IMPORTANT: A friendly counselor who listens to a man’s concerns, answers his questions, and gives adequate, clear and practical information about the procedure—especially its permanence—will help a man make an informed choice and be a successful and satis ed user, without later regret (see Female Sterilization, Because Sterilization Is Permanent). Involving his partner in counseling can be helpful but is not necessary or required.
|The 7 Points of Informed Consent
Counseling must cover all 7 points of informed consent. In some programs the client and the counselor sign an informed consent form. To give informed consent to vasectomy, the client must understand the following points:
- Temporary contraceptives also are available to the client.
- Voluntary vasectomy is a surgical procedure.
- There are certain risks of the procedure as well as benefits. (Both risks and benefits must be explained in a way that the client can understand.)
- If successful, the procedure will prevent the client from ever having any more children.
- The procedure is considered permanent and probably cannot be reversed.
- The client can decide against the procedure at any time before it takes place (without losing rights to other medical, health, or other services or benefits).
- The procedure does not protect against sexually transmitted infections, including HIV.
Reaching the Vas: No-Scalpel Vasectomy
No-scalpel vasectomy is the recommended technique for reaching each of the 2 tubes in the scrotum (vas deferens) that carries sperm to the penis. It is becoming the standard around the world.
- Uses one small puncture instead of 1 or 2 incisions in the scrotum.
- No stitches required to close the skin.
- Special anesthesia technique needs only one needle puncture instead of 2 or more.
- Less pain and bruising and quicker recovery.
- Fewer infections and less collection of blood in the tissue (hematoma).
- Total time for the vasectomy has been shorter when skilled providers use the no-scalpel approach.
Both no-scalpel and conventional incision procedures are quick, safe, and effective.
Blocking the Vas
For most vasectomies ligation and excision is used. This entails cutting and removing a short piece of each tube and then tying both remaining cut ends of the vas. This procedure has a low failure rate. Applying heat or electricity to the ends of each vas (cauterizing) has an even lower failure rate than ligation and excision. The chances that vasectomy will fail can be reduced further by enclosing a cut end of the vas, after the ends have been tied or cauterized, in the thin layer of tissue that surrounds the vas (fascial interposition). If training and equipment are available, cautery and/or fascial interposition are recommended. Blocking the vas with clips is not recommended because of higher pregnancy rates.