiquitous health and lifestyle features of the newspapers?
Yet since my own snip, I've found that almost every man I know has either had or been obliged to consider having a vasectomy. Men, though, prefer to talk about football or the Third Way or the decline of the BBC. One friend told me the other day that having had a vasectomy some years ago, he is now undergoing expensive fertility treatment to have his blocked sperm released into a test tube so that his current partner can try to have a baby. When the subject is raised with men who haven't yet succumbed to the pressure of Millennium Woman, they usually wince, as when seeing a batsman catch a fast inswinger just inside the thigh. Then they look smug.
But even if we become more enlightened, there are no grounds for thinking that the vasectomy curve leads irresistibly upwards. For one thing there are big national variations-perhaps vasectomy is even a crude measure of the private power of women in a society. In France, it is almost unknown. In the US, it is now the second most common form of contraception (after condoms), with 500,000 operations a year. Adjusted for population, that is twice as many as Britain's 50,000, which, curiously, has been steady since the early 1980s. About 11 per cent of British men, mostly in their thirties and forties, have had a snip, compared with 12 per cent of women (aged 16 to 49) who have had the more complex and traumatic sterilisation operation. Almost everywhere in recent years, consumption of the pill has tumbled (a British survey of clinic-users found it dropping from 70 per cent in 1975 to 44 per cent in 1997) while use of the condom has gone up, thanks to anxieties about sexually transmitted disease. We can and do change our birth control techniques.
My complaint against MSI and other such organisations is that they cannot be trusted to guide our choices because they are propagandists as well as service providers. Earlier this year, MSI published the results of a survey said to confirm its own view that vasectomy is a low-risk, painless procedure. Only a quarter of the men asked agreed that the procedure was "very good/effective/professional." Had the respondents experienced any continuing problems? Almost 9 per cent said they had and a further 10 per cent were unwilling to commit themselves. Yet not one of the 500 men surveyed said he would refuse to recommend vasectomy
By the way, I had another letter from MSI the other day. It was headed, "Congratulations!" and continued: "I am pleased to inform you that the last two semen samples you sent showed no sperm present. You may now stop using other forms of contraception, as your vasectomy has been successful." Millennium Woman be praised.
