Vasectomy

History

• Discussed with partner; joint decision encouraged

• Plans for future children

• Reason for choosing vasectomy (e.g., family completion)

• History of scrotal surgery (e.g., hernia repair, varicocele surgery)

• Understanding of procedure (including the need for follow-up testing)

• History of clotting disorder, significant comorbidities, or cryptorchidism

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Counselling

• Irreversible nature: Stress that reversal success is not guaranteed and often dependent on time since procedure.

• Procedure timeline:

  • Azoospermia confirmed after 3 months or 20 ejaculations (whichever is later).

  • Requires semen analysis to confirm no sperm before stopping other contraception.

• Risks and side effects:

  • Haematoma, infection, sperm granulomas, small failure rate (0.1–0.15%).

  • Rare recanalisation of vas deferens, potentially leading to pregnancy.

• Does not impact libido, testosterone levels, or sexual function.

• No link to testicular or prostate cancer.

• Inform about non-scalpel technique (lower risk of complications).

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When to Refer

• History of scrotal/inguinal surgery, trauma, or infections (may require specialist assessment).

• Presence of large varicocele, hydrocele, or inguinal hernia requiring correction.

• Cryptorchidism (undescended testicle).

• Significant medical problems (e.g., uncontrolled bleeding disorders).

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Management of Complications

• Haematoma:

  • Rest, cold compress, and analgesia.

  • Surgical drainage for large haematomas.

• Infections: Oral antibiotics for mild infections; abscesses may need drainage.

• Epididymo-orchitis: Rapid-onset, painful swelling of scrotum; manage with:

  • Antibiotics (e.g., doxycycline or ciprofloxacin based on likely pathogens).

  • Testicular support and analgesia.

• Sperm granulomas: Often self-limiting; rarely cause significant discomfort or require intervention.

• No significant impact: Haematospermia, minor haematuria typically resolve without treatment.

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Reversal

• Success rates depend on:

  • Time since vasectomy (higher success if <5 years).

  • Surgeon’s expertise.

  • Age and fertility status of partner.

• Alternatives:

  • Testicular sperm aspiration (TESA) for use in IVF as an alternative to reversal.

  • Intracytoplasmic sperm injection (ICSI) for fertilisation with extracted sperm.

• Educate that reversal does not guarantee natural conception, especially if >10 years post-vasectomy.

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Additional Notes

• Provide a written information leaflet for patient education.

• Advise follow-up to ensure effective contraception until semen analysis confirms azoospermia.

• Emphasise importance of using alternative contraception during the interim period.