Vasectomy occlusion techniques for male sterilization
RHL practical aspects by Xiaozhang L
As large numbers of vasectomies are performed worldwide on mainly healthy men at their request, it is important to provide high-quality services based on the best evidence available. Although vasectomy is a minor surgery, it should be performed only by well-trained health-care providers in appropriate clinical settings using proper equipment and supplies. Relevant service delivery guidelines, including infection prevention protocols, should be followed to make the operation as safe and effective as possible.
FIRST CONTACT (PRIMARY CARE) LEVEL
- Provide clear, balanced information about both vasectomy and tubal occlusion to all couples interested in permanent contraception, including the advantages and disadvantages of each method. Encourage them to ask questions and correct any misunderstandings. Men and women should be informed that both methods carry a small risk of failure and that pregnancies can occur several years after the procedure. Men considering a vasectomy should be told about the possibility of chronic testicular pain after vasectomy, although it is uncommon (1). Women in particular should be informed that vasectomy is simpler to perform, safer, and less expensive than tubal occlusion.
- Refer interested couples to clinics where vasectomies are performed and help men in getting a vasectomy.
- Follow-up men after they have undergone the procedure. If a vasectomized man reports complications of vasectomy, listen to his concerns and, as appropriate, provide treatment or referral.
REFERRAL HOSPITAL (SECONDARY CARE) LEVEL
- Screen men requesting vasectomy for medical eligibility using the WHO medical eligibility criteria guidelines (2). Ensure that the requesting man or couple is able to make an informed choice about the procedure. The risks associated with the procedure should be weighed against its benefits. If a man is adjudged to be ineligible for vasectomy, offer other forms of contraception and re-evaluate his eligibility at a later date and offer vasectomy if the man is found to be eligible.
- Perform the vasectomy procedure. The no-scalpel approach is recommended for exposing and isolating the vas deferens. The incision technique would be an alternative method in case the vas is difficult or impossible to palpate from the cord structure. For vas occlusion, it is recommended that fascial interposition be used in combination with simple ligation and excision. When performing fascial interposition, pull down the fascia covering the vas to uncover the seminal vesicle end of the vas and then tie the fascial membrane over the epididymal end together with the tissue behind the seminal vesicle end about 5 mm below the previous tie of the seminal vesicle to create a natural tissue barrier (testicle end is inside the fascia and seminal vesicle end is outside). Cauterization with heat or electricity can be an alternative occlusion technique if equipment is available. Proper infection-prevention procedures should be maintained at all times.
- Refer clients who need further counselling or those with medical conditions that render the surgery more difficult, potentially increasing health risks, to the facility best equipped and staffed to handle surgical difficulties or complications.
- Inform client to use condoms or other forms of contraception for the first 3 months after a vasectomy. If the partner of a newly vasectomized man has been using a contraceptive method, she can continue to use it during this time. If semen analysis is available, make an appointment to conduct a semen analysis any time after 3 months following the procedure.
AT HOME OR IN THE COMMUNITY
Satisfied vasectomy clients can help to popularize vasectomy in their communities by telling others about their own experience with the method.
- Family planning: a global handbook for providers. Geneva: World Health Organization, 2007
- Medical eligibility criteria for contraceptive use. Third edition. Geneva: World Health Organization; 2004
This document should be cited as: Xiaozhang L. Vasectomy occlusion techniques for male sterilization: RHL practical aspects (last revised: 1 September 2008). The WHO Reproductive Health Library; Geneva: World Health Organization.