VASECTOMY

 

Vasectomy is the voluntary surgical procedure for permanently terminating fertility in men.

Methods

Incisional (1 or 2 small incisions)

No-scalpel technique (NSV) (preferred method)

Mechanisms of Action

By blocking the vas deferens (ejaculatory duct), sperm are not present in the ejaculate.

Benefits

Contraceptive

• Highly effective (0.1–0.15 pregnancies per 100 women during the first year of use)
• Permanent
• Does not affect breastfeeding
• Does not interfere with intercourse
• Good for couples if pregnancy or tubal occlusion would pose a serious health risk to the woman
• Simple surgery done under local anesthesia
• No long-term side effects
• No change in sexual function (no effect on hormone production by the testes)

Limitations

• Must be considered permanent (not reversible)
• May be regretted later
• Delayed effectiveness (requires up to 3 months or 20 ejaculations)
• Risks and side effects of minor surgery, especially if general anesthesia is used
• Short-term discomfort/pain following procedure
• Requires trained physician
• Does not protect against STDs (e.g., HBV, HIV/AIDS)

Clients Issues

• The client has the right to change his mind anytime prior to the procedure.
• No incentives should be given to clients to accept VS.
• A standard consent form must be signed by the client before the procedure.
• Spousal consent is not mandatory.
• In mobile VS programs, counseling and followup should be the same as at fixed sites and all recommended infection prevention practices should be followed.

Who Can Use Vasectomy

• Men of any reproductive age (usually less than or equal to 50)
• Men who want a highly effective, permanent contraceptive method
• Men whose wives have age, parity or health problems that might pose a serious health risk if they become pregnant
• Men who understand and voluntarily consent to the procedure
• Couples who are certain they have achieved their desired family size

Conditions Requiring Precautions

CONDITION	RECOMMENDATION
Single and/or with no living children	Counsel very carefully and allow additional time to make an informed decision.
Symptomatic heart disease or clotting disorders, diabetes mellitus, severe anemia	Clients with significant medical problems may need special surgical and followup management. This procedure may need to be done in a high-level facility, and not in an ambulatory facility. Significant medical problems should be controlled before surgery.
GTI/Orchitis	Treat before the procedure.
Local skin or scrotal infection	Delay procedure until infection is resolved.
Other problems: Large varicocele, inguinal hernia, filariasis, scar tissue, previous scrotal surgery, intrascrotal mass, undescended testes and proven fertility, cryptor-chidism (if bilateral and proven fertility), AIDS-related disease	With any of these conditions, the procedure must be performed by a provider with extensive experience and skill in performing vasectomy.

Who Should Not Use Vasectomy

• Clients who are uncertain of their desire for future fertility
• Clients who do not give voluntary, informed consent

Management of Common Side Effects

SIDE EFFECT/ PROBLEM	MANAGEMENT
Wound infection	If skin infection is present, treat with antibiotics. If abscess is present, drain and treat as indicated.
Excessive swelling	If swollen scrotum is present and is large and painful, it may require surgical management. Provide scrotal support as needed.
Hematoma (scrotal)	Apply warm, moist packs to site and provide scrotal support. Observe; it will resolve over time.

Clients Instructions

• Keep bandage on for 3 days.
• Do not pull or scratch wound while healing.
• You may bathe after 24 hours but do not let the wound get wet. After 3 days you may wash the wound with soap and later.
• Wear a scrotal support, keep the operative site dry and rest for 2 days.
• For pain, take 1 or 2 analgesic tablets (acetaminophen, ibuprofen or paracetamol) every 4 to 6 hours and apply ice packs.
• Avoid heavy lifting and hard work for 3 days.
• If comfortable, you may resume sexual intercourse in 2 or 3 days. Remember to use condoms or another family planning method for 3 months or until you have ejaculated at least 20 times.
• Stitches are not usually required with no-scalpel vasectomy. If stitches must be removed, return after 1 week. (If absorbable stitches were used to close the skin, there is no need to return unless there are problems.)
• Come back for a semen test 3 months after the operation if you wish to have proof that the vasectomy is completely effective.

General Information

• Vasectomy does not provide protection from pregnancy until after 3 months, 20 ejaculations or when no sperm are seen in a microscopically examined semen specimen.
• Vasectomy will not affect sexual performance because the testes still function normally.
• Vasectomy does not provide protection against STDs, including AIDS. If either partner is at risk, the couple should use condoms even after vasectomy.

WARNING SIGNS FOR VASECTOMY CLIENTS Fever (greater than 38°C or 100.4°F) Bleeding or fluid coming from the incision area A very painful or swollen scrotum If your partner misses a period Contact health care provider or clinic if you develop any of the above problems.

Who Can Provide

• Physicians
• Paramedics (in special circumstances)

Where It Can Be Provided

• Hospitals
• Clinics
• Health Posts

Note:Vasectomy can be performed in any facility with a procedure room, appropriate equipment, recommended infection prevention practices and the ability to provide drugs and equipment to handle emergencies.

---

 

RELATED WEBSITES ON VASECTOMIES:

 

Vasectomy.com

 

Vasectomy Information

 

Vasectomy Medical.com

 

4-Men.Org: Vasectomy Blues

 

Vasectomy Offers Many Advantages