Pre-service Education on FP and AYSRH

1. Pre-service Education on FP and AYSRH Session II, Topic 11 Vasectomy

2. What is a Vasectomy? • A safe and simple surgical procedure. It provides permanent contraception for • men who decide they will not want any more children. • The procedure involves tying and cutting a segment of the vase deference which carries sperms. • It is also known as male sterilization

3. Vasectomy: Mechanism of action • Works by closing off each vas deference keeping sperms out semen. • This entails cutting and removing a short piece of each tube and then tying both remaining cut ends of the vas deference. • The incision to access the vas is normally done on the scrotum • Semen without sperm is ejaculated but it cannot cause pregnancy.

4. Vasectomy: Mechanism of Action Adopted from Family Planning A Global Handbook for Providers

5. Effectiveness of Vasectomy • Vasectomy is very effective at 99.9% with correct use. • Use of reliable methods of contraceptive for three months after the procedure is necessary. • semen is checked after three months to ensure that it does not have any more sperm

6. Effectiveness of Vasectomy More effective Vasectomy Less effective In this progression of effectiveness, where would you place Vasectomy or Male sterilization? More effective Less effective

7. Advantages • Safe and easy to perform • Permanent method of contraception. • Nothing to remember except to use condoms or another effective method for at least three months after the procedure • No supplies needed, and no repeated clinic visits required after no sperm is seen in the semen

8. Advantages contd. • Can be tested for effectiveness at any time • Does not affect a man’s ability to have sex • Increased sexual enjoyment because there is no need to worry about pregnancy • No known long-term side effects or health risks • More effective and less expensive

9. Disadvantages • Requires minor surgery by a specially trained physician • Does not protect against STIs and HIV • Not immediately effective • Must be considered as permanent/Irreversible  These should Discomfort for 2-3 days • Pain in the scrotum, swelling and bruising which decreases in about 2 – 3 days • Brief feeling of faintness after the procedure

10. Timing for Vasectomy • A man can have a vasectomy any time he requests it. There is no medical reason to delay • Without any blood tests or routine laboratory tests, blood pressure check, hemoglobin test, cholesterol or liver function, and even if the semen cannot be examined by microscope later to see if it contains sperm

11. Who Can Have Vasectomy? • Most men can have vasectomy • But they may need to wait if: • They have problems with genitals such as infections, swellings or lumps, injuries in the penis or scrotum • They have other serious health conditions or infections e.g. diarrhea

12. Medical Eligibility Criteria for vasectomy • Accept means no medical reason to deny client vasectomy • Caution means the procedure can be performed in a routine setting but with extra preparation and precautions, depending on the condition. • Delay means postpone vasectomy. These conditions must be treated and resolved before vasectomy can be performed. Give the client another method to use until the procedure can be performed.

13. Medical Eligibility Criteria for vasectomy (continued) • Special means special arrangements should be made to perform the procedure in a setting with an experienced surgeon and staff, equipment to provide general anesthesia, and other backup medical support. For these conditions, the capacity to decide on the most appropriate procedure and anesthesia regimen also is needed. Give the client a backup method to use until the procedure can be performed.

14. Medical Eligibility Criteria for Vasectomy (continued) Source: WHO MEC 5th Edition

15. Warning Signs of Complications When these complications occur the client must return to hospital immediately. • Severe bleeding or blood clot after the procedure. bleeding under the skin that may cause swelling or redness of the wound that becomes worse • Signs of severe infection: Redness, heat, swelling, and pain at the incision site, pus at the incision site, • Severe scrotal or testicular pains that lasts for months, • For pain give analgesics after ruling out infection and for infection give antibiotics and scrotal support.

16. Counteracting Misconceptions on Vasectomy • Does not remove testicles it is not castration. • No change in sexual behavior and sexual desire • Does not cause hormonal imbalance – the “men will continue being a men grow beard, maintain his deep voice etc.” • -Does not cause a man to grow fat or become weak, less masculine or less productive. • -Does not cause any diseases later in life. • --Sperm do not build up in the body

17. Counseling for Informed Consent To give informed consent to vasectomy, the client must understand the following points: • Temporary contraceptives also are available to the client. • Voluntary vasectomy is a surgical procedure. • There are certain risks of the procedure as well as benefits. (Both risks and benefits must be explained in a way that the client can understand.) • If successful, the procedure will prevent the client from ever having any more children. • The procedure is considered permanent and probably cannot be reversed. • The client can decide against the procedure at any time before it takes place (without losing rights to other medical, health, or other services or benefits). • The procedure does not protect against sexually transmitted infections, including HIV.

18. Summary • A man considering sterilization should think carefully: “Could I want more children in the future?” Health care providers can help the client think about this question and make an informed choice. If the answer is “Yes, I could want more children,” another family planning method would be a better choice.