VOL: 99, ISSUE: 46, PAGE NO: 28
Maggie Gormley, RGN, is clinical nurse specialist and psychosexual therapist, Margaret Pyke Centre, London
Vasectomy or male sterilisation is the surgical operation of severing or electrocoagulation (Marie Stopes method) of the two ducts (vas deferens) that connect the testes to the seminal vesicles and urethra. The operation can be performed under either a local or a general anaesthetic. The procedure is quick and easy and is 99.9 per cent effective as a method of contraception. It has no effect on sexual functioning.
Male or female sterilisation requires counselling because the outcome of the operation should be seen as permanent (Belfield, 1999). Male sterilisation seems to carry more myths than female sterilisation, and these will need to be raised and discussed with both the man and his partner (Everett, 2001).
When discussing a vasectomy it is important to look at other effective methods of contraception and to ensure the couple has given consideration to them all. It is essential that a careful medical history of both partners is taken to determine that there are no contraindications for any of the contraceptive methods listed in Box 1.
A vasectomy is usually performed under a local anaesthetic. It can be done under general anaesthetic, which may be suitable when there is a known allergy to local anaesthetics, if the patient faints easily or simply because the patient insists on it. The man may also have a physical condition that could complicate the operation such as those mentioned above.
The nursing implications for vasectomy differ depending on how much responsibility is taken by the surgeon. Some nurses may be involved in counselling before the operation and in caring for the man during the procedure. The nurse will almost certainly be required to attend to the patient immediately postoperatively and to check for bleeding before he leaves the clinic.
Wearing tight underpants for a week (day and night) will help to prevent swelling or bruising. Heavy lifting or vigorous sport should be avoided for at least a week following the operation, and sexual activity can be resumed as soon as the man feels comfortable.
Side-effects and complications after a vasectomy are usually minimal but depend very much on the skill of the surgeon and on how well the man cares for himself postoperatively. The most common problems are infection or haematoma. Infections are treated with anti-biotics and haematoma with antibiotics, analgesia and scrotal support.
Studies show that 45 per cent of couples aged over 40 in the UK rely on sterilisation as a contraceptive (Dawe and Meltzer, 2001). This gives many the freedom to enjoy sexual intercourse without the anxiety of pregnancy, and sharing the decision on whether to have the procedure can strengthen a relationship.
There are no standardised guidelines for vasectomy reversal. The procedure may be available via the NHS if the man has been on a waiting list for 18 months.