Vasectomies
Scott M. Strayer, MD,
MPH
Assistant Professor
UVA Family Medicine
Case Presentation
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JL is a 35 year old male who presents to your
clinic to discuss contraception. His wife is
currently 35 as well and is taking oral
contraception despite being a smoker and
having a history of a DVT several years ago.
He asks you what their options are as a
couple. He mentions that he really hates using
condoms.
Indications
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For males who do not wish to have children, or
any more children, but who wish to have
sexual intercourse.
Contraindications
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Local Infection
Coagulation Disorders
Inability to palpate and elevate both vasa
Marked stress from a recent event, such as
divorce or financial setback (relative)
Lack of adequate informed consent
Complications
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Scrotal Ecchymosis
Hematoma
Infection
Sperm granuloma (can be symptomatic or
asymptomatic)
Vasectomy failure (less than 1%)
Neuroma (treated with procaine injection)
Complications
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Congestive epididymitis (can cause chronic
testicular pain and may be avoided by leaving
testicular end of vas open)
Possibility of slight increase in prostate cancer
(but weak evidence)
Comparison with BTL
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Tubal ligation has 14 deaths per year versus zero
“attributable” deaths per year for vasectomies
Tubal ligation has a higher rate of major morbidity
Vasectomies have a higher rate of minor complications
Average cost of vasectomy $500
Average cost of tubal ligation $1500-$3500
Failure rate in tubals is 0.4%, but can lead to ectopic
pregnancies
Reversal rates are similar
Success of vasectomy can be easily checked with
sperm count