Abstract

TikTok, a popular video-sharing application, reflects growing interest in male contraception among a young audience. The top 100 videos with #vasectomy were compiled using a web-scraping application. Content and demographics from videos posted before and after the Dobbs v. Jackson Women’s Health Organization United States Supreme Court decision were systematically analyzed by 2 independent reviewers and a third arbitrator. Few videos offered any scientific claims or health care information (12%), and even fewer were made by a health care professional (6%). The videos scored an average of 0.19 out of 5 in quality of health information on the DISCERN scale. They averaged 83% in understandability and 1.3% in actionability on the PEMAT scale. TikTok content with #vasectomy frequently mentioned abortion (11%) and the male role in contraception (70%), but there is a lack in quality health information about the procedure itself.

Introduction

Vasectomy procedural volume has increased significantly following the Dobbs decision in June 2022.¹ In the months following the Dobbs decision, men seeking a vasectomy were over twice as likely to be under the age of 30 compared to the year prior.¹ In the setting of large national shifts in access to reproductive health care, these trends suggest a growing interest in vasectomy among young men. Viral TikTok videos about vasectomy are another sign of rising interest.² Almost half of the US digital population uses TikTok, a popular short-form video-sharing application.³ TikTok captures a unique audience of reproductive-age men, with about half of its users being between the ages of 16 and 34 and 46% being male.³ To assess the information presented to this audience, we systematically analyzed TikTok content with the hashtag #vasectomy.

Methods

We analyzed the top 100 most-liked videos on TikTok tagged #vasectomy. The web-scraping application Apify was used to automatically download, extract, and compile information on February 24, 2023.⁵ The videos were systematically coded on a standardized rubric by two independent reviewers (Alexandria Mullikin and Khushnood Faraz) with a third reviewer (Jessica Liu) who arbitrated differences. Each video was scored by reviewers on a rubric of 24 predefined descriptive variables and 2 validated tools (Table). The modified 5-point DISCERN scale was used to assess quality of health information and the Patient Education Materials Assessment Tool (PEMAT) to assess understandability and actionability.^6,7 All reviewers were formally trained together to standardize scoring. Duke University Medical Center’s Institutional Review Board determined this exempt as non–human subjects research.

Table. Select Video Characteristics of 100 Videos Evaluated

Results

The top 100 videos on #vasectomy comprised 353 million views, 43 million likes, and 1.5 million shares. While video creators were frequently people seeking vasectomy (n = 25, 25%) or the partner of someone who had a vasectomy (n = 48, 48%), few videos discussed their personal experience or their partner’s experience with vasectomy (18 of 100, 18% overall). The majority of videos focused on humor (52%), followed by personal or partner experience (18%), social commentary (9%), and reaction videos (8%). Pain was commonly mentioned or depicted as a side effect of vasectomy (27%), though very few videos discussed other side effects (4%), sexual function (3%), or urinary side effects (2%).

Videos were posted between April 2020 and February 2023, both before (57%) and after (43%) the Dobbs decision on June 24, 2022 that removed the federal right to abortion. Videos in both time frames discussed abortion or used #roevwade (pre-Dobbs: 4 of 57, 9%; post-Dobbs: 7 of 43, 16%). The majority of videos in the overall sample highlighted the male role in contraception (70%). Videos in both time frames mentioned abortion access (11%), negative experiences with other birth control (13%), and gender disparities (12%).

Few videos were made by a health care professional (n = 6, 6%) and 3% of videos were focused on medical education. Only 12% of videos offered any scientific claims or health information. Of these, several videos stated that vasectomy is reversible without discussing success rates of reversal (4 of 12, 33%). One video claimed that vasectomy is “extremely dangerous” without further elaboration (1 of 12, 8.3%). Some videos highlighted a vasectomy failure (n = 10, 10%), but none discussed vasectomy failure rates (n = 0, 0%). None of the videos offered additional resources to those seeking a vasectomy (n = 0, 0%).

The videos had low-quality health information on the DISCERN scale, with an average of 0.19 out of 5 (median, 0; interquartile range [IQR], 0-0). The videos averaged 82.5% for understandability on the PEMAT scale (median, 83.3%; IQR, 83.3%-85.7%) and 1.3% in actionability (median, 0%; IQR 0%-0%).

Discussion

Today, 1 in 5 Americans search TikTok for health information before consulting their doctor, especially young people.⁷ However, top videos with #vasectomy lacked high-quality medical information, and very few popular videos featured health care professionals. The lack of health professional creators contrasts with other reproductive health topics such as IUDs and medication abortion, where health professional creators are frequently featured in top videos.^8,9 Previous research suggests men’s attitudes about vasectomy are influenced by misconceptions about pain, invasiveness, and side effects.¹⁰ However, few of the top videos provided evidence-based content regarding the safety and efficacy of vasectomies. For example, while pain was commonly mentioned or shown in popular videos, none provided objective data about the severity or duration of pain one can expect postoperatively. Additionally, health care professionals might offer data on reversibility to counter suggestions that vasectomy is nonpermanent. This gap in knowledge highlights an opportunity on TikTok for health professionals to dispel misinformation and guide patients to make informed decisions about their reproductive health.

Strengths of this study include the use of 2 standardized scoring tools and a standardized procedure for compiling video content. Limitations include the subjective nature of content analysis and inability to evaluate viewer assessment of information quality.

Conclusion

Despite a growing audience of young men who may be interested in vasectomy, top #vasectomy videos on TikTok provide little health information and infrequently feature health professionals. Health professionals who wished to engage might have a significant opportunity to educate viewers with evidence-based information.

Acknowledgments

We asked our colleague, Dr Matthew Zerden, an ob-gyn and vasectomy provider, to create a video presenting accurate and approachable information from the perspective of a health care provider. Dr Zerden is the Medical Director of His Choice Durham Chapel Hill: HisChoiceDurham.com.

Funding/Support: Dr Swartz reports funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development as a Women’s Reproductive Health Research fellow, grant K12HD103083. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Conflict of Interest Disclosures: Dr Swartz reports consulting fees from Organon & Company.

Ethics Statement: Duke University Medical Center’s Institutional Review Board determined the non-human subjects research exempt.

Data Availability: The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.