Male Sterilisation

Question 1

Briefly describe the mechanism of action of male sterilisation

Answer 1

Division and removal of a section of the vas deferens

Question 2

What are the advantages of male sterilisation?

Answer 2

• Very effective in preventing pregnancy
• Permanent
• Sex need not be interrupted to use contraception

Question 3

What are the disadvantages of male sterilisation?

Answer 3

• It requires a minor surgical procedure that carries a small risk of haematoma and infection
• There is a post-operative period for vasectomy to be confirmed as effective
  
  • Effective contraception is required until azoospermia is confirmed — 12 weeks is the optimal time to schedule a post-vasectomy semen analysis
• People may regret having had the procedure:
  
  • The assessment process is designed to ensure that people at risk for regret are identified and fully informed about alternative long-acting reversible contraceptive methods
• Vasectomy cannot easily be reversed, and the NHS does not routinely offer reversal procedures
• Vasectomy does not protect against sexually transmitted infections.
• Rarely, the procedure fails after clearance has been given that there are no spermatozoa in the ejaculate
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Question 4

What risks are associated with male sterilisation?

Answer 4

There is a small risk of testicular or scrotal chronic post vasectomy pain (CPVP)→ may develop months or years after the procedure

Question 5

Briefly describe how to assess someone considering male sterilisation

Answer 5

• Check the World Health Organization (WHO) Medical Eligibility Criteria for contraceptive use to ensure that sterilization is a suitable choice for the person.
• Assess the person’s:
  
  • Mental capacity
  • Level of understanding of the advantages, disadvantages, procedures involved, and relative failure rates of a vasectomy or tubal occlusion
  • Risk for later regret
  • Cultural, religious, psychosocial, psychosexual, and psychological issues
• Also assess their 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 sterilization
• On male, perform scrotal examination

Question 6

Which groups of people may require additional care when counselling about sterilisation?

Answer 6

• Younger than 30 years of age
• Without children
• Taking decisions in reaction to the end of a relationship
• Possibly at risk of coercion by their partner, family, or health or social welfare professionals

Question 7

What is the efficacy of male sterilisation?

Answer 7

Vasectomy has a lifetime failure rate of approximately 1 in 2000 men following negative semen testing

Question 8

How can male sterilsation fail?

Answer 8

• Surgical error
• Re-growth of vas deferens
• Post-operative period for vasectomy to be confirmed as effective
  
  • Effective contraception is required until azoospermia is confirmed→ 12 weeks is the optimal time to schedule a post-vasectomy semen analysis.