Vasectomies

Vasectomy is one of the most effective methods of contraception, in which the tubes which carry sperm from the testicles to the outside world are interrupted, so sperm cannot leave the body to fertilise an egg. It should be considered a PERMANENT and IRREVERSIBLE procedure. Attempts at reversal are possible privately but at significant cost and they may not be successful. Studies suggest that up to 7% of patients being sterilized later express regret so this decision needs careful thought and with consideration that personal circumstances can change (e.g. family tragedy, or new partner in the future). Having said that, it is often an excellent option for men who feel certain they would never want any more children in any scenario. We would always recommend discussing vasectomy with your partner first.

Make sure you have considered alternative options for contraception, which include barrier methods or your partner using hormonal contraception including the pill, the contraceptive implant, or the coil. Female sterilisation is another option although this is more invasive and has a higher failure rate.

Any man can have a vasectomy, however some medical conditions may make this more complicated, and need discussion prior to the procedure. These include – severe obesity, other medical conditions such as bleeding problems or blood thinning medication, previous operations around the genitals including hernia surgery or scrotal surgery. If you are diabetic you will need to have recent blood tests demonstrating good control of this in order to safely proceed. Allergies to anaesthetic or latex are also very important to discuss.

It is also important to think extra carefully if you are under 30 years old (see below), you do not have any children already, if you have a child less than one year old, or if your partner is pregnant, as rates of regret are higher in all these groups. You should also be cautious in making this decision if you have had recent difficulties in the relationship with your partner.

If you partner is in her 40s or above, you should also consider the menopause in your decision making. If your partner is nearing the age when her mother went through the menopause or if your partner has menopausal symptoms (reduced frequency of periods, hot flushes, etc) it may be that the vasectomy will not be needed for very long and thus the risks of the procedure may outweigh any benefit. We are happy for a woman to abandon the need for contraception if she is over 50 and has not had a period in 1 year, or for women who are between 40 and 50 and have not had a period for 2 full years. When thinking about this, bear in mind that the vasectomy does not work immediately and there is at least a 4 month wait until your first test. Additionally, if your partner were to consider HRT, on option is a progesterone releasing coil that will not only help with menopausal symptoms (in conjunction with a tablet or patch) but will also provide effective contraception – so if your partner thinks she may use HRT please discuss your options more fully with your GP, or alternatively call us and request a consultation with one of our doctors.

If you are less than 30 years old and you have had fewer than 2 children, especially if you are single (whatever your age), please consider the following points before having a vasectomy:

1. You may regret it. Men who have vasectomies when they are in their 20’s, especially if they have had fewer than two children, are the ones most likely (1 in 7 risk) to seek vasectomy reversal at a later date. They may regret their vasectomy decision particularly if reversal is not successful.

2. You may change. Many men who think they will never want children when they are in their early 20’s are delighted with fatherhood when they are in their 30’s. You may be totally convinced now that you will never want children, but people change and you may have a much different outlook 10 years from now.

3. Women change. Similarly, women who have no desire for children when they are in their early 20’s may have a much stronger desire when they are in their 30’s and when many of their friends are having children of their own.

4. Relationships end. Since about 42% of UK marriages end in divorce (10% of civil partnerships ‘divorcing’), you may not be with the same partner ten years from now and a new partner may have a much stronger desire for children than your present partner does.

5. Vasectomy should be considered a permanent and non-reversible procedure because vasectomy reversals are not always successful. So before having a vasectomy, be aware of all of the other options and that reversal is expensive and not available on the NHS.

6. Young men may wish to consider sperm storage. It may well be worth the investment, (typically £300 for first sample, £150 subsequent samples, then £300 annually thereafter) but do bear in mind that there is quite a cost implication involved in using the sperm to create a pregnancy subsequently

You will be shown into a consulting room and asked to lie down on a couch so you can be examined by the surgeon to confirm the procedure can be undertaken- very rarely this will not be possible if your tubes cannot be accessed adequately. We usually play some music and will be talking to you throughout the procedure, which will last 20-30 minutes. Your skin will be carefully cleaned with antiseptic solution and the groin area covered with sterile sheets. A fine needle will then be passed underneath the skin in the middle of the scrotum and local anaesthetic injected. (Most patients report some short- lived pain or discomfort at this stage, but the remainder of the procedure should be free of any sharp pain, although some men experience a sensation of tugging, pressure or squeezing). We will then pierce a small hole in the middle of the scrotum and through this bring out one tube at a time and disconnect/seal the tubes off. At the end of the procedure you will have a tiny skin wound which usually does not need any sutures. We will place some gauze in your tight-fitting underwear by way of dressing to wear for a few days afterwards until everything is healing up.

You should not drive after the procedure so will need to arrange transport home.
We would recommend taking it easy for a few days, wear supportive underwear day and night, and use simple pain relief like paracetamol. It is best to avoid showering for 48hrs and soaking (e.g. baths/swimming) for 3-4 days. You should also avoid strenuous exercise and heavy lifting for 1-2 weeks afterwards. You may resume sexual intercourse when you feel comfortable.

You will need to have a semen sample 12 weeks after the procedure, and this must go directly to Poole Hospital – we will give you more information and the sample kit for this on the day. IT IS ESSENTIAL YOU HAVE THIS SAMPLE CHECKED AND ENSURE WE HAVE GIVEN YOU THE ALL CLEAR BEFORE STOPPING CONTRACEPTION. No assurance can be given that you have become infertile without these tests and no responsibility can be accepted for failure of the operation if the required sample is not submitted at the appropriate time. It is recommended you have at least 24 ejaculations prior to this to ensure no sperm reservoir remains in the tubes by the time the sample is taken.

Excessive bruising/bleeding/swelling or infection (rarely significant problems with these, but in worse-case scenario could require further procedure in hospital to wash out scrotum). Chronic (persistent) pain in scrotum/testicle (1-2%)- can be permanent in tiny minority, rarely severe but could interfere with quality of life and could need further medical or rarely surgical treatment.

Testicular atrophy (loss of testicle due to interruption of blood supply)- extremely rare (0.0001%). Early failure – risk when the sample is taken that there is still live sperm – risk 0.5%, usually due to tubes re-joining or (very rarely) there being an additional tube present.

Late failure – 0.05% – meaning tubes re-join after ‘all clear’ – even years after vasectomy.

• Ensure nil strenuous is planned for a few days afterwards and no straining/heavy lifting for 1-2 weeks afterwards

• Prepare some ice packs/ice trays in freezer in case needed for any swelling after

• Carefully shave the skin of the scrotum/all hair below the penis 3-4 days prior to the
  procedure

• Eat and drink something before your appointment

• Take a bath or shower on the morning of your appointment and try to keep warm
  prior to the procedure.

• Ensure you have transport home arranged (you must not drive yourself)

• Take pain relief (ie paracetamol) 1 hour prior to your appointment

• Ensure you have some freshly laundered, supportive, tight-fitting underwear (i.e.
  briefs not boxers shorts) to wear after the procedure