VA is expanding contraception access for male Veterans

When they hit puberty, young girls are exposed to contraception options from their primary care provider or OBGYN. At almost every visit afterwards, care providers ask girls and women about contraception and their available options. Urologist Dr. John De Caro noticed there was not a similar program or system in place for men at any stage of their lives. Enter the Male Contraception Initiative.

A lack of a standard practice

When De Caro joined Charlie Norwood VA in Augusta, Georgia, in October 2021, his first goal was to create a telehealth program specifically for urology. As someone who uses remote technology at work, he was excited about the prospect of developing a new program to bring urology care to Veterans in remote locations.

Seeing his program gain traction in Augusta and building momentum, he turned his attention to another gap in care that could address Veterans: male contraception.

“Unlike women, there’s not really an OBGYN equivalent for men when it comes to the routine issues of contraception,” De Caro said. When boys and young men go to visits, there are suggested questions providers can ask, but there’s no standard practice or guidelines for recurring conversations.

“When I see Veteran patients ask about vasectomies, men are often the ones bringing it up first to their primary care provider or women are bringing it up to men. There’s not a proactive approach in place,” De Caro said.

Male VA doctor

Urologist Dr. John De Caro

Awareness of male contraception

For a surgical approach to contraception, there are generally two options: tubal litigation for women and vasectomies for men. Women who undergo the procedure are required to undergo general anesthesia, and they have a longer recovery period and other potential risks.

“Men have a shorter recovery period, only need local anesthesia and can often return to work the next day,” he added. Despite these benefits, women are about 40% more likely than men to undergo a surgical contraception procedure.

Through a three-pronged approach, De Caro is working to bring greater awareness to male contraception options and benefits. By collaborating with primary care colleagues to create a standard of practice, easing the process of setting up vasectomy appointments and developing an online patient decision making support tool, he sees progress.

The innovation journey

A colleague introduced him to innovation specialist Kelsey Shull and he became familiar with the opportunities for innovation across VHA. After applying to the VHA Innovators Network (iNET) Spark-Seed-Spread program, De Caro earned Spark status for his idea of the “Male Contraception Initiative.”

“At almost every facility, being involved in innovation is often at the cost of the individual who is spearheading it. At VA, iNET offers opportunities to carve out time specifically for innovative work. It makes innovation a piece of what you do for VA not just an add-on that you have to try and squeeze in,” he said.

According to De Caro, iNET has added a layer to his work that provides time, financial support, and buy-in from VA leadership to address what he sees as a critical issue in care.

While his idea is in the early stages, De Caro is already receiving support from Augusta VA to follow through on his idea. “Thomas Dykes, the chief of Urology at the Augusta VA, has been wildly supportive. And Kelsey Shull has been instrumental in guiding me through this process,” he said.

Innovation Heroes is a recurring series from the VHA Innovation Ecosystem, focusing on VA employees who are driving innovation forward and improving the lives of their colleagues and/or Veterans. Want to become an innovation hero? Visit our website to learn more about opportunities for involvement in innovation at VA.

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