Every March Madness vasectomy is different. You might have your reasons for asking a doctor to cut a small hole in your scrotum; extract the vas deferens; sever the tube and cauterize it; and then, after fixing one-eighth-inch titanium clamps to each end, stuff it back inside your scrotum. And me, I might have different reasons.
Josh and Camille Richmond’s thinking went like this: Twelve years ago, Josh and Camille had a girl named Taylor. Taylor is absolutely perfect. She has long brown hair and a buccaneer’s smile, and every afternoon she leaves a trail of food wrappers and crumbs from the kitchen to the gray leather sofa in the living room. If you don’t let Taylor run around outside, she’ll go mad. On Fridays, she has two different soccer practices with two different teams. Josh and Camille didn’t see how a child could get more perfect than that.
When Taylor was 6 years old, Josh had open-heart surgery. The operation went fine. But afterward, Josh felt like pressing a reset button on parenthood. He wanted to have the experiences he had with Taylor one more time. The doctors advised Josh to take it easy after the surgery. But about nine months later, Josh and Camille had another girl. They named her Piper.
Piper is also absolutely perfect. She is towheaded and has round, cherubic cheeks, and she is obsessed with pink to a degree that would impress Barbie. On St. Patrick’s Day, Piper refused to put on a green dress because that is a color that boys wear. She finally acceded to the dress. But she insisted on pink tights.
Josh and Camille decided to not have any more perfect children. Taylor and Piper, they knew, would sap every last ounce of their energy. At first, they thought Camille would have a tubal ligation — the procedure known as “having your tubes tied.” Taylor had been born by Cesarean section, and the Richmonds figured Camille would have tubal ligation during her second C-section. But Camille’s labor with Piper progressed quickly, and she didn’t have another C-section. The couple’s eyes turned to Josh’s tubes. Josh would have a vasectomy.
Sometime later, Josh heard an ad on a Eugene, Oregon, sports radio station. The ad said he could schedule a vasectomy on the first full day of the NCAA tournament. The promotion — now widely known as the March Madness vasectomy — can be found at urology practices from Cape Cod to Elgin, Illinois. It promises to turn a grisly husbandly duty into a few comfy days watching Duke-Mercer and Ohio State–Dayton. It has — here’s the nut graf, so to speak — flipped the old ideas of masculinity and vasectomy upside down.
A urologist would stand over Josh just after the tipoff of Florida-Albany. “You’ll always get to brag about that, right?” Josh said the night before. “‘You know what I did during 2014 March Madness? I sat back and watched every game possible. People were catering to my needs.’ Seems like an awesome gig.”
On the afternoon of the vasectomy, Josh and Camille sat in a waiting room at the Oregon Urology Institute. The building has a metal roof and flagstone and wood accents. It’s a little like having your scrotum cut open in an REI.
Josh was wearing loose-fitting gray sweatpants and pink-and-black sneakers. He was more worried about missing a chunk of the Oregon-BYU game than anything that would happen to him in the exam room.
“It’s only temporary,” he said.
“What, the pain?” Camille said.
Dr. Douglas Hoff of the institute would be performing the operation. “Did you ask him how many he’s done?” Camille said.
“Have you seen a urologist’s house?” Josh said.
Josh and Camille can answer each other with questions because they’ve been together forever. They met in 1999, when Josh was 23 years old. Camille was 18 and fresh out of high school. Josh had a job doing maintenance on public ball fields around Eugene. Camille’s mom worked for the city, and she got Camille a summer job working with Josh. Josh was the boss. Camille was something like his intern.
“I couldn’t stand him when I first met him,” Camille said. “I thought, This guy’s a jerk.” To Camille, Josh seemed to be lecturing her on how to paint a first-base line. Camille is friendly and has a fast, hearty laugh, but she doesn’t take criticism well.
Camille set out to show Josh he had nothing to teach her. She hauled the five-gallon buckets of white paint from the truck to the baseball fields, and she painted the baselines perfectly. Her stubbornness, in turn, had a strange side effect. It impressed the hell out of Josh. Josh and Camille spent 40 hours a week that summer accidentally proving they were perfect for each other. After the summer was over, Camille asked Josh out. That was 15 years ago. “She’s kind of a death-do-us-part girl,” Josh said.
Camille is a nurse in the neurological wing of Sacred Heart Medical Center in Eugene. She had come to Josh’s vasectomy as a loving wife but also as an interested spectator. She was going to go into the exam room and watch those holes be cut. “She geeks out over it,” Josh said.
Camille had been watching similar things for years. “He’s kind of a medical freak,” she said of Josh. Josh had radiation treatments for cancer when he was 14 years old. Nearly two decades later, he had his open-heart surgery for a condition caused by the radiation. His heart valves were replaced. Josh’s medical rap sheet is so long that he’ll forget to tell you about the time he had a needle stuck in his eye to correct a vision problem.
In the face of torture, Josh is a sphinx. “He plays everything down,” Camille said. “In turn, that makes everyone calm.” Between her job and his hospital stays, Josh and Camille have a tolerance for anatomical detail that exceeds every couple’s since Alfred Kinsey and Clara McMillen. At the dinner table, Camille’s mom sometimes has to ask them to change the subject.
“Joshua!” a medical assistant called.
Josh and Camille walked from the waiting room to an inner office and into an exam room. It had a green, uncomfortable-looking chair and a Sony monitor and some terrifying implements. Josh, who could write a book about doctor-patient relations, heard instruction that struck him as odd. He was told to drop his pants, but also that he could keep his sneakers on during the procedure.
Dr. Douglas Hoff, a blandly handsome man of 42, was performing Josh’s vasectomy. “Who goes into urology in the first place?” Hoff asked. “Someone who’s comfortable dealing with dicks all day.”
That, ladies and germs, is urology humor. Note the oozing sore of double entendre. Urologists have a million of ’em. Like when they inject anesthesia into your scrotum and then call you “numb nuts.” Vasectomy jokes are particularly treasured. This is because urologists think vasectomies are so mundane. “Most of my patients are cancer — prostate, bladder, kidney,” Hoff said. “Getting to do fertility work, for gosh sakes, it’s a nice distraction.”
The history of the vasectomy in America is a futile attempt to get this point across. Urologists note that the procedure is nearly foolproof. According to Dr. Ed Sabanegh, the chairman of the urology department at the Cleveland Clinic, only one in 1,000 vasectomies fail. A vasectomy does not affect sexual function. It requires only a local anesthetic. The procedure usually takes about 10 or 15 minutes. Yet Dr. Eugene Kramolowsky, a urologist in Richmond, Virginia, found his vasectomy patients are often more anxious than his patients who have cancer.
“Successful vasectomy projects cater to the psychological needs of men,” the journal Studies in Family Planning noted in 1983. In other words, the vasectomy has to be sold. The first appeal is usually to manliness. Mom went through the pain of childbirth. She hardly deserves the indignity of tubal ligation or an intrauterine device. Dad should “step up to the plate,” “take one for the team” — pick a cliché. From a 1996 episode of Home Improvement:
Jill: If you did this, not only would you be protecting me from surgery, but you’d be making a real commitment to me and our relationship. In my eyes, that makes you even more of a man.
Tim: [Grunting.] I want to be more of a man, yeah.
Hoff thought the appeal to man’s better instincts was fine, except that some of his patients fainted when he described the procedure. Worse, their wives did, too.
The second way to sell vasectomies took the opposite tack. The surgery wouldn’t be a gesture of enlightened manhood. It would be a return to look-ma-no-responsibilities boyhood. The man cave replaced the master bedroom. And just as athletes like Rafael Palmeiro once made Viagra safe for public consumption, the vasectomy would be couched in the soothing language of sports.
In 2008, Terry FitzPatrick, administrator of the Oregon Urology Institute, had a brainstorm. What if he promised vasectomy patients they could watch all the basketball they wanted? FitzPatrick took his idea to a Eugene marketing firm. The owners, John Prevedello and Scott Hettick, created an ad full of urology humor. They called the campaign “Snip City.” They came up with tagline, “Lower your seed!”
Prevedello and Hettick sent a commercial script to “The Score,” a 1,000-watt FM sports radio station. The script got into the hands of a host named Justin Myers. Myers agreed to record it with the proviso that he wouldn’t use his name. The ad played several hundred times. The whole campaign cost about $500.
A local columnist wrote an article about Snip City. Then it went viral. The effect was instant: The vasectomy became a gag, a lark, just as urologists had hoped. Snip City was Sports Illustrated’s “Sign of the Apocalypse.” Dan Patrick mentioned the promotion on his radio show, and guys called in for an hour to share vasectomy stories. The medical assistants at Oregon Urology still remember the single documented instance of the “bro vas” at their clinic — the two pals who came in and got their procedures done back-to-back. The vasectomy had become the equivalent of matching tattoos.
A few years later, Hettick called urology practices around the country to see about selling them their own Snip City campaign. He found many had already swiped it. Evan Cohen, the administrator of Urology Associates of Cape Cod, came up with the idea of offering every vasectomy patient a free pizza.
On a normal, non-basketball week, the Oregon Urology Institute performs three or four vasectomies. This year, in the week before the tournament, they performed 24. On Friday, March 21, one of Hoff’s colleagues had scheduled five himself. The March Madness vasectomy brought the urologist’s shtick out of the exam room. It placed the vasectomy at the bottom of the urological food chain. Most important, it allowed a man to display his commitment to the mother of his children by watching sports all day. Seems like an awesome gig.
Hoff was describing exactly what he would do to Josh during his March Madness vasectomy. First: “He can have Valium before we start the procedure. That’s what they get hit with at the door, if they want.”
Renee Anderson, one of the institute’s medical assistants, said the burly patients usually opt for Valium, while the small, “squirrely” guys usually decline. It’s just one of those things.
Next, Hoff’s team cleans the scrotum. Then Hoff locates the vas deferens — the “vas,” in urologist lingo. The vas deferens is a duct that carries sperm. Hoff narcotizes the vas and its environs with anesthesia. “I use the no-needle injector,” he said. “It’s like an air rifle. You cock it, it compresses the air, and carries the medicine through the skin and into the vas. I typically hit the vas four to five times with my air gun.” Hoff’s air gun is a silver cylinder, about eight inches long, that’s shaped like Flash Gordon’s rocket ship.
Though numbed by the air gun, Josh would be awake when Hoff opened his scrotum. “I do the no-needle technique, which is a Chinese technique,” Hoff said. “They came up with that one-child policy, so they’re doing millions and billions of vasectomies over there. What’s nice is, it’s quick and easy and it has a lower infection rate and lower bleeding rate.
“But anyway, you just use a clamp with a sharp point. You poke a hole in the skin about a quarter-inch in size. Skin has layers in it, kind of like wood. Like a grain. So in this technique, you’re splitting between the grain, not cutting across it. That’s why it bleeds less.
“You use that to spread the skin,” Hoff continued, “and you have a little ring clamp that you can use to grab the vas. You grab the loop of the vas, cut it, and cauterize it in both directions to destroy the channel.”
During cauterization, a vasectomy patient often sees a small plume of smoke rise from between his legs. This is usually when a urologist trades in his “numb nuts” gag for the one about how the patient can finally tell his wife he’s really smokin’ down there. Cauterization also produces an unusual smell. Jordyn Bloom, another of Oregon Urology’s medical assistants, said the aroma is like burning hair.
After the vas deferens has been severed and cauterized, Hoff will place a titanium clip at each loose end. Then he will push the vas deferens back through the hole in the scrotum.
“The bad news,” Hoff said, “is you got two of ’em.” That is, two vasa deferentia. Two tubes. After the first has been sliced apart, Hoff will punch another hole in the scrotum and begin to fish for the second.
Josh came out of Hoff’s office with a strange smile on his face. It was as if he’d ventured beyond the barrier between earth and heaven and come back with an ecstatic truth. His words came slowly. “That was … surprisingly … simple,” he said. “I was … not impressed.” On his scale of medical woe, Josh put a vasectomy below open-heart surgery and radiation and at about the same level as a cavity filling.
Camille had watched the surgery from a chair that offered a clear view of Hoff’s air gun. Camille is also tough to impress, medically speaking. “No, but it was interesting,” she said. “The vas deferens is just like what it looks like in the text books: a big, white tube. It was clamp, clamp, cauterize, and it’s done.”
Josh and Camille walked from the institute toward a Buffalo Wild Wings restaurant across the street. Josh moved with short, deliberate steps. Camille kept pace like a trainer escorting a concussed quarterback off the field.
“Do you feel like you have to walk slowly?” Camille asked Josh.
“I feel like I have to,” Josh said, “but I don’t feel like I need to. Does that make sense?”
Josh had refused the Valium — he went “total solo,” he said, except of course for the local anesthetic. Josh had remembered Camille’s hours and hours of painful labor and thought, I can take a little piece of that. Also, he wanted to be lucid for the second half of Oregon-BYU.
Josh and Camille walked into Buffalo Wild Wings.
“Is this our guest of honor?” the hostess asked.
Josh nodded. The hostess led Josh about 10 feet and pointed to a cushy, polyester recliner. From the chair, Josh could see 20 televisions.
The recliner was the Oregon Urology Institute’s latest brainstorm. This year, everyone who bought a March Madness vasectomy got a kind of throne at Buffalo Wild Wings. Terry FitzPatrick had posted their names and surgery times on the chairs. Josh was scheduled for 1:15, followed by Broc at two, Denver at 2:15, Mike at 2:30, and Gabriel at 3:30. If the vasectomy retained any trace of its former horror, it would be wiped out when the newly snipped patient munched on mango habanero wings in full view of the restaurant. Josh could look at the wincing guy next to him and say, “You must be Broc …”
Oregon was pulling away from BYU when a waitress arrived with a tray. Atop the tray was a package of frozen peas. It was another gift from the institute. Josh took the bag and placed it on his crotch atop his sweatpants. Then he demurely covered the bag with his T-shirt. Camille left for a few hours, while Josh watched Florida-Albany and Saint Louis–NC State and North Dakota State–Oklahoma. He drank a couple beers — the vasectomy is the rare operation that allows you to drink both the night before and a couple hours later. Around 7 p.m., Camille returned with Taylor and Piper. While Josh recovered, the whole family sat in Buffalo Wild Wings and watched March Madness.
On Friday, Josh was sitting splay-legged on his gray leather couch at home. He had traded his sweatpants for jeans. He was watching Creighton fend off a valiant rally from Louisiana-Lafayette. Camille was baking cookies in the kitchen. The Richmonds live in a pretty, light-filled house with a gas fireplace and albums full of vacation pictures and a big backyard for Taylor and Piper to run around in.
Josh had slept through the night without taking so much as Tylenol. “I’m moving around gingerly because I don’t want that ‘Oops, I shouldn’t have done that’ moment,” Josh said. “There’s a little pressure. But nothing unbearable.”
That morning, Josh had gone to a uniform store to pick up an outfit for his side gig as Taylor’s soccer coach. The man at the counter told Josh, “You must have been snipped.” He could tell by the walk.
“Can I fill that prescription for you?” Camille asked from the kitchen. Dr. Hoff had given Josh a prescription for oxycodone.
Josh said, no, he was doing OK.
Later, Camille asked, “Can I get you something frozen for your gentleman parts?”
Josh said he was still doing OK.
Besides the pain, urologists say men’s biggest fear of a vasectomy is its ineffable psychological toll. Studies in Family Planning noted an anxiety that a vasectomy “is the same as castration, that it decreases a man’s sexual abilities, and that it leads to a loss of vitality or body hair, or a change of voice or personality.”
Josh detected no such loss of mojo. “No emotion,” he said. “The thing is, the two kids we have, they’re awesome. But I don’t even know how I’m going to juggle those two when they both get active.”
Camille had to work at the hospital every other weekend. It was hard enough for both of them to get to all the soccer practices and basketball games and recitals. On the previous Friday, Josh had missed one of Taylor’s games for the first time. Some coworkers had thrown him a birthday party and Josh thought he should go. It was clear he didn’t want to miss another game.
Urologists call a vasectomy “permanent irreversible sterility,” but it’s not always permanent. The Oregon Urology Institute has seen men get a vasectomy; then meet someone new and get a reversal; and then, after redeployment is complete, come back to the institute for another vasectomy. Josh and Camille wouldn’t be seeking a reversal. The March Madness vasectomy might be the promotional equivalent of a spring Toyotathon, an odd side effect of the process in which sports and manliness became synonyms. But in a strange way, Josh Richmond’s sliced vasa deferentia had become another chapter in a love story. “When Josh wants his little boy,” Camille said, “we’ll just adopt.”