Scalpel versus no-scalpel incision for vasectomy
RHL practical aspects by Xiao-Zhang L
Although no-scalpel 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 maximize client safety.
FIRST CONTACT (PRIMARY CARE) LEVEL
- Provide information concerning vasectomy to the couples who are interested in permanent contraception. Correct any misunderstandings and myths related to vasectomy. Inform women and men about the advantages of vasectomy over female sterilization, in particular, the simplicity and ease of the no-scalpel vasectomy procedure.
- Refer potential vasectomy clients to the medical center or hospital where vasectomy is performed.
- 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 (1). 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 eligibility at a later date and offer vasectomy if the man is found to be eligible.
- Perform the vasectomy procedure. Use the no-scalpel approach for identifying and exposing 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. Use proper infection-prevention procedures at all times.
- Refer clients who need further counseling and those with medical conditions that may increase the risk and difficulty of surgery to the facility best equipped and staffed to handle any potential surgical difficulties or complications.
- If semen analysis is available, make an appointment schedule. If not, inform client to use condom or other forms of contraception for 3 months after surgery.
AT HOME OR IN THE COMMUNITY
Satisfied vasectomy clients can help to popularize no-scalpel vasectomy in the communities they live by telling others about their experience with the method.
- Medical eligibility criteria for contraceptive use. Third edition. Geneva: World Health Organization; 2004.
This document should be cited as: Xiao-Zhang L. Scalpel versus no-scalpel incision for vasectomy: RHL practical aspects (last revised: 27 July 2009). The WHO Reproductive Health Library; Geneva: World Health Organization.