Vasectomy
Posted in Men's Health Info
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 Vasectomies
- 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.
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| 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.
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| 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
Contact health care provider 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: Vasectomies 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
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