Sterilization options to stay child-free

FOLLOW YOUR ARROW: Michael Simpson of Cullowhee says he's known for most of his adult life that a traditional family structure, including kids, isn't for him. Photo courtesy of Simpson

When James Brinkmann was 17 years old, his friends started having children. He witnessed up close what parenting entailed and he knew he didn’t want it yet.

“I saw the adjustments they were having to make,” he recalls. “It made me realize and appreciate and respect the amount of commitment and the loss of control that I would experience if I had kids.”

His desire not to have children later solidified. “It cemented 100% around age 28,” he says. He was in a long-term relationship with a woman who also did not want to have children.

Brinkmann researched sterilization and discussed ramifications of the decision with his therapist. Four years ago, a urologist in Asheville performed his vasectomy. “I just felt like it was the right thing to do,” he says.

Brinkmann was one of the estimated half-million American men who have a vasectomy each year, according to research published in the journal Urology. (The American College of Obstetrics and Gynecology estimates the number is close to 200,000 vasectomies in the United States per year.) Xpress was unable to determine how many vasectomies occur in Buncombe County or North Carolina.

Dr. Brian Cohen at Mission Urology at Mission Health says vasectomy is “a straightforward, pretty simple procedure that takes 15 to 20 minutes to do in the office.” Basically, the procedure “disrupts the conduit, called the vas deferens, so that the sperm cannot make their way into the ejaculate at the time of ejaculation,” he says.

Cohen prescribes his patients a one-time dose of Valium beforehand, so the patient is as relaxed as possible during the procedure, he says.

Vasectomy is “very common,” he explains, estimating that he performs between three and five of them a week.

Most of his vasectomy patients are parents who don’t want any more children. “I do see some people that have just made a decision [and are] not interested in having kids,” he adds.

A vasectomy is a reversible procedure, with a 40%-90% success rate in achieving pregnancy afterward, according to the Cleveland Clinic. “The shorter the period of time [from the vasectomy] the more successful the reversal,” Cohen explains. “The longer the period of time, usually the less successful.” He says requests for reversals are “pretty rare” at his practice.

Making choices

A patient consults with a health care provider prior to a sterilization procedure. This is when some would-be patients run into difficulties.

Brinkmann says “the first urologist who was supposed to work on me [for a vasectomy,] refused to even see me.” He recalls arriving at his appointment at a urology office in Asheville and waiting for what felt like a long time. “Then, this nervous nurse came in and she was like, ‘I’m so sorry, but the urologist says that [they] won’t see you, that you’re too young and that [they] refuse to work on you,” he recalls.

The nurse found a second urologist at the practice who met with him immediately (and who apologized, Brinkmann says, for his colleague’s sudden cancellation). After a consultation and a health exam, Brinkmann’s vasectomy was scheduled for six months later.

Even though he eventually had a vasectomy, Brinkmann says, “Being told by somebody that I don’t have the ability to make informed judgments about my own body … felt really, really horrible in the moment. It still does.”

Michael Simpson, 23, a bartender in Asheville who lives in Cullowhee, says his general practitioner laughed at him when he asked for a referral for a vasectomy.

“At my last checkup, I brought it up [and asked] ‘Is there anyone you recommend?’” he recalls. “My doctor literally laughed it off. I just smiled and nodded, thinking, ‘It’s still gonna happen, whether you like it or not. I’m not changing my mind!’”

Simpson says he felt “patronized” by his GP’s reaction. “I felt like the doctor’s perspective was very skewed toward that traditionalist mindset that everyone’s gonna want kids eventually,” he says.

Helping patients make their own decisions is key, says Kat Lewis, health center manager at the Planned Parenthood Asheville clinic. Health care providers should be noncoercive during consultations about any type of contraception with all genders, she says.

They should “not ever provide anything other than basically medical facts and guidance,” she says. “Because at the end of the day, it’s a decision [clients] have to make for their body.”

Lewis acknowledges that “often in the history of obstetrics, in the history of eugenics, there’s been coercive care and providers who think that their decision is the best decision for the patient.” Health care providers should prioritize “autonomy and noncoercive care,” she says.

Tying tubes

Unlike vasectomies, sterilization for women is permanent. The medical term is a hysteroscopic tubal sterilization, although it can be done in different ways. The procedure is called a tubal, tubal occlusion, tubal ligation or, colloquially, “getting my tubes tied,” says Lewis.

Approximately 600,000 tubal ligations are performed each year in the U.S., according to the American College of Obstetrics and Gynecology.

A tubal sterilization involves obstructing the path that eggs travel to the uterus. “After the procedure, there will be scar tissue in the fallopian tubes and therefore the tubes will close,” Lewis explains. “It’s essentially closing off your tubes from functioning and blocking sperm from joining with the egg.”

The procedure requires making incisions in the abdomen and therefore has a longer recovery time than men have after a vasectomy, according to the Mayo Clinic.

There are a few different ways of performing the operation. A common procedure is a postpartum tubal ligation, which can involve removing either the middle segment of the Fallopian tubes or the entire tubes, explains Dr. Elizabeth England, faculty member for Mountain Area Health Education Center’s OBGYN Specialists.

Another common tubal ligation procedure involves laparoscopic surgery (with the aid of the camera), where a portion of the tube is removed or a titanium clip is permanently attached, England says.

Child-free by choice 

Some people who don’t want to have children identify themselves as child-free or child-free by choice. Those terms are used differently than the word childless, which is generally used to refer to someone who wants children but does not or cannot have them.

The Pew Research Center reports that 23% of nonparents predicted they are “not at all likely” to have children in the future in a 2021 survey. This was a slight increase from 2018, when 21% of nonparents answered that way.

Among the nonparents Pew surveyed, 56% said they “just don’t want to have children.” Medical reasons, financial reasons, the “state of the world” and “climate change” were among the reasons nonparents gave for not wanting children.

The COVID-19 pandemic may also be influencing people’s reproductive decisions. According to a survey about family formation during the pandemic, conducted by the conservative organization Institute for Family Studies and the Wheatley Institution at Brigham Young University, 17% of Americans expressed a decreased desire to have children since the COVID-19 pandemic began. The survey found that the desire by middle- and lower-income Americans to have children decreased since the beginning of the pandemic by 6% and 11%, respectively.

Simpson says he realized at age 18 that he didn’t want children. “A traditional family life is something I’ve honestly never really fantasized about,” he says. He cites mental health as one of the main reasons for his lack of interest. “I think I’m the limit of people I can take care of,” he says with a laugh.

He is open with his family about his plans not to have children and hasn’t faced any opposition from his parents. “I think my dad’s a little disappointed because he’s one of those people who loves being a dad,” he says. “But my mom has said, ‘I can see why you don’t want kids and that’s probably not a great idea for you.’”


Brinkmann left his long-term relationship in 2019 and has been figuring out how to navigate Asheville’s dating scene as someone who won’t have kids. “I’ve put it in my dating profile, because I feel that it’s important,” he says, adding that he does not want to waste anyone’s time.

But sharing his lack of a desire to have children on online dating profiles has also “not felt great at times,” he says. “It’s given me attention that I’ve not necessarily wanted, where some people interpret it as basically me saying that I’m looking for casual sex.”

Brinkmann tried a different tactic of bringing up his desire not to have children after a few dates. But that also led to complications, he said, when women responded that they do want to become parents.

Brinkmann no longer makes a decision in advance about when to share the information and instead says “I rely on my gut.” He feels fortunate that the woman he is currently dating, who is a mother, initiated the conversation by bringing up her lack of interest in having more children.

Simpson, on the other hand, says he shares his lack of interest in having children “once I realize there’s a connection there.”

He identifies as aromantic, meaning he is not interested in romantic relationships. Talking about his aromanticism and his child-free status get his personal boundaries out in the open. He explains, “Even if it’s sometimes uncomfortable in the process, it always simplifies things in the long run.”

Where and how 

A vasectomy can cost between $300 and $1,000, according to data from Kaiser Family Foundation. Tubal ligation procedures can cost between $1,500 and $6,000. Coverage by private health care insurance varies by plan.

NC Medicaid Managed Care and NC Medicaid Direct insurance covers sterilization for both men and women over age 21; it does not cover reversal procedures. Medicaid recipients are required to sign a consent form at least 30 days prior to a sterilization procedure.

People who are looking to be sterilized should ask for referrals from their health care providers, as the specific procedures offered can vary by practice. MAHEC’s Ob-Gyn Specialists do perform tubal ligations. MAHEC also has a Vasectomy Clinic at MAHEC Family Health Center Biltmore; it is the only office in Buncombe County that accepts Medicaid for a vasectomy.

The Planned Parenthood Asheville clinic doesn’t perform tubal ligations or vasectomies; nor does Western North Carolina Community Health Services, which is one of Asheville’s federally-qualified health centers.


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About Jessica Wakeman
Jessica Wakeman is an Asheville-based reporter for Mountain Xpress. She has been published in Rolling Stone, Glamour, New York magazine's The Cut, Bustle and many other publications. She was raised in Connecticut and holds a Bachelor's degree in journalism from New York University. Follow me @jessicawakeman

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3 thoughts on “Sterilization options to stay child-free

  1. Patricia Bass

    I never wanted children and never had any of my own. I helped my second husband raise his daughter from age 9. I am still less than interested in little kids and infants. Parenting is a serious commitment and obviously some people are not equipped to handle it.

  2. Bright

    Good for you, Mr. Brinkman! When this world finds a way to feed and take care of kids (and the people creating them), it seems that then would be a responsible time to put more on the planet. But, hey, that’s imo. Me…I’m just standing in long lines and waiting in traffic. La.

    • WNC

      Solid argument for closing the borders which have been purposely left open for both people and fentanyl.

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