Vasectomy Counseling

Aka: Vasectomy Counseling

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II. Indications

  1. All Vasectomy patients 2-4 weeks before procedure

III. Risk factors: Regretting Vasectomy

  1. Age under 30 years (12.5 times more likely to request Vasectomy reversal)
  2. Few children (but men with no children are less likely to request reversal)
  3. Relationship not stable
  4. Religious affiliation prohibiting Vasectomy
  5. Pressure from partner to have procedure
  6. Vasectomy performed during time of personal crisis
  7. Lack of discussion with partner regarding Vasectomy
  8. Hope Vasectomy will solve sexual and marital problems
  9. High interest regarding reversibility issues
    1. Vasectomy Reversal
    2. Sperm banking

IV. History

  1. Marital status
  2. Number of children
  3. Reason for choosing Vasectomy
  4. Medical History
    1. Diabetes Mellitus
    2. Hypertension
    3. Bleeding Disorders
    4. Sexually Transmitted Disease
    5. Other genital infection or Urinary Tract Infection
    6. Genital Trauma
    7. Chronic Pain in genitalia
  5. Surgical history

V. Education: Describe procedure anatomically

  1. Using diagram to show normal sperm course
  2. Show Seminal Vessicles produce ejaculate
  3. Show location of incision in Scrotum

VI. Education: Describe benefits (compared with Tubal Ligation)

  1. Lower risk procedure compared with Tubal Ligation
    1. Tubal Ligation is intra-abdominal procedure
  2. Postoperative recovery is much faster for Vasectomy
  3. Vasectomy is more effective than Tubal Ligation
    1. Tubal Ligation long-term failure: 18.5 per 1000
    2. Vasectomy long-term failure: <2.5 per 1000
  4. Vasectomy efficacy more easily confirmed
    1. Semen Analysis confirms Vasectomy efficacy
    2. Pregancy (often Ectopic Pregnancy) confirms Tubal Ligation failure

VII. Education: Defuse Misconceptions

  1. Vasectomy minimally affects semen volume (5-15%)
  2. Vasectomy does not affect male characteristics
  3. Vasectomy does not increase the following risks
    1. Vasectomy should not affect libido and sexuality
    2. No increased risk of cardiovascular disease
    3. No increased risk of Testicular Cancer
    4. No increased risk of Prostate Cancer
    5. Cox (2002) JAMA 287:3110-5 [PubMed]

VIII. Complications (11%)

  1. Failed Vasectomy (or Unwanted Pregnancy)
    1. Failure within first year: 0.15% (1 in 400)
    2. Longterm failure rate: 0.04% (1 in 2300)
  2. Postoperative Infection
    1. No-Scalpel Vasectomy: 0.7%
    2. Incisional Vasectomy: 2.2%
  3. Perioperative bleeding
    1. No-Scalpel Vasectomy: 2.4%
    2. Incisional Vasectomy: 4%
  4. Postoperative Hematoma
    1. No-Scalpel Vasectomy: 2.4%
    2. Incisional Vasectomy: 12.5%
  5. Epididymitis (2%)
  6. Sperm Granuloma (1%)
  7. Post-Vasectomy pain syndrome
    1. Pain for months to years following Vasectomy
    2. Severe pain may occur in 1-6% post-Vasectomy
    3. Leslie (2007) BJU Int 100(6): 1330-3 [PubMed]

IX. Exam

  1. Scrotal and perianal skin
    1. Dermatitis
    2. Infection
  2. Testes
    1. Testicular Pain or tenderness to palpation
    2. Testicular nodularity
    3. Hydrocele
  3. Vas deferens
    1. Vas mobility (ease of isolation)
    2. Congenital absence of vas deferens (single vas)
      1. Associated with renal anomalies
    3. Accessory vas deferens or duplicated vas (rare)
  4. Miscellaneous
    1. Varicocele
    2. Inguinal Hernia

X. Protocol: Obtaining Consent

  1. Emphasize need for secondary Contraception until negative post-vasectomy Semen Analysis
    1. Temporary Contraception used until Semen Analysis
    2. High rate of no follow-up for Semen Analysis (19-45%)
  2. Emphasize permanence of procedure
    1. Vasectomy reversal is typically an out-of-pocket cost of at least $16000
    2. Vasectomy reversal rates for successful pregnancy: 45-70%
      1. Most effective if female partner younger than 40 years old
      2. Most studies suggest best efficacy if Vasectomy reversal timing at shorter duration from the Vasectomy (esp. <3 years)
  3. Answer any related questions
  4. Read and sign consent form

XI. Education: Review preoperative instructions

  1. Give Vasectomy preoperative handout
  2. Consider Conscious Sedation (e.g. Valium 5-10 mg)
  3. Patient has transportation if premedication is used
  4. Partner clips hairs on anterior Scrotum
  5. No Aspirin 2 weeks before procedure
  6. No NSAID or Platelet inhibitor 4 days before procedure
  7. Wear athletic supporter (jock strap) to appointment
  8. Shower and clean Scrotum on surgery day

XII. Resources

  1. Vasectomy Patient Education Handout
    1. UrologyEdVasectomyJmg.htm
  2. Choosing Vasectomy Movie (Requires Flash)
    1. VasIntro.html

XIII. References

  1. Alderman (1991) J Fam Pract 33(6):579-84 [PubMed]
  2. Haws (1995) Am Fam Physician 52(5): 1395-99 [PubMed]
  3. McDonald (1997) Br J General Practice, p.381-6
  4. Rayala (2013) Am Fam Physician 88(11): 757-61 [PubMed]

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