Worldwide, approximately 3-6% of couples are using vasectomy as a method of contraception [3, 9]. In the first stage of study we have found total 311 couples that underwent vasectomy during 2005 to 2007. The population in Shahroud area is about 200,000, which means there are 62229 couples. It means that prevalence of vasectomy in Shahroud area is approximately 5% that is similar to vasectomy's worldwide prevalence. Other studies also report the same occurrences in Iran. In this study we have found a sharp increase in numbers of couples who have chosen vasectomy between 2005 and 2006; however, there was no difference between 2006 and 2007. By comparison, the vasectomy prevalence has progressively declined in Asia over the past 15 years with the exception of Bhutan, Iran and the Republic of Korea .
As It is displayed in table1, 19.4% of men had more than 12 years of school education and 36.6% of males that accepted vasectomy had between 5-9 of school education. Among women 9.6% were educated more than 12 years and 35.4% of females whom their husbands accepted vasectomy had between 9 to 12 years of school education. A majority (85.5%) of vasectomy recipients were from urban area. Barone, M.A. and co-workers in their nationwide practice-based survey, have founded that Low-income, minority and less educated men were underrepresented among vasectomy recipients . But in a survey of male subjects attending the Kingston Contraceptive Clinic for vasectomy, showed that usage of vasectomy was predominantly related to social class . Some other studies report that those who choose vasectomy are belong to higher socioeconomic group . A study in Nepal found that the major occupation of vasectomised men was agriculture (73.7%), with a literacy rate of 83.0% . We have found a significant difference in sources of information about vasectomy during 3 years (2005-2007) (table1). Although the most important sources of information about vasectomy in all 3 years were health providers, the role of health workers in acceptance of vasectomy was lower and the role of media and friends were higher in 2007 as compared with previous years. Similarly in other studies, the most important sources of information about vasectomy were health providers followed by family or friends . The result of present study shows the necessity of carrying out the educational programs for improving the knowledge and attitude of the health workers.
Level of education was significantly higher in vasectomy group among both male and female (table2). Education level in vasectomy group was significantly lower than people that have chosen non permanent methods (p < 0.05).
In our study, couples who have accepted vasectomy were significantly more educated than couples that have accepted tubectomy. They also had lower age, lower child number and higher income. Therefore we suggest specific consultations and education programs for people who have indications for choosing permanent methods of contraception.
Vasectomy is more common than female sterilization in only 5 countries. These countries are Bhutan, Denmark, the Netherlands, New Zealand and Great Britain. In 8 countries: Australia, Bhutan, Canada, the Netherlands, New Zealand, the Republic of Korea, Great Britain and the United States, the prevalence of vasectomy use exceed 10%. New Zealand has the highest occurrence of vasectomy at 19.3 . Although one of the most important reasons mentioned by couples who choose to have a vasectomy is the lower cost; [14, 15] however, in our study the higher socioeconomic level of people who accepted vasectomy as compared with tubectomy group shows that the mentioned factor does not have an important role in our area. Other causative factors to selection of vasectomy are lower side effects, mortality and simplicity of the surgical procedure of vasectomy [16, 17]
In a cross-sectional study carried out in Iran, one of the most important reasons for vasectomy refusal was concern about complications, including the risk of sexual disability after vasectomy .
A descriptive study that was conducted in south-western Ethiopia displayed that men's choice of vasectomy as a method of contraception was 79%. The prevalence of men that were not in agreement with vasectomy because of possible loss of children due to death or divorce was 21%" .
In the third stage of present study after assessment the attitude about vasectomy only 12.6% of women were worried about impotency and the majority of the women who have chosen contraceptives, except vasectomy, thought that their husbands would prefer tubectomy to vasectomy. Therefore we suggest a consultation and specific educational programs for both males and females. Similar findings were reported in several previous studies [20–22].
Culture and community aspects influence the ability and willingness of men to obtain a vasectomy. In our study 35 percent of interviewed women said that they would prefer concealment about their contraception method if they choose vasectomy.