Any time a man requests it (if there is no medical reason to delay).

Ensuring Informed Choice

Important: a friendly counsellor who listens to a man’s concerns,answers his questions, and gives clear, practical information about the procedure—especially its permanence—will help a man make an informed choice and be a successful and satisfied user, without later regret (see Female Sterilization, Because Sterilization Is Permanent). Involving his partner in counseling can be helpful but is not required.

Counselling must cover all 6 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).

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.

Differences from conventional procedure using incisions:

• 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.

Advantages:

• 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.

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.

A man who has chosen a vasectomy needs to know what will happen during the procedure. The following description can help explain the procedure to him. Learning to perform a vasectomy takes training and practice under direct supervision. Therefore, this description is a summary and not detailed instructions.

1. The provider uses proper infection-prevention procedures at all times (see Infection Prevention in the Clinic).

2. The man receives an injection of local anesthetic in his scrotum to prevent pain. He stays awake throughout the procedure.

3. The provider feels the skin of the scrotum to find each vas deferens—the 2 tubes in the scrotum that carry sperm.

4. The provider makes a puncture or incision in the skin:

– Using the no-scalpel vasectomy technique, the provider grasps the tube with specially designed forceps and makes a tiny puncture in the skin at the midline of the scrotum with a special sharp surgical instrument.

– Using the conventional procedure, the provider makes 1 or 2 small incisions in the skin with a scalpel.

5. The provider lifts out a small loop of each vas from the puncture or incision. Most providers then cut each tube and tie one or both cut ends closed with thread. Some close off the tubes with heat or electricity. They may also enclose one end of the vas in the thin layer of tissue that surrounds the vas (see Vasectomy Techniques, above).

6. The puncture is covered with an adhesive bandage, or the incision may be closed with stitches.

7. The man receives instructions on what to do after he leaves the clinic or hospital (see Explaining Self-Care for Vasectomy, below). The man may feel faint briefly after the procedure. He should stand first with help, and he should rest for 15 to 30 minutes. He usually can leave within an hour.

Also if:

He has bleeding, pain, pus, heat, swelling, or redness in the genital area that becomes worse or does not go away.

General health advice: anyone who suddenly feels that something is seriously wrong with his health should immediately seek medical care from a nurse or doctor. His contraceptive method is most likely not the cause of the condition, but he should tell the nurse or doctor what method he is using.