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Contraception - Management
How should I assess a man who is considering vasectomy?

  • Assess the man's:
    • Mental capacity to make the decision about vasectomy:
      • If there is any doubt about his mental capacity, the case should be referred to court.
    • Level of understanding of the advantages, disadvantages, and relative failure rates of vasectomy and alternative long-term reversible methods of contraception. See Advice and information.
    • Risk for later regret. Take additional care when counselling people who are:
      • Less than 30 years of age.
      • Without children.
      • Taking decisions during pregnancy.
      • Taking decisions in reaction to the loss of a relationship.
      • Possibly at risk of coercion by their partner, family, or health or social welfare professionals.
    • Cultural, religious, psychosocial, psychosexual, and psychological issues.
  • Take a clinical history, perform a clinical examination, and check the UK Medical Eligibility Criteria to ensure that the man does not have any concurrent condition which may require an additional or alternative procedure or precaution.
  • Assess the risk for sexually transmitted infection and, when appropriate, advise testing, promote safer sex, and/or refer for counselling:
    • If the man is at risk for sexually transmitted infection, recommend correct and consistent use of condoms.
  • Assess also the man's partner's suitability for sterilization, as the couple's clinical history, present symptoms, or abnormal examination findings may influence which partner goes forward to have sterilisation.
Clarification / Additional information
  • The couple's clinical history, present symptoms, or abnormal examination findings may influence which partner goes forward to have sterilisation. For example,
    • Vasectomy for the man may be preferable:
      • If the woman has any contraindication to general anaesthesia.
      • If the man requires repair of an inguinal hernia repair and the vasectomy could be performed under the same anaesthetic.
    • Tubal occlusion for the woman may be preferable.
      • If a past history of genital or scrotal surgery in the man would make it necessary to perform vasectomy under general anaesthesia.
    • The levonorgestrel-releasing intrauterine system for the woman might be the most appropriate contraceptive if she has menorrhagia.
    • A hysterectomy may be an alternative if significant gynaecological pathology, such as large fibroids or a prolapse, is present.
  • It is considered good practice to perform a genital examination of the man to exclude potential problems (a large varicocele or hydrocele, for example, that may mean that the vas is more difficult to palpate and general anaesthesia is required).
  • Similarly a bimanual pelvic examination to be performed on the woman before surgery so that the decision to proceed is made in the light of all the available information and there are no unexpected findings under anaesthesia.
  • The woman's history and examination may also reveal risk factors for laparoscopic tubal occlusion. Previous laparotomy, previous abdominal or pelvic surgery, previous pelvic inflammatory disease and obesity are all factors that increase the risk of a laparotomy with a laparoscopic approach.
  • Sometimes, examination reveals previous surgery that the woman has omitted in the history. Detecting these factors prospectively allows for the woman to be warned of the risk of laparotomy and also allows for an experienced surgeon to be present and the possibility of opting for a minilaparotomy or open laparoscopy if tubal occlusion is still requested.
Basis for recommendation
  • These recommendations are based on guidelines published by the Royal College of Obstetricians and Gynaecologists [RCOG, 2004].

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