Male Sterilisation by Vasectomy (Permanent male contraception and its reversal)

Threshold

Norfolk and Waveney Integrated Care Board 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.

The patient and where appropriate, their partner, have should be fully counselled which should include:

• The patient is aware that sterilisation is considered permanent, and that reversal is not routinely funded on the NHS.
• The patient is certain that their family is complete
• The patient understands that sterilisation does not prevent or reduce the risk of sexually transmitted infections
• 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
• The patient has been counselled that there is a small but well-known failure rate to vasectomy
• The patient has sound mental capacity for making the decision as emotional instability or equivocal feelings about permanent sterilisation are contraindications 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.

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.

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.

Situations where a patient is already on a Urology waiting list for a scrotal procedure under general anaesthetic to prevent multiple interventions.