The pre-vasectomy consultation

Vasectomy can change your life. Mostly for the better, but sometimes for the worse. The pre-vasectomy consultation is often only a few minutes long, at the end of which you may be asked to sign a consent form. In most instances this one consultation is the only opportunity you get to have your questions answered by your doctor–hopefully this article will help you to get the best out of the short time you have.

To illustrate what us guys really know about vasectomy, Marie Stopes International recently carried out a survey of men in the UK. The lack of knowledge is astounding!

  • Only 26% of men could correctly identify the right description of a vasectomy procedure.
  • Only 36% of men knew that you still ejaculate after vasectomy.
  • Only 43% of men knew that vasectomy did not raise the voice pitch.
  • 30% of men thought it was easily reversible if you wanted further children.
  • Only 48% of men knew that vasectomy offers no protection against sexually transmitted diseases and HIV/AIDS.

Maybe this is the typical level of knowledge of men that go for a vasectomy consultation.

So what can you do to make your consultation count?

1. Take time to research and consider all aspects of vasectomy in order to make sure it’s right for you, and it’s a decision you are happy with. You may find that after careful consideration that vasectomy isn’t the right decision for you at the moment, or just isn’t right for you–period.

2 . Do some research in order to ask the doctor relevant questions, and most importantly, understand the answers.

What kind of pre-vasectomy research should I do?

To make the best use of the time you have at the consultation, it’s a good idea to have a basic understanding of how a vasectomy is performed. This will save time, as the doctor will have less need to explain basic anatomy allowing you and him to discuss questions you have that are specific to you. Remember, you only have a few minutes of his time–use it wisely to ask questions important to you, based on your “Homework”!

So my list of research topics would be:

a) What a vasectomy is and how it’s performed.
b) Established risks and benefits of vasectomy.

By researching these broad topics, you will soon find that you have a whole host of questions that you need answers to. If you are unfamiliar with any of the medical terms you encounter in your research, then please look them up! There are many websites that explain medical terms effectively.

One source of information is colleagues, or family members who have had a vasectomy. Their stories may tend to grow in the telling, but anyone who has had a vasectomy will usually be willing to answer questions from their experience honestly.

Obviously the internet is an excellent source of information, but there are also some good books and articles written from various viewpoints available. If you wish to get a better understanding of any terms, or want to chat to other men about vasectomy then please visit the newsgroup alt.support.vasectomy. You will get a variety of views and opinions on vasectomy, and there are guys there that can explain terms to you, and answer any questions you may have.

The decision

As part of the decision making process, it’s a good idea to discuss all the available birth control options, and the pro’s > con’s of all methods to work out which is the most suitable method for you. Vasectomy isn’t the right choice for everybody. It’s NOT a method of birth control–it should be considered as permanent sterilization and you need to be sure you are happy with this.

All methods of birth control have risks–vasectomy included. In order to make an informed decision, you need to research the risks of all methods of birth control, and perform a “Risk assessment” for each method based on your individual circumstances, then work out which method represents the lowest overall risk to you as a couple. Part of the risk assessment should be to work out how you feel about being sterile. Some men simply can’t cope mentally with being sterile, so you should consider this along with all of the other risks and benefits.

A list of considerations might include:

a) What options do we have–which is most suitable for us as a couple?
b) Who is driving this decision?
c) The “What if’s”.

In the case of who is driving this decision, it’s invariably going to be a joint decision to a certain extent, but it has to be something both are happy about–you in particular. It also needs to be a decision arrived at without pressure being applied.

The “What if’s” is basically a list of scenario’s that could happen in the future, and how you would feel about having been made permanently sterile. Reversal IS possible, and it is possible to produce biological offspring using sperm taken from the epididymus and IVF. However, both of these methods are expensive and there are no guarantees that they will work. If you are considering sperm banking then you are probably not ready to be sterile in the first place.

You need to consider how you would feel if you and your wife / partner split up–would you want the option of starting a new family in the future? What if you were unfortunate enough to have a bereavement of your wife or child? Would you want to keep your options open for the future? I know it’s upsetting to think of these things, but to be honest with yourself about vasectomy then you need to!

It might help you to know who is considered to be good and bad vasectomy candidates

Vasectomy is most likely to benefit:

  • Couples in long term, stable relationships
  • Couples who both agree they have all the children they want.
  • Couples that have been carefully counselled, discussed the risks and benefits fully and have not made a rushed decision under pressure.
  • Where other methods of birth control are unsuitable, or the wife/partner has health problems that make pregnancy unsafe.

Vasectomy is least likely to benefit:

  • Men in couples in which one partner is unsure about having children in the future.
  • Men whose relationships are unstable or going through a stressful phase.
  • Men who are considering the operation just to please their partners, or are being pressurised by their partner.
  • Men who are counting on having children later by storing sperm or by surgical reversal of the vasectomy.
  • Men who are single, divorced or separated at the time of vasectomy.

The reason 90% of men request a reversal is a change in partner. Also, another high risk category is young men under 30 who have many life changes and choices ahead. Men who had a vasectomy in their 20’s are 12.5 times more likely to have a reversal than men who have a vasectomy aged 35+.

At the consult

Firstly, don’t be surprised (or offended) if the doctor asks your wife to be present at the counselling. To the best of my knowledge this isn’t a legal requirement anywhere, nor does your wife have to give permission for you to get a vasectomy. Your wife may be asked to sign to confirm her presence at the counselling session, but NOT to give any form of “permission”–it’s YOUR body and only you can sign the consent form.

The reason for requesting for your wife’s presence is often a local policy based on sound statistical research. Studies that have looked at reasons for regretting vasectomy have repeatedly found that the men least likely to regret vasectomy are where the couple have had joint counselling, and is not a rushed decision. For example, in one study couples that took an average of 22 months to decide reported 99.7% satisfaction with vasectomy.

At the consultation the doctor will discuss the procedure, give you a physical examination and answer any questions you may have. The doctor will feel your scrotum to see if there are any lumps or bumps he can detect, and to see if the tubes will be easily accessible during the procedure.

Key points for you to mention are any lumps, bumps or pains in that area, or any concerns you have about your general health / wellbeing. Remember the guy doing the consult may not be your GP, so may not have your medical records in front of him. You need to bring information to his attention. Where possible, it’s a good idea to discuss vasectomy with your GP in the first instance, and ask if there is anything in your medical record that indicates vasectomy may not be right for you, or may cause you problems in the future.

You will have the opportunity to discuss your questions–so go prepared! Think about what you want to ask in advance, and take in a written list. You will get a lot of information from the consultation. Realistically, what are the chances of you remembering most of it? It may be an idea for you to take a pen and paper with you to write down any answers. Also, ask for any information such as leaflets, booklets or video’s he has available to take home and study at your leisure.

The doctor should give you information on what the procedure is on the day of the vasectomy, how to look after yourself in the days following vasectomy and the procedure for testing if you are clear. He may or may not have this in leaflet form–here is where the pen and paper might come in handy.

You may be asked to sign a consent form at the end of the consultation. This is for the procedure itself, but remember that there is no obligation on you to go through with it. You may change your mind and decide you don’t want to go ahead having already signed the form. Doctors are used to this, but it is common courtesy to let them know you have decided against going ahead. You aren’t going to get quizzed as to why–but you will get thanked for letting him know.

Lastly, and most importantly take this opportunity to check on the doctors experience. You may not know that a Doctor is able to perform vasectomy with minimal training. Because it’s regarded as a simple procedure, they only need to be present for a handful of procedures, and do a few procedures under supervision to be deemed competent. That means that the guy who may be wielding a scalpel at your nuts has done less than ten of them before! OK, doctors do have to train and practice on someone, but does it need to be you? Infection rates are lower with experienced surgeons, and although I have no studies to point to, I would suggest that complications across the board are bound to be lower with an experienced surgeon. Dr. Pollock of Canada who is an expert in treating post vasectomy pain syndrome states on his website that “Rough surgery” is a cause of long term problems. It’s perfectly reasonable to ask about his experience. Ask how long he’s been performing vasectomy, how many he regularly performs, what complications he’s experienced and how he’s treated them. If he’s not able to satisfy you that he’s suitably experienced, then consider if he’s the Doctor you want to perform this procedure. Even under HMO plans you can often choose from a very small list of practitioners. Shop around until you find one you like!

After the consult

Take a deep breath! A couple of weeks would be good! Whilst keeping your options open, carefully consider and discuss all of the information given, and be honest with yourself about your thoughts and feelings.

It’s ultimately your decision. Vasectomy is an elective procedure and you must be certain it’s what you want to do. Again, it’s not a method of birth control but permanent sterilization. I’m hoping that whether you decide to have a vasectomy, or decide that it’s not right for you that this article has been useful to you in making an informed decision.

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