Vasectomy for trans women & femmes: what you need to know

For trans women and femmes, getting a vasectomy can be a gender affirming experience as it is 99.95% effective at preventing pregnancy. The procedure is quick, low-risk and can be done at a GP clinic. While hormone replacement therapy (HRT) can reduce sperm count, it is not a guarantee that no sperm is present.

It is often perceived that losing your fertility and ability to have biological children must be a negative experience. For some trans people, however, the inability to procreate by either not being able to become pregnant or impregnate someone else is affirming of their gender. Even though vasectomies aren’t marketed towards women, I found that I was able to navigate the experience to provide a gender affirming result.

General Information

A vasectomy should be considered a permanent modification and contraception method. There is a common misconception that it can easily be reversed.  A vasectomy reversal requires a much more intensive procedure and isn’t always successful. If the idea of something being permanent sounds scary or you aren’t ready to make a decision about whether or not you want to have kids, there are a few methods of conceiving after a vasectomy:

• IVF using sperm retrieval.
• Freezing a semen sample, and/or embryo freezing if you have an egg provider.
• Attempting to have it reversed.

These workarounds all come with their own cost, changes to HRT, etc., so it is best to go into the process with the understanding that it may be permanent.

All anatomies are suitable for a vasectomy. I was worried about this as someone who has experienced atrophy while being on HRT. However, my doctor during the physical exam reassured me that the atrophy I had experienced hadn’t affected the vas deferens (the ‘tubes’), and there wasn’t any issue with getting the procedure done at the GP clinic. If the tubes are harder to locate, it is still possible to get the procedure done, it may just require going to a specialist.

Vasectomy Procedure 

The procedure is relatively straightforward if done at a GP’s clinic. The doctor should explain the procedure and provide an opportunity for questions beforehand. There is a pre-procedure genital check to ensure the vas deferens are suitable to have the procedure done in a GP office.

My personal experience of the procedure was that after the local anaesthetic, I experienced some pulling/tugging but no pain. During the procedure, there was some awkward small talk with the nurse and weird surgical smells, but nothing that couldn’t be planned for if you are aware of your needs and able to communicate them to your doctor beforehand. Overall, some sensory considerations to be aware of are:

• The ceiling lights can be intense, so you may want to bring something to cover your eyes.
• Have your headphones or similar handy, discuss with the doctor beforehand if you can wear them.
• Something to distract yourself with. I was able to be on my phone during the procedure.
• Depending on your clinic, it may be a requirement that someone take you home after the procedure.

A follow-up sperm count is generally recommended to be completed twelve weeks post-op, which is done by providing a semen sample to a pathology clinic. Until this has been given the all clear, you shouldn’t rely on the procedure as a method of contraception.

Vasectomy Recovery 

Resting as much as possible for the first couple of days, and following the recovery instructions from your doctor, will help. The bag of frozen peas is not a movie trope, they will be a lifesaver and important to help with swelling. Frozen peas can be curved around the body, unlike a flat rectangular ice pack. After the procedure, I spent most of the rest of the day lying down. I would highly recommend having things you need as close as possible to minimise getting up and down. While I was able to move around, it was also helpful to have someone with me who was able to retrieve things, so I didn’t have to move as much.

The next day I was able to return to working from home and I just needed to take regular breaks to lay down, or work from the couch. By the evening, I was attending the Word on the Sheets launch, while in a bit of discomfort, the pain was manageable enough to sit in the audience.

Most of the pain had subsided in less than a week, but the bruised/tender feeling persisted for 2-3 weeks.

Tucking, Underwear and Clothing 

Tucking may not be possible for two to four weeks after the procedure. Tucking too early may increase bruising and the risk of blood clots, further delaying healing. It will be a battle between safety and comfort, a gaff or tight underwear may provide a suitable middle ground. I found that tighter underwear was okay, but anything with a narrow band put too much pressure on the area and was painful. My suggestion would be to plan ahead and have a few options for underwear and clothing that allow for you not to be completely popped up.

Reframing Genitals Around Pleasure

For me, having a vasectomy has allowed my body to feel more aligned with my gender. I love the emasculating nature of a vasectomy because, for me, that emasculation has been deeply freeing. The possibility that my ejaculate could impregnate someone always felt deeply tied to maleness, so removing that possibility changed the way I relate to them.

It has made my body feel less connected to a reproductive role and instead grounded in intimacy and sex on terms that align with my gender. I no longer view my genitals as a pregnancy risk, but as a strap that I always have on me. In that sense, my genitals feel snipped from masculinity and instead tied to pleasure in a way that feels queer to me.