Birth Control Challenges

Dear Lori and Jeff,

My husband and I have been together for almost twenty years, have two beautiful children and, for the most part, are happily married. The one issue to which we can’t seem to find any resolution is birth control. Throughout our relationship, I’ve been the one who has held the responsibility for protection, through several different methods. But now that we are very certain that we don’t want more kids and I’m more than ready to no longer be manipulating my body, so I’ve asked him to get a vasectomy. He pushes back saying it’s too permanent and it will make him feel like less of a man. How do I get him to finally be the one to take responsibility for this aspect of our relationship?

Signed, Off The Pill

Dear OTP,

Lori and Jeff: Most couples will experience at least one significant challenge that arises from having to resolve conflicts between individual needs and the needs of the relationship. However, couples can either become entrenched in a battle against one another, blaming each other for the stress and tension, or learn how to come together and work as a team.

Lori: Your feelings are not only valid, but shared by a multitude of women in long-term committed relationships. Women have historically had to bear the burden of this responsibility and with the incredible advances in medicine and technology it is almost unfathomable that the role has yet to become balanced between men and women. Add in the relatively recent reversal of Roe v. Wade and many women across the country have collectively experienced increased stress, fear and urgency to find more reproductive security.   

The painful truth is that you can’t try to convince your partner to do something to their body without creating a significant risk of consequences to the relationship. Pushing a partner to make a choice out of pressure, guilt or shame will open the door for resentment, loss of trust, and an erosion of emotional intimacy. However, that doesn’t mean that you just cave and keep taking responsibility for pregnancy prevention. You also get to set boundaries and advocate for your health needs. Invite your partner to join you in conversation with fresh eyes and a willingness to listen. Not having another baby needs to be seen as a joint goal for which you will collaboratively work towards finding a solution. Set up a time to talk about why it’s important not to get pregnant again. Lay out the energetic, time and financial costs, changes to lifestyle, schedules and sacrifices that another child would require. Starting here roots the conversation in a solid “why”. Then be willing to brainstorm all of the possible ways to prevent pregnancy, their risks, rates of success and consequences. Lastly, share your feelings, fears, needs and boundaries and invite your husband to do the same. Be willing to validate each other's felt experiences so you can move past defensiveness and into a spirit of collaboration.

Jeff: For men, there have been restrictively few options when it comes to birth control, so we usually defer to our female partners to decide what works best for them. When the suggestion arises for men to use a condom, most will roll their eyes and say something about the loss of sensation or the degradation of the experience. Additionally, condoms are only 98% effective at preventing pregnancy and that’s only with perfect use. The average, taking into account potential improper use, is around 87%. This number may seem relatively high, but no one wants to be part of the 13% with an unwanted pregnancy. The only real alternative is a vasectomy.

It is important, however, to understand the fear the men can have about surgically altering their genitals. One thing that women will never fully appreciate is how unbelievably sensitive the male nether region is to pain. Knowing that, it should come as no surprise that most men cringe at the thought of a sharp object getting anywhere close to that area. There’s also concern that sex might feel different or that it might not work like it did before. Studies show that these fears are statistically unfounded. More appeasing data is that the reversal of vasectomies are 95% successful.

One additional factor to consider is that getting a vasectomy, especially if there are feelings of pressure from it being done for someone else, might bring up some possible unresolved feelings around the trauma of circumcision. This will be a topic for an entirely separate column (parents’ conflicting opinions about getting their kids circumcised), but I’ll just say here that most men have never really explored the trauma from having their bodies forever altered in the first few months of their lives with no ability to provide consent and without any consideration of how it might impact their lives. Just be aware that this seemingly safe and simple procedure might represent a whole host of other issues for your husband that you (and he) might not fully understand.

Lori and Jeff: It may be helpful for both of you to see a gynecologist and urologist together to receive the same information and create a cohesive list of options to discuss. Set an intention to have a kind, compassionate conversation that explores and acknowledges both of your needs, worries and fears. If you still haven’t made movement towards a solution, it may be time to contact a licensed couples therapist to help you bridge the gap.