Vasectomy is a simple operation carried out under local anaesthetic as an outpatient but, as with other types of surgery undertaken primarily for social reasons (eg cosmetic surgery), it gives rise to numerous complaints and litigation. In the past it was necessary for a partner/spouse to give consent for sterilisation (male or female) but this concept is now considered to be out of date. However the patient’s doctor should counsel him about the benefits and disadvantages of sterilization before referring him for surgery.
Complainants frequently claim that the doctor made the operation sound trivial and that if they had known that things could go wrong they would never have had the operation. They should be told that pain, swelling and bruising are all likely to occur post-operatively and that there is a 1-2% risk of intractable pain that may continue for months. Those men involved in heavy manual work should be warned that secondary bleeding can occur with serious consequences if they do not take several days off work. The scrotal sacs should be examined for abnormalities before surgery takes place and also a medical history taken with particular reference to anti-coagulants and anti-convulsants.
Patients must be informed that they will remain fertile for 3 or 4 months following a vasectomy and that they must continue to practice contraception until analysis of the seminal fluid shows that sperm are no longer present. Two samples of seminal fluid should be produced no earlier than 10 or 12 weeks following vasectomy. If either of the first two tests show any sperm then the test must be repeated until two consecutive analyses show no sperm dead or alive. If a few motile (swimming) sperm persist it is wise to recommend re-vasectomy as this may be due to early recannulisation (a rejoining of the 2 cut ends of the vas) Recannulisation can also occasionally occur at a later stage.
There are fewer vasectomies performed nowadays compared with 10 years ago and requests for reversal of vasectomy (known as vaso-vasostomy) are increasing. The longer the time interval between the vasectomy and the reversal the less chance of success. Pregnancy rates of between 35 and 80% can be expected if the interval is 5 years or less but rates drop to between 9 and 35% after 10 years.
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