Meet the Doctor Performing Free Van Vasectomies to “Close the Contraception Gap”

Lately, my social media feeds have been filled with men sharing their vasectomy stories. As they gingerly walk out of the procedure, they explain how quick it was and how relatively, well, fine, they feel. As these men often point out, their wives have been bearing the burden of birth control and childbirth for years — why not do their part when it’s this easy?

This is the message that Esgar Guarín, M.D., a board-certified physician trained in maternal, child, and reproductive health, has devoted the past decade of his life to spreading. After leaving behind his previous career, largely focused on obstetrics, he decided to shift his focus to performing vasectomies. (The numbers just make sense, he says: “Men are the ones who are fertile every day from the moment they hit puberty until they die.”)

So, he started SimpleVas and opened two Iowa-based clinics that focus solely on “snipping” — he’s performed over 3,000 to date — making him a rarity in the field. He’s also spent the past eight years traveling the world with World Vasectomy Day, a nonprofit offering the procedure and using a combination of traditional storytelling and medical expertise to talk about “the participation of men in contraception and reproductive life,” he explains.

“We want people to realize that it’s not just individuals with female parts who are responsible for childbearing, deliveries, all the contraceptives, and also permanent contraception. No,” he says. 

Beyond the philosophical debate, there's also this simple fact: “There's a huge advantage by having our genitals outside of our body hanging out,” Dr. Guarin says. “It just allows for an intervention that is easier and safer — and it's slightly more effective." A tubal ligation (cutting or blocking the fallopian tubes to prevent eggs and sperm from meeting) requires being put under anesthesia and weeks of recovery time, whereas vasectomies (cutting or sealing the tubes that carry sperm to prevent it from being released during ejaculation) are so simple that post-op patients can drive themselves home. 

Yet, worldwide, for every vasectomy that happens, there are 20 tubal ligations. “The landscape in terms of reproductive equity and equality is not good. The gap in the participation in permanent contraception is huge,” he says. That comes down to a lack of education and just plain ignorance. Namely, the still-persistent cultural perception and narrative that the procedure is somehow emasculating. 

While numbers are better in the United States than in many other countries, there’s still a huge gap. For every person who gets a vasectomy, there are three people getting their tubes tied, according to Dr. Guarín. That’s why he decided to create the country’s first-ever mobile vasectomy clinic to perform vasectomies across the country, while also highlighting the simplicity of the procedure, especially in contrast to its permanent reproductive equivalent, the tubal ligation. A tubal ligation requires an operating room and a hospital setting or surgical center — serious infrastructure — but a vasectomy? “All you need is a really skilled surgeon. That’s it,” he says. Not to mention, while out-of-pocket costs for a tubal ligation can run up to $6,000 for those without insurance, the average out-of-pocket cost of a vasectomy in the U.S. is about $1,200 to $1,500, Dr. Guarín says. (Dr. Guarín charges half of that, $699, as a matter of “reducing the obstacles for men to get it done.”)

“I envisioned myself driving through an interstate highway with phrases and images around the mobile clinic generating conversation and triggering controversy” — and after three years of deliberating, he knew he had to do it, he says, even if it meant convincing his wife to take equity out of his house in order to finance it. ("From a business standpoint, I have to tell you, it was a terrible idea," he laughs. "The return on investment is pretty much nonexistent. It didn't take a financial specialist to tell me that.")

What Dr. Guarín couldn’t have envisioned at the time was that there’d soon be a “vasectomy revolution" making him busier than ever — but not exactly for the reasons he’d hoped. When the United States Supreme Court overturned Roe v. Wade in June 2022, the reaction was swift, with requests for the procedure skyrocketing, which Dr. Guarín refers to as “bittersweet.” 

“For those of us who have dedicated our lives to the promotion of responsible male participation in contraception, we've been pushing for this. We've been trying to convince men, and we've been trying to reduce the points of friction in the whole process. To make it simpler, make it easier to access, cheaper,” he says. “We finally get to see this change, and it's great, but it seems like it took restricting the rights of an individual to choose in order for the counterpart to say, ‘You know what? We're gonna do it.’” 

Immediately after the Supreme Court ruling, Dr. Guarín noted a spike of about 15% in young, childless patients under 30, but the biggest surge — an estimated 20 to 25% increase — was “amongst men in their mid-to-late 30s who had made their decision of not having any children at all years prior and had done nothing about it and were relying on their partners for contraception, which is exactly the point that we're trying to make: that men have to participate,” he adds. “The men who came to my clinic basically said, ‘Oh, I was fine with my partner getting her shots or taking birth control pills, but I’m here now that I don’t feel I can fall back on an abortion.’ So, the attitude was like, ‘I don't want to have children, but you take care of it. And if something fails, you will take care of it.’ Their hand was forced and that was what pushed them.”

Previously, Dr. Guarín’s philosophy on vasectomies was positive, a way to “express satisfaction with one's fertility,” he says. Dr. Guarín firmly believes they’re an “empowering tool” for both men and women. While he notes sometimes there’s a sense of grief, he insists it shouldn’t be the case: “You're not leaving anything behind. You're moving into a new stage of your life, a stage where you don't have to worry about an unplanned pregnancy.”

In summer 2022, he saw the other side: People choosing a vasectomy not out of satisfaction with the children they already had, but out of lack of control over their bodies and fear of what might happen next. A couple came to his mobile clinic and explained that although they wanted children, they were getting a vasectomy due to heightened risk of ectopic pregnancy — and the legitimate concern that they might not be able to receive a life-saving abortion.

“They felt in the environment where they were, that they were not going to receive the proper healthcare and there was this awful fear that she could die,” Dr. Guarín shares. “He said, ‘I love her so much that I don't want her to go through that and risk losing her,’ which was a ridiculously beautiful thing, but it’s the expression of frustration and fear because of the political environment, which is really, really sad.”

While the uptick in conversation around — and men seeking out — vasectomies has certainly helped his business, Dr. Guarín isn't exactly in it for the money if you hadn't gathered. Case in point: In November, he performed 80 free vasectomies in the mobile clinic and on a recent week-long trip to Ecuador with World Vasectomy Day, he performed 100 vasectomies free of charge. “I don’t care. I have two daughters and I'm absolutely convinced that I can leave a more equitable reproductive world behind when I'm gone,” he says. “I think it's worth doing.”