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Published byPhilomena Tucker Modified over 9 years ago
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Vasectomies Scott M. Strayer, MD, MPH Assistant Professor UVA Family Medicine
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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.
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Indications For males who do not wish to have children, or any more children, but who wish to have sexual intercourse.
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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
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Complications Scrotal Ecchymosis Hematoma Infection Sperm granuloma (can be symptomatic or asymptomatic) Vasectomy failure (less than 1%) Neuroma (treated with procaine injection)
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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)
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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
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