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Voluntary Surgical Contraception

for Men
Vasectomy
Dipresentasikan oleh
Rukmono Siwishanto

Vasectomy: Global Use

Male: 43 million

Source: Church and Geller 1990.

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Vasectomy in the US
!

Third most popular contraceptive method

Used by 13% of married couples of reproductive age

Use growing three times faster than oral contraceptive pill use

Source: Liskin, Benoit and Blackburn 1992.

Types of Vasectomy
!

No-scalpel technique (preferred)

Incisional

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Incisional Vasectomy
!

1 or 2 incisions in the scrotum

99% of operations occur under local anesthesia

Different methods of occlusion can be used

Ligation
Cautery
Combination

No-Scalpel Vasectomy
!

Developed in China, introduced in US in 1988

Improved anesthesia

Clinician holds tubes in place under skin

One puncture

No stitches needed

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Incisional Vasectomy: Complications

After Procedure in US
Complication

Rate1

Hematoma

1.95

Infection

3.48

Per 100 vasectomies; 65,155 cases

Source: Kendrick et al 1987.
1

No-Scalpel Vasectomy
Failure rate:
$ 0.2B0.4%
Complications
$ Hematoma
$ Infection
$ Epididymitis
Overall < 2%
Mortality < 0.001%

Source: Carignan 1995.

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No-Scalpel Vasectomy: Complications

After Procedure in China
Complication

Rate1

Hematoma

0.09

Infection

0.91

Per 100 vasectomies; 179,741 cases

Source: Li et al 1991.
1

Comparison of No-Scalpel Vasectomy

and Incisional Approach
Thailand
Complications
Cases

Number

Rate1

No-scalpel

680

32

0.4

Incisional

523

163

3.1

Method

Per 100 vasectomies

2 hematoma (surgical drainage not required); 1 infection
3 9 hematoma (2 required surgical drainage); 7 infection
Source: Nirapathpongporn et al 1990.
1
2

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Advantages of NSV over Incisional

Vasectomy
Advantages of NSV
Entry technique

Reduces risk of bleeding and hematoma.

Anesthetic method
Instruments

Does not cause swelling at the injection

and puncture site. Provides regional block
of vasal nerves, which reduces discomfort.
Vas is secured externally.

Skin closure

Not needed.

Damage to tissue

Less damage.

Complications

Fewer complications.

Time for procedure

Requires less time.

Source: AVSC International 1997.

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Vasectomy: Client Issues

!

The client should make the decision for sterilization

voluntarily.

The client has the right to change his mind anytime prior to the
procedure.

The client should understand that voluntary sterilization (VS) is

a permanent (not easily reversible) method.

No incentives should be given to clients to accept VS.

A standard consent form must be signed by the client before

the procedure.

Spousal consent is not required.

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Vasectomy: Mechanism of Action

By blocking the vas deferens (ejaculatory duct), sperm are not
present in the ejaculate.

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Vasectomy: Contraceptive Benefits

!

Highly effective (0.1B0.15 pregnancies per 100 women during

the first year of use)

Permanent

Does not interfere with intercourse

Good for couples if pregnancy or tubal occlusion would pose a

serious health risk to the woman

Simple surgery done under local anesthesia

No long-term side effects

No change in sexual function (no effect on hormone

production by testes)
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Vasectomy: Noncontraceptive Benefits

!

Does not interfere with woman breastfeeding

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Vasectomy: Limitations
!

Must be considered permanent (not reversible)

Client may regret later

Delayed effectiveness (requires up to 3 months or 20

ejaculations)

Risks and side effects of minor surgery, especially if general

anesthesia is used

Short-term discomfort/pain following procedure

Requires trained physician

Does not protect against STDs (e.g., HBV, HIV/AIDS)

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Vasectomy: Long-Term Reproductive

Health Effects
!

Prostate cancer: slight increased risk reported, but newer

studies fail to support this information

Testicular cancer: no association based on several studies

Cardiovascular disease: no association based on studies

HIV transmission: no data to support decreased rate of

transmission

Source: Pollack 1993.

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Who Can Use Vasectomy

Men:
!

Of any reproductive age (usually #50)

Who want a highly effective, permanent contraceptive method

Whose wives have age, parity or health problems that might

pose a serious health risk if they become pregnant

Who understand and voluntarily consent to the procedure

Who are certain they have achieved their desired family size

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Vasectomy: Who May Require

Additional Counseling
Men:
$ Who are uncertain of their desire for future fertility
$ Who do not give voluntary, informed consent

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Vasectomy: Condition Requiring

Precautions (WHO Class 3)
!

Local skin or scrotal infection

Acute genital tract infection

Acute systemic infection (e.g., cold, flu, gastroenteritis, viral

hepatitis)

Symptomatic heart disease or clotting disorders, diabetes1

Appropriate precautions include delay of procedure until condition

improves or resolves.
Procedure may need to be done in a high-level facility.
Source: WHO 1996.
1

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Vasectomy: Conditions Requiring an

Experienced Clinician and Full Backup
!

Large varicocele

Inguinal hernia

Filariasis

Scar tissue

Previous scrotal surgery

Intrascrotal mass (until

cause determined)

Undescended testes and

proven fertility

Cryptorchdism (if bilateral

and proven fertility)

AIDS-related disease

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Vasectomy: US Demographic Data

Site:
$ 75% performed in physician's examining room
$ 21% in clinics
$ 3% in ambulatory surgical centers
Provider:
$ 72% performed by urologists
$ 28% by general practitioners

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Vasectomy: Postoperative Problems

!

Wound infection

Hematoma

Granuloma

Excessive swelling

Pain at incision site

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Vasectomy: Client Instructions

!

Keep bandage on for 3 days.

Do not pull or scratch wound while healing.

You may bathe after 24 hours but do not let the wound get wet.
After 3 days you may wash the wound with soap and water.

Wear a scrotal support, keep the operative site dry and rest for
2 days.

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Vasectomy: Client Instructions continued

!

For pain take 1 or 2 analgesic tablets every 4 to 6 hours and

apply ice packs.

Avoid heavy lifting and hard work for 3 days.

Avoid sexual intercourse for 2 or 3 days or until comfortable.

$ Use condoms or another family planning method for 3
months or 20 ejaculations.

Return after 1 week if nonabsorbable stitches used.

Return for a semen test 3 months after the operation.

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Vasectomy: General Information

!

Vasectomy does not provide protection from pregnancy until

after 3 months, 20 ejaculations or when no sperm are seen in a
microscopically examined semen specimen.

Vasectomy will not affect sexual performance because the

testes still function normally.

Vasectomy does not provide protection against STDs,

including AIDS. If either partner is at risk, the couple should
use condoms even after vasectomy.

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Warning Signs for Vasectomy Clients

Return to clinical if following problems occur:
!

Fever (greater than 38BC or 100.4BF)

Bleeding or fluid coming from the incision

A very painful or swollen scrotum

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Vasectomy: Program Requirements

!

Adequate training in counseling and client assessment (history

and physical exam)

Competent providers trained to operate on awake or lightly

sedated clients

Steady supply of sterile or high-level disinfected instruments,

gloves and equipment

Use of internationally recommended infection prevention

practices

Availability of emergency equipment/drugs

Referral centers for major problems

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Vasectomy: Common Medical Barriers

!

Age restrictions (young and old)

Parity restrictions (less than two living children, no male child)

Marital status/spousal consent requirements

Provider bias

Process hurdles

Who can provide:

$ Specialists only
$ Physicians only

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