II. Indications
- All Vasectomy patients 2-4 weeks before procedure
III. Risk factors: Regretting Vasectomy
- Age under 30 years (12.5 times more likely to request Vasectomy reversal)
- Few children (but men with no children are less likely to request reversal)
- Relationship not stable
- Religious affiliation prohibiting Vasectomy
- Pressure from partner to have procedure
- Vasectomy performed during time of personal crisis
- Lack of discussion with partner regarding Vasectomy
- Hope Vasectomy will solve sexual and marital problems
- High interest regarding reversibility issues
- Vasectomy Reversal
- Sperm banking
IV. History
- Marital status
- Number of children
- Reason for choosing Vasectomy
- Surgical history
- Medical History
- Diabetes Mellitus
- Hypertension
- Bleeding Disorders
- Sexually Transmitted Infection
- Other genital infection or Urinary Tract Infection
- Genital Trauma
- Chronic Pain in genitalia
V. Education
- Describe procedure anatomically
- Using diagram to show normal sperm course
- Show Seminal Vesicles produce ejaculate
- Show location of incision in Scrotum
- Describe benefits (compared with Tubal Ligation)
- Lower risk, less expensive procedure compared with Tubal Ligation
- Tubal Ligation is intra-abdominal procedure
- Vasectomy typically costs $1000, while a Tubal Ligation costs $6000 (as of 2025 in U.S.)
- Postoperative recovery is much faster for Vasectomy
- Vasectomy is more effective than Tubal Ligation
- Tubal Ligation long-term failure: 18.5 per 1000
- Vasectomy long-term failure: <2.5 per 1000
- Vasectomy efficacy more easily confirmed
- Semen Analysis confirms Vasectomy efficacy
- Pregancy (often Ectopic Pregnancy) confirms Tubal Ligation failure
- Lower risk, less expensive procedure compared with Tubal Ligation
- Defuse Misconceptions
- Vasectomy minimally affects semen volume (5-15%)
- Vasectomy does not affect male characteristics
- Vasectomy does not increase the following risks
- Vasectomy should not affect libido and sexuality
- No increased risk of cardiovascular disease
- No increased risk of Testicular Cancer
- No increased risk of Prostate Cancer
- Cox (2002) JAMA 287:3110-5 [PubMed]
VI. Complications (11%)
- Epididymitis (2%)
- Failed Vasectomy (including Unwanted Pregnancy)
- Overall failure rates are <1%
- Failure within first year: 0.15% (1 in 400)
- Longterm failure rate: 0.04% (1 in 2300)
-
Postoperative Infection
- No-Scalpel Vasectomy: 0.7%
- Incisional Vasectomy: 2.2%
- Typically minor local Skin Infections
- Perioperative bleeding
- No-Scalpel Vasectomy: 2.4%
- Incisional Vasectomy: 4%
- Postoperative Hematoma (most common)
- No-Scalpel Vasectomy: 2.4%
- Incisional Vasectomy: 12.5%
- Double the risk when operators perform <10 vasectomies per year
- Sperm Granuloma (1%)
- Painless in 97% of patients with sperm Granuloma
- Post-Vasectomy pain syndrome
- References
VII. Exam
- Scrotal and perianal skin
- Dermatitis
- Infection
-
Testes
- Testicular Pain or tenderness to palpation
- Testicular nodularity
- Hydrocele
- Vas deferens
- Vas mobility (ease of isolation)
- Congenital absence of vas deferens (single vas)
- Associated with renal anomalies
- Accessory vas deferens or duplicated vas (rare)
- Miscellaneous
VIII. Protocol: Obtaining Consent
- Emphasize need for secondary Contraception until negative post-vasectomy Semen Analysis
- Temporary Contraception used until Semen Analysis
- High rate of no follow-up for Semen Analysis (19-45%)
- Emphasize permanence of procedure (yet 6% of men seek reversal post-Vasectomy)
- Answer any related questions
- Read and sign consent form
IX. Education: Review preoperative instructions
- Give Vasectomy preoperative handout
- Consider Conscious Sedation (e.g. Valium 5-10 mg orally taken 30-60 minutes before procedure)
- Patient has transportation if premedication is used
- Partner clips hairs on anterior Scrotum
- No Aspirin 2 weeks before procedure
- No NSAID or Platelet inhibitor 4 days before procedure
- Wear athletic supporter (jock strap) to appointment
- Shower and clean Scrotum on surgery day
X. Resources
- Vasectomy Patient Education Handout
- Choosing Vasectomy Movie (Requires Flash)