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Tuesday Nov 13, 2018

FPs and Vasectomies: Help Your Patients Make a 'Snip' Decision

I'd like to address a disparity regarding family planning. Guys, it is time to step up to the plate. I'm talking vasectomy here, and family physicians are ideally positioned to provide this service.

[physician discussing vasectomy with patient]

I was interviewed last year about why more men don't get vasectomies.(www.huffingtonpost.com) My response was that they do here in Valdez, Alaska. I live in a remote community in a state known as the last frontier, and the men here are tough. They have to be. (So are the women, but that's a different post.) The reality is that in our community, most women don't get their tubes tied; the men do.

There are exceptions. We perform elective tubal ligations during cesarean sections and offer the full range of reversible contraception. But for permanent birth control, I always recommend vasectomy. It is easier to perform than tubal ligation, ablation or hysteroscopic tubal occlusion and does not entail major surgery. I can do this procedure in my office in about 20 minutes. I discuss it during prenatal visits and as part of discharge planning after a delivery.

I have donated many vasectomies to fundraising auctions over the years. I started with Ducks Unlimited, an organization that is effective in wetlands preservation. I offered a vasectomy that was auctioned with the tagline "Make sure you're shooting blanks." It raised a ridiculous amount of money. I've offered vasectomies through other local charities since then, and we found that adding a catchy phrase helps get people's attention. For example, the line for the local museum auction was "Your sperm-producing days are history."

I realized that these campaigns were a true success when the winner of one auction started jumping up and down with his arms raised over his head in a victory dance. At another amusing event, the wife of an auctioneer started bidding. The auctioneer came in the next day.

For every vasectomy I donated, I had multiple other procedures scheduled by the same patients and families. It was a good loss leader. I charge half the rate of a urologist because I really want my male patients to step up.

I learned how to perform vasectomies from a no-scalpel vasectomy course offered by the AAFP many years ago. It is an easy procedure that requires some specialized instruments. I use a local anesthetic with oral narcotic and a benzodiazepine. I don't use clips, preferring the technique outlined in the AAFP course, which has a low complication rate and excellent evidence as to its safety and efficacy.

I practice in a small town, so I would know if there were problems or unintended pregnancies. Instead, my biggest concern is that for some reason, men often try some heroic adventure the day after their vasectomy. I had one patient ride a snow machine across the Valdez Glacier. Another took a glacier rescue class and spent the day jumping into crevasses while wearing a harness. I use these as examples of what men should not do when I advise them to sit at home and watch TV for the next several days.

Nationally, women are three times more likely to undergo a sterilization procedure than men,(www.ncbi.nlm.nih.gov) but men can, and should, take responsibility for their own fertility.

There are financial and professional benefits for us to provide this service, as well. It is an easy procedure with little significant risk, and family physicians, by the nature of our practice, can promote its use. It is time for men to step up.

John Cullen, M.D., is president of the AAFP.

Posted at 04:28PM Nov 13, 2018 by John Cullen, M.D.

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