Sterilized men who don't have children face criticism for being selfish, immature and shortsighted. "I've had someone tell me that it was wrong of me to make the choice when I was still a kid," says Ciaccio. "I've had people tell me that I've robbed my future wife the opportunity to be a mother. I don't think I can count the number of people who said I'll change my mind and it'll be too late." But here's the question that young men who have gotten vasectomies are asking: Why is it acceptable to make the permanent choice to have kids at a young age and not OK to make the permanent choice to not have kids? "The truth is, I put more thought and energy into not having kids than many people do into having them," says Ciaccio. "What's the worse scenario -- a man regretting his vasectomy or a man regretting accidental parenthood?"

There are always exceptions -- like the man one urologist recalled, who got a vasectomy after he and a bunch of drunken buddies decided they didn't want to get their girlfriends pregnant; he later visited the doctor requesting a reversal -- but the bulk of the childless men who opt for vasectomies seriously think through the consequences. A Scottish survey of 78 men and women who were voluntarily childless concluded: "The findings of this study suggest that voluntary childlessness is not an expression of neurosis or immaturity; rather, it is a complex decision of which the benefits are considered to outweigh the costs of social nonconformity."

According to Lunneborg's research, there are four major reasons men don't want children: They want the freedom to change jobs without financial obligations to children; they want time and space for personal development; they have never felt a need to have children and are happy as they are; and they don't want the responsibility of raising a child.

Even so, not all men who don't want children are interested in vasectomy. They're either happy with their current method of birth control, don't like the idea of a doctor messing with their prized parts or aren't 100 percent sold on the permanence of their feelings. But to a segment of men who've determined they don't ever want children, getting a vasectomy doesn't feel like an extreme measure. The Australian study found that men who are most likely to seek sterilization are what researchers call "early articulators" -- they've made the explicit decision at a young age not to have children. They choose surgery because they are unwilling to cope with the anxieties of using contraception that is not permanent.

Before Ciaccio got his vasectomy, he and Keuling were so paranoid that a birth control "oops" would ruin their plans for a child-free future that they simultaneously practiced three forms of birth control -- the pill, condoms and withdrawal. Still, any time Keuling's period showed up a few days late, they were terrified. "Living with the threat of accidental pregnancy is hellish, plain and simple," says Ciaccio.

Ciaccio didn't take the decision to get sterilized lightly. As an experiment, every day for one year, he asked himself if he had to make the choice that day, would he have a vasectomy. For 365 days straight, the answer was yes. Many days, he polled Keuling for her feelings, too. Before meeting with surgeons, he created a four-page document that outlined his reasons for wanting a vasectomy, his knowledge of the procedure and potential side effects, such as swelling, bleeding or infection. "I included the answer to any question the doctor could envision throwing at me before it could even escape his lips," he says. All three doctors that he interviewed were willing to do the surgery. "Doctors are starting to recognize that people have as much of a right to ensure their child-free status as they do to have children."

Even though it has been four years since Ciaccio had his surgery -- and he is still confident that he made the right decision -- he continues to hear criticism from some friends and co-workers. "Not a day has passed in the past three years when I haven't thought about my vasectomy and smiled," he says. "But I still have people tell me I'm going to regret it later in life. My favorite response to that is to ask if they're planning on having kids. If the answer is yes, I respond, 'You'll change your mind and it'll be too late!'"

Many of the doctors who spoke with Salon said that although they discourage vasectomies in men in their 20s with no children, if the patient is still adamant after being counseled "six ways and sideways" on the risks of the procedure, they most likely will not turn him away. "I offer a service and I don't make moral judgments," says Dr. Brett Mellinger, a urologist in private practice in Long Island, N.Y., who performed Ciaccio's vasectomy. "The individual has to get the information and make the appropriate decision."

About 6 percent of men who undergo a vasectomy will eventually request a surgical reversal, most of the time because they want to have children with a new partner. While there are no statistics on how many of those men already have children, Dr. Larry Ross, a urologist at the University of Illinois at Chicago, estimates that only 10 to 15 percent of the patients he sees who come in for a reversal are childless men who have changed their minds. Dr. Arnold Belker, a clinical professor of urology at the University of Louisville School of Medicine who has been practicing for 35 years, does not recall ever doing a microsurgical vasectomy reversal, his specialty, on a childless man. Unlike the 10-minute vasectomy procedure, reversal surgery requires approximately four hours on the operating table, time off work and a $10,000 to $25,000 out-of-pocket investment, since reversals aren't covered by insurance. "While it's very easy to do a vasectomy, it is very difficult to undo it," says Warren.

To weed out the wishy-washy so that this doesn't happen, doctors try to drive home the permanence of the vasectomy when they counsel interested men. "You can't do a vasectomy thinking that it can be reversed," says Dr. Larry Lipshultz, chief of male reproductive medicine and surgery at Baylor College of Medicine in Houston. While the success rates of returning sperm to the ejaculate are pretty good -- in the 80 percent range if reversed within the first 10 years -- post-reversal pregnancy odds aren't as high. And the more time that passes from the vasectomy, the lower the chances of a successful reversal. Some men change their minds after learning the stats.

Add one modern twist to the decision-making process: Thanks to the widespread use of reproductive technology, post-vasectomy pregnancy is now possible using in vitro fertilization or intrauterine insemination. Guys can bank their sperm before the procedure (though most don't) or can get sperm extraction surgery after the fact. Both are expensive. Asks Lipshultz: "How many men want to put out $20,000 for not having to use condoms?"

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