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Vasectomies

Vasectomies. Scott M. Strayer, MD, MPH Assistant Professor UVA Family Medicine. Case Presentation.

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Vasectomies

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  1. Vasectomies Scott M. Strayer, MD, MPH Assistant Professor UVA Family Medicine

  2. Case Presentation • 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.

  3. Indications • For males who do not wish to have children, or any more children, but who wish to have sexual intercourse.

  4. Contraindications • 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

  5. Complications • Scrotal Ecchymosis • Hematoma • Infection • Sperm granuloma (can be symptomatic or asymptomatic) • Vasectomy failure (less than 1%) • Neuroma (treated with procaine injection)

  6. Complications • 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)

  7. Comparison with BTL • 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

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