Sense and Sterility

Eric Lis

Do you think Bruce Wayne got a vasectomy?

Contraception has traditionally been the woman’s “responsibility.” There are definite socio-political reasons for this, but on a very concrete level, it’s also because for most of history it’s been easier to alter the reproductive cycles of women than of men. Plants that prevent pregnancy in women have probably been used since pretty much the dawn of human history; as the legend goes, the Romans got so much use out of silphium that they drove it to extinction (we know that silphium was used for much more than just contraception, of course, but let’s not let facts get in the way of a good story). That said, it’s relatively easy to find plants which will temporarily alter a woman’s fertility, but twenty thousand years of searching has never produced a chemical which will easily and harmlessly reduce a male’s fertility. Modern medicine has been making some interesting strides towards male contraceptive medications, but to date such drugs remains expensive, impractical, or heavy in terms of side effects, and because they largely consist of molecules which require very advanced techniques to produce, these aren’t likely to be available in a medieval fantasy setting. The only practical medical intervention to reduce male fertility available in our era, and thus presumably throughout history, has been the vasectomy, and this technique has only deliberately been used for contraception for less than a century.

Vasectomy is among the simplest surgical procedures known to modern science. Relatively painless and straightforward, the procedure is done routinely throughout the world and, from a certain point of view, is probably one of the most cost-effective and morbidity-reducing medical procedures in existence. To give an overly simple description, a tiny incision is made in the male’s groin and the vas deferens, the tube which carries sperm, is cut or tied. Because the body continues to produce sperm, the surgery is theoretically reversible, although for complicated reasons involving our stupid, stupid immune systems this reversal isn’t reliable and sterilization may become permanent.

The question is, given the lifestyles of many adventurers, where they face the possibility of death daily and where a child would be a significant burden, do adventurers take steps to sterilize themselves, reliably or otherwise? Many adventurers balk at the prospect of bringing children into their lifestyle, but also don’t want to give up sex. Given how advanced pseudo-magical surgery can be in most fantasy settings, it isn’t a stretch to imagine that some variant of the vasectomy exists on Toril or wherever. For that matter, adventuring spellcasters have presumably researched magical means of easily and instantaneously inducing reversible fertility. Of course, if the sterility is caused by magical means, it may be deactivated by antimagic fields or spells that break enchantments, but this presumably still makes it more certain protection than what we have in our world.

In regards to surgical interventions like the vasectomy, you would also have to wonder whether spells like regeneration would undo the vasectomy and restore the body to its natural state, whether the target of the spell wanted it or not. Creatures saved from death may find themselves involuntarily fertile again, making the processes of healing and resurrection just a tiny bit more complicated and irritating.

Finally, one other complication: who would perform these surgeries and cast these spells? This sort of magic is typically the purview of divine casters much more than arcane casters, so it’s possible that wizards wouldn’t be capable of casting sterility spells. In our world, any procedure that induces sterility, however reversible, tends to be frowned upon by the most common religious authorities, who often oppose sex outside of reproduction and/or advocate for being fruitful and multiplying. This is probably very much the case in most fantasy worlds as well, where the gods of healing tend to also be those who advocate for fertility, growth, renewal, or other concepts that encourage (or require!) followers to have lots of children. It’s entirely possible that in some communities, sterility spells might be the only form of “healing” spell that the local lawful good healers refuse to cast, or which their gods might refuse to grant. Adventurers (and ordinary citizens, of course) might find themselves in the interesting position of having to track down the local druids, or for that matter, neutral or even evil spellcasters, to provide a service that their own church refuses. 

More than four years ago, Dr. Eris Lis, M.D., began writing a series of brilliant and informative posts on RPGs through the eyes of a medical professional, and this is the one that appeared here on June 26, 2016. Lis is a physician, gamer, and author of the Skirmisher Publishing LLC OGL sourcebook Insults & Injuries, which is also available for the Pathfinder RPG system