Sterilisation by Vasectomy & Reversal (Permanent male contraception and its reversal)

Threshold

Norfolk and Waveney Integrated Care Board (ICB) normally commission male sterilisation (vasectomy) services under local anaesthetic in a primary or community care setting. All patients requesting vasectomy should first be fully assessed and counselled to ascertain if the procedure is indeed the most appropriate intervention. This counselling and assessment should be in line with Faculty of Sexual and Reproductive Healthcare Clinical Guidance: Male and Female Sterilisation Recommendations.

Vasectomy in a Primary or Community Care Setting should only be carried out in patients who meet all of the following criteria:

a) The patient understands that the sterilisation procedure is intended to be permanent and is often difficult or impossible to reverse. The reversal of sterilisation operation would not be routinely funded by the ICB (except under exceptional circumstances, upon which a funding request would be completed and forwarded to the ICB for approval),

AND

b) The patient is certain that his family is complete,

AND

c) The patient has sound mental capacity for making the decision as emotional instability or equivocal feelings about permanent sterilisation are contraindications to vasectomy,

AND

d) The patient has received counselling about the availability of alternative, long-term and highly effective contraceptive methods and these are either contra-indicated or unacceptable to the patient,

AND

e) The patient understands that sterilisation does not prevent or reduce the risk of sexually transmitted infections,

AND

f) The procedure will normally be carried out in a primary or community care setting under a local anaesthetic (Faculty of Sexual and Reproductive Healthcare, 2014).

AND

g) The patient has been counselled that there is a small but well known failure rate to vasectomy

Exclusion criteria:

Anybody under the age of 18
Cryptorchidism
Lack of capacity to give informed consent

Vasectomies should normally only be carried out in secondary care for the reasons documented below. Referrals will need to confirm the reasons why the procedure cannot be undertaken in a primary or community care setting.

a) Situations when a vasectomy under local anaesthetic may not be possible in primary care

It has not been possible to identify either one or both vas deferens, prior to undertaking local anaesthetic no scalpel vasectomy surgery. (This inability to distinguish the vas from any other structures could be as a consequence of previous scrotal surgery, or the presence of a hydrocoele, spermatocoele, inguinal hernia, or thickened scrotal skin.)
The patient, when attending for vasectomy surgery, has such profound and severe “local anaesthetic operation” anxiety, that it is inappropriate to proceed with the surgery.

b) Situations where vasectomy under local anaesthetic is contraindicated in primary care

The patient has an allergy to local anaesthetic.
The patient is receiving anticoagulation/antiplatelet therapy which cannot be safely paused preoperatively for long enough to allow safe local anaesthetic surgery in general practice.

c) Situations where a patient is already on a Urology waiting list for a scrotal procedure under general anaesthetic to prevent multiple interventions
Reversal of Sterilisation:

The reversal of sterilisation by vasectomy is not routinely funded.

This policy will be reviewed in the light of new evidence, introduction of new contraceptive methods into the market, or new national guidance, e.g. from NICE

Cases for Individual Funding Consideration (Patients who do not meet the policy criteria)

On a case to case basis, patients might be eligible for surgical intervention, in consideration of their exceptionality. The requesting clinician must provide information to support the case for being considered an exception, by submitting an individual funding request and will not be funded unless there are exceptional clinical circumstances.