I can’t remember exactly how I got involved doing vasectomies. The outgoing senior partner used to do them at the practice I joined as a GP and I think as the new boy I was just expected to take over. I was packed off to the local vasectomy clinic to be trained.
Earning my scissors
Somewhat apprehensive at first, I was pleased to discover it wasn’t exactly rocket science or even brain surgery. The most important bit, I worked out, was to anaesthetise the skin effectively, so that the first incision was not painful. If the patient felt that first cut, they would be tense and fidgety for the rest of the procedure.
Locating a tube slightly smaller than a drinking straw is not exactly easy, but if the target is springing up and down like a bouncy castle it can be considerably more challenging.
The tube subject to all the attention is called the 'vas deferens'. I remember this because there is a vas deferens between a man and a woman (sorry).
Having identified it and shoved some local anaesthetic into it, the other trick is to make sure you don’t let go of it until it is cut. Once you have your fingers wrapped round that tube, it’s amazing how many distractions can sail into view: itchy ears, sneezing behind the mask and on one memorable occasion, theatre trousers that gradually descended below my nether regions.
Short back and sides
Basically the procedure involves cutting the tube, stitching the ends, repeating the procedure on the other side, and then stitching up the skin. There are all sorts of variations, but I’m not going to go into too much detail about the nuts and bolts. These can be found elsewhere.
I soon learned that the actual surgery was the easy bit. What was more difficult was wending my way through the mire of consent, working out who wanted a vasectomy. who had been forced to ask for a vasectomy, whether there was a legal obligation to get the wife’s consent and what was really going on in the guy’s head when he came requesting ‘the snip’.
Remember, this was the 1970s. The idea that a person’s body was their own and could within reason do what they wanted with it (provided they had capacity to make such a decision) was still in its infancy.
Also, most straight people who lived together were married. Although we had just come out of the swinging Sixties, it was still a very conventional society in the UK. There was this niggling worry that if you went ahead with the procedure without the partner’s consent you could be sued. Literally, an old wives’ tale and uncorroborated as it turned out. But enough to prevent all but the most foolhardy vasectomist from performing the op without the wife’s moniker on the consent form.
I’ve seen fire and I’ve seen rain, but I’ve never seen so much anguish as when a man and a woman have a ding dong about a vasectomy. Sometimes it was the man who had to be literally dragged by the short and curlies into my consulting room; sometimes it was the woman who was just in love with being pregnant and wanted baby after baby.
Fast forward to today
Fortunately, these days we take a much more laid-back view and vasectomy surgeons happily chop away at any man who can give their own informed consent.
However, encouragement should be made to involve a partner if there is one. Although reversal is possible, it’s by no means guaranteed, and the procedure is best looked on as an irreversible cessation of fertility.
This means the scenarios we normally avoid thinking about need to be confronted, such as the death of a child, the death of a spouse or the break-up of a relationship. There’s also the complications, which although infrequent are not insignificant.
Taking my own medicine
For my own part, it seemed like a good idea at the time. It still does. My wife had already gone through enough with childbirth and contraception (not to mention conception), and I felt beholden to ‘sort things out’ once and for all.
Having been an anaesthetist in my youth I ran a little sideline gassing for surgeons at a private clinic. So at the end of the list, I just hopped on the table and let the surgeon do his work. In case you’re wondering, yes, I did consider doing it myself, but I couldn’t trust my feet to hold the mirror still.
I drove myself home and luckily, the local anaesthetic kept working until I reached my destination.
Things were recovering well until the doorbell rang. I was just in time to see a lorry disappearing down the road, having unceremoniously dumped the order I’d been waiting for for weeks on the pavement.
One tip is that if you’re going to have a vasectomy, don’t schedule any major lifting until you've had a day or so off your feet.
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