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.
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)
Increased risk of problems, 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.
- 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 you are poorly controlled we probably recommend perioperative antibiotics, but even those do not always avoid infection. You should have a prior appointment for assessment.
- 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 personality types:
- 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.
- 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 / 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).
- 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 very 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 (uncommon, patients should be scanned beforehand to ensure no renal agenesis)
- Third Vas Deferens (this can easily be missed and can cause a failure, fortunately it is uncommon)
- Testicular cancer (very rare, not an absolute contraindication, but probably best to fix first)
- 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…