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 …