Reasons against a vasectomy
Emotional, logical and legal reasons against a vasectomy
You have decided it may be the time to have a vasectomy and you have come to this website to book a vasectomy. In the next few minutes I will try to change your mind and tell you not to have a vasectomy:
The 3 most important question you need to discuss with your partner are these:
- What happens if our relationship splits and somebody else wants children with you (common in western societies)
- You or your partner change your mind (occasionally happens to existing couples)
- something happens to one of your children (rare, but important for younger couples).
If you do not have a current partner you need to be aware, that failure to warn a partner of your vasectomy would almost certainly mean your partner would be granted a divorce with all the implications.
When thinking about this procedure also consider the following:
- Have I really sat down with my partner and considered all alternatives? Click here for some of the very good alternative methods. Sometimes it is just worth to wait a little bit longer before going ahead. Some of the longer acting contraceptive methods i.e. the coil or an implant can postpone such a decision safely for some time.
- Am I now of an age where I don’t want any children anymore, whatever happens?
- Have I got enough children or are there still some secret wishes in me or my partner?
- If my life changed and reversal was not successful would adoption be an alternative I can consider?
- Am I of an age where I should consider freezing sperm?
- Am I so worried about vasectomy, it’s not really an option? There are good female alternatives available now. It’s not the end of the world if you don’t really want to do it. If you have read the clinical and the personal FAQs of this website and you are still not reassured you may wish to reconsider the above.
Medical contraindications to vasectomy:
- Intrascrotal Hernia (needs fixing first) and
- Lack of Mental Capacity (Note: Court order needed, which has to be initiated by the person with Power of Attorney for Medical Care).
- Poorly controlled diabetics (HbA1c >69)
Increased risk of problems, pain, complications, disappointment or regret:
There are a number of important clinical issues we need to know in order to be able to counsel you appropriately and avoid disappointment, complications, acute or chronic problems, long term pain and more…
- Very obese patients (BMI over 35): Can sometimes be difficult to operate on and have higher infection rates. We recommend a prior appointment for assessment.
- Diabetic patients (need good HbA1c control to avoid postoperative complications). Infection rates are higher in patients with poor HbA1c control. If your HbA1c is 69 or higher you need to see a doctor to get your diabetes controlled in order to be able to have any elective surgery including vasectomy.
- Smokers have a 400% higher infection risk in all procedures. We recommend to stop smoking at least 3-4 weeks before vasectomy. https://www.ncbi.nlm.nih.gov/pubmed/22566015. We currently believe vaping is better than smoking.
- Certain patient groups and personality types suffer greater complications / pain / regret after vasectomy:
- Patients, who have great anxiety about the procedure, feeling forced into it or feeling very negative about the whole prospect or are generally mistrusting: These patients tend to not do always well and are at high risk of PVP (post vasectomy pain or other regrets ).
- Patients on chronic pain treatment and taking regular painkillers appear more likely to have more severe pain in recovery and more likely to have chronic problems after vasectomy. This is particularly true for patients on prescription (opioid or codein based) painkillers. This is possibly due to a phenomenon called hyperalgesia. There is a short 2 minute video here that explains hyperalgesia.
- Type A personalities, the need for control: This can include patients, who want to know every single detail about the procedure and worry greatly in advance. This sometimes also shows in other ways: A need to control every single aspect of their lives and focus on minute detail, they are unable to hand over control and mistrust the doctor or nurse or health professionals in general.
- PTSD patients: A previous bad health experience has caused post traumatic stress (PTSD): This also increases the risk of post-vasectomy problems.
- Scatty, disorganised patients & bad listeners: Some patients are scatty and generally disorganised, they cannot listen to others, they fail to read information, absorb information we are forwarding or balance information with their own (mis)conceptions or beliefs. This failure leads in turn to anxiety as they remain uninformed. Sometimes they rather research google, again because of mistrust of “official” information.
- Official mental health conditions: Depression and Personality Disorders can negatively affect outcomes and patient satisfaction.
- Patients who are “too busy”: Other issues that ring alarm bells with us are frequent appointment changes (“too busy at work” = anxiety, unwilling to engage) or non-attendance of the consultation / webinar / procedure and failure to complete the forms we send (which are quite educational and again mean patients have not had a chance to inform themselves in a structured way).
- Please note, that I am doing the same local anaesthetic in every person and the scores are everything from “No pain at all” to “Excruciating” (albeit rarely) . We ask this 5 weeks later in the side effects questionnaire. This shows there are people with much lower pain tolerance than others. 97% of patients score the pain of the Local Anaestetic no higher than mild to moderate discomfort. High anxiety levels can in some patients create a low pain tolerance due to the constant adrenaline in the body and a “brain in overdrive“. Very low pain tolerance in return can also suggest high anxiety levels and sometimes and to varying degrees high painkiller use / abuse, little self discipline, a personality putting blame on others “the eternal victim”, strong imagination of bad things to happen, over-interpretation of minor mishaps happening to everyone as catastrophic “the drama queen”. All these are, in our experience, a predictor for poor outcomes after vasectomy, chronic long term pain and problems and generally poorer outcomes after any surgical procedure.
- The good news: However, just because a patient has a mental health condition like i.e. depression or anxiety it does not mean they will not do well with a vasectomy. The above information is in our experience quite specific.
- Coagulation disorders (i.e. van Willebrands etc. or prior bleeding problems at other surgical interventions): This is very important as it can cause significant bleeding and side effects and a medical opinion has to be sought prior to vasectomy.
- Absence of a vas deferens (this is the tube. Sometimes a second vas cannot be felt by the surgeon and there can be 3 reasons: Either it is not there or it is very small or the surgeon is having a bad day). The easy patient is the one with only one vas. He only has to have one side done and will be negative. The second easier one is reason 3, the surgeon having a bad day. Often the patient can be brought back at another date and often the vasectomy completed without problems. Sometimes another surgeon may be more lucky or more experienced. The tricky one is the patient with a very thin and atrophic vas. When doing sperm samples this patient will remain fertile, but the surgeon is unable to find the vas. Fortunately, this is rare, but sometimes it can require an open exploration under General Anaestethic, a review by another surgeon or the acceptance that a vasectomy may be to difficult to achieve.
- Third Vas Deferens (this can easily be missed, again because the third vas can be thinner or more atrophic. It is also dangerous to interrupt “thin” structures without a scan as these can also represent blood vessels, so this situation can be tricky. Therefore this often means vasectomy failure, fortunately it is uncommon)
- Testicular cancer (very rare, not an absolute contraindication, but generally it obviously takes priority)
- History of fainting (only extreme cases cause problems, but it is important to know, so we can prepare)
- Young patients (<25y) with children and patients without children (<30y): Higher statistical risk of regret*.
*Please complete the Young Patient Form, which will help you to go systematically through your thought processes and us to understand your reasons)
And why should I be the one to have a vasectomy?
If safety is paramount, vasectomy is perfect (but if non-permanent contraception is needed the female Implant may be similarly good and other long acting methods are also interesting). A man, who has had children or definitely never wanted any and is of an age, where (further) children would be a real burden is an ideal candidate for vasectomy. If you want to be in control of your destiny and it is clear to you there shall definitely be no more children with anybody. If you like your wife to be able to stop using hormonal contraception and the above applies, too, then vasectomy is also an excellent choice.
The choice is yours…