KEY POINTS FOR PRACTICE
| • Vasectomy is a safe and effective permanent contraception option with no increased risk of prostate cancer, cardiovascular disease, or nephrolithiasis. |
| • No-scalpel or minimally invasive techniques reduce risks of postoperative hematoma, infection, pain, and bleeding compared with an incisional vasectomy technique. |
| • Occlusion of the open vas deferens with both mucosal cautery and fascial interposition has the lowest failure rate. |
| • Postoperative semen analysis after 8 weeks by an in-office sample or home mail-in kit can be used to assess sterility so that alternate contraception may be discontinued. |
| From the AFP Editors |
More than 500,000 men in the United States choose to undergo vasectomy every year, and procedure volumes have increased by more than 150% since the 2022 Dobbs v Jackson ruling on abortion following a slow decline over the previous two decades. Vasectomy is a safe, effective, and permanent form of contraception, with pregnancy rates of 1.1% or less from 2 to 5 years postprocedure compared with pregnancy rates of 2.9% 1 year after tubal ligation. Vasectomy is less invasive, carries fewer anesthetic and surgical risks, and enables quicker recovery than tubal ligation. The American Urological Association (AUA) published guidelines for performing vasectomy and counseling patients before and after the procedure.
PREOPERATIVE EVALUATION AND COUNSELING
Patient Counseling
The preoperative consultation provides an opportunity to answer patient questions, address misconceptions, and provide an overview of the procedure and postprocedure course, including complications (Table 1).
TABLE 1. Information to Be Provided During Preoperative Vasectomy Counseling Sessions
| Vasectomy is intended to be a permanent form of contraception. |
| Vasectomy does not produce immediate sterility. Following vasectomy, another form of contraception is required until vas occlusion is confirmed by postvasectomy semen analysis. |
| Even after vas occlusion is confirmed, vasectomy is not 100% reliable in preventing pregnancy. The risk of pregnancy after vasectomy is approximately 1 in 2,000 for men who have postvasectomy azoospermia or rare nonmotile sperm. |
| Occlusion failure may occur in up to 1% of vasectomies, necessitating repeat vasectomy. |
| Options for fertility after vasectomy include vasectomy reversal or surgical sperm retrieval with in vitro fertilization; however, these options are not always successful and may be expensive. |
| Surgical complications (eg, symptomatic hematoma, infection) occur in up to 2% of patients. |
| Chronic scrotal pain associated with a negative impact on quality of life may occur after vasectomy in up to 2% of patients. |
| Other permanent and nonpermanent alternatives to vasectomy are available. |
| Prevasectomy sperm cryopreservation may be discussed but is not required. |
A scrotal examination is required to identify any mass requiring further investigation or anatomic issues (eg, absence of the vas, difficulty in isolation of the vas, or body habitus that could make the procedure difficult). Examination may also reveal patient anxiety or discomfort that may prevent the procedure from being performed under local anesthesia. This examination can be performed at the time of counseling or just before the procedure if counseling is conducted virtually.
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