- S Jamel, foundation year 1 doctor1,
- S Malde, specialist registrar in urology1,
- I M Ali, general practitioner with special interest in urology2,
- S Masood, consultant urological surgeon1
- 1Department of Urology, Medway NHS Foundation Trust, Gillingham ME7 5NY, UK
- 2Halfway Surgery, Chatham ME4 4QR, UK
- Correspondence to: S Malde
- Accepted 19 December 2012
A 40 year old man attends your clinic with his 37 year old wife to discuss long term contraceptive options. They inform you that they have three children and have completed their family. The wife has been taking oral contraception for the past five years but does not want to continue with this. They have both considered other contraceptive options and have decided on vasectomy.
What you should cover
Patient selection and counselling is crucial. To determine if vasectomy is suitable for them, consider the following points.
Ideally both partners should be present.
Establish the patient’s age, relationship status or stability, and number of children. Young, single men with no children are more likely to regret their decision and request a reversal later in life.
Discuss other contraceptive methods. Female sterilisation (tubal ligation) can be done hysteroscopically under local anaesthesia; or laparoscopically or through a mini-laparotomy, under general anaesthesia. Consequently, the morbidity of the procedure is higher than for vasectomy, and some studies suggest that the reported lifetime failure rate is higher, at 1 in 200.
Emphasise the need to use alternative contraception after vasectomy until semen analysis confirms the absence of sperm (usually three months).
Ask about any current systemic or sexually transmitted infection, coagulation or other blood disorders, and chronic testicular pain, as these will influence the timing of and preparation for surgery. A small number of patients will …