I had the procedure mid-2021 and other than suffering through an extended recovery period of 6 weeks, it's been well worth it.
I had already followed same checklist as you; getting frequent tests (4-6 weeks) and sharing results openly, asking her for her test results as well as offering to pay for them, stocking various contraceptives like the sponge (production stopped globally during covid), gel, female condoms, and an ample supply of Plan B (they are fairly cheap on Amazon). And I did this for the same reason - traditional hats just killed any chance at success.
With the surgery safely in hand (so to speak) it's been rather easy to guide new SB's into being comfortable with BB. As before I wait to the latter part of the negotiations to bring it up, as I want to establish some level of rapport and trust before breaking her in (sorry, had to) with my physical limits and my testing regimen as a justification for asking for BB. In the last 2 years, many, perhaps 65% were good with the idea before I even mentioned the surgery. Some, maybe 25%, countered that they were not on birth control, and I would have to pull out. When I pulled out the V-card instead (will I ever stop?), that took care of that issue (issue - pun intended). The rest just gave me a hard stop (oh man!) and that was the end of the conversation.
With my current #1, she reflexively jumped off me the first time I started to CIP. I had to remind her I am shooting blanks and after that she's not only ok with it, she's begging Daddy to fill her up. So in the SB space, especially with SB's under 26 or so, it's a fairly easy process. But the concept still goes soft (limp? deflated?) when I meet most pros, who are more skeptical (and rightly so) about accepting my de-caffeinated status. So I still keep a dozen or so female condoms on hand.
One other thought on this. As I mentioned earlier I'll be heading to Philippines soon. There are a few scammers around who try to pull the old "That's my sister you just got pregnant! Now pay me and my cousin the cop or suffer" schtick. Of course that's when I'll tell them to get that paternity test stat!
To address your central point/observation: Yes, I agree that awareness and fear of catching an STD from going BB seems to be almost non-existent. And using birth control doesn't seem to be the "must have" it was 10-25+ years ago either. So, counter-intuitively it's up to the SD to ensure there are no unplanned pregnancies, and that both are relatively safe from STD's as well. And on that note, I'll close by adding that earlier this year I started taking PreP, which greatly reduces the chance I will get HIV (almost the only uncurable STD around). I guess we are replying on her poor judgement here. But hey, her poor decision-making skills and poor judgement are what pulled her into the Sugar Bowl.
Life is good
The Cat