1. Vasectomies Scott M. Strayer, MD, MPH Assistant Professor UVA Family Medicine

2. Case Presentation JL is a 35 year old male who presents to your clinic to discuss contraception. His wife is currently 35 as well and is taking oral contraception despite being a smoker and having a history of a DVT several years ago. He asks you what their options are as a couple. He mentions that he really hates using condoms.

3. Indications For males who do not wish to have children, or any more children, but who wish to have sexual intercourse.

4. Contraindications Local Infection Coagulation Disorders Inability to palpate and elevate both vasa Marked stress from a recent event, such as divorce or financial setback (relative) Lack of adequate informed consent

5. Complications Scrotal Ecchymosis Hematoma Infection Sperm granuloma (can be symptomatic or asymptomatic) Vasectomy failure (less than 1%) Neuroma (treated with procaine injection)

6. Complications Congestive epididymitis (can cause chronic testicular pain and may be avoided by leaving testicular end of vas open) Possibility of slight increase in prostate cancer (but weak evidence)

7. Comparison with BTL Tubal ligation has 14 deaths per year versus zero “attributable” deaths per year for vasectomies Tubal ligation has a higher rate of major morbidity Vasectomies have a higher rate of minor complications Average cost of vasectomy $500 Average cost of tubal ligation $1500-$3500 Failure rate in tubals is 0.4%, but can lead to ectopic pregnancies Reversal rates are similar Success of vasectomy can be easily checked with sperm count