Having a vasectomy can raise lots of questions about emotional implications, side-effects and reversal. We asked an expert to tell us more and find out why fewer men in the UK are choosing to undergo the procedure.
Figures from NHS Digital reveal that the number of vasectomy procedures performed in sexual and reproductive health services and NHS hospitals has plummeted. Prior to 2015/16 there had been a long-term decline in the number of vasectomies performed, with the number falling by half (50%) between 2008/09 (22,156) and 2014/15 (11,113). Since then the number has remained at around 11-12,000 a year.
Sexual health experts disagree over the reasons for such a steep decline. Some argue the trend reflects societal shifts, with couples now opting to have children in their late 30s and 40s, and, aware that relationships might not last, being reluctant to take steps that are seen as irreversible.
Others believe that diminishing NHS funding for the surgery and the fact that it is increasingly being offered by GP practices are to blame, as well as misconceptions among men over getting 'the snip'.
Some Clinical Commissioning Groups (CCGs) have since begun funding vasectomies. However, while all female contraception is subsidised, the only two methods of male contraception - vasectomy and condoms - are not funded by some CCGs.
What to consider before having a vasectomy
Whatever the underlying reasons for the fall in vasectomies, if you are considering having the procedure it is important to think carefully about whether you are absolutely sure you do not want any more children. It is a major life decision that should not be taken lightly, and should always be made with your partner (if you have one).
Remember, knowledge is power in such situations. The majority of men consider having a vasectomy for some time before proceeding. Take advantage of the counselling services on offer prior to having the surgery. Listen to what the counsellor and your GP have to say and make an informed decision.
"During the pre-operative assessment, the patient is reminded that vasectomy is considered to be a permanent method of contraception and that they will not have any more children as a result. This is also discussed during the consent process with the vasectomy surgeon," says Debi Hammond, head of vasectomy services at Marie Stopes UK.
"Counselling is offered to all vasectomy clients, and there is also a two-week ‘'cooling off' period from pre-assessment to procedure to allow the client extra time to consider, now that he is fully informed of the pros and cons of vasectomy."
Potential emotional side-effects
According to Hammond, men choose vasectomy for several reasons, most commonly for its reliability. Vasectomy has an early failure rate of less than 1 in 100 men and a late failure rate of 1 in 2,000 men.
Many men choose to have the surgery once their family is complete and it is now their time to take responsibility for the contraception, or perhaps because their partner is having difficulty with her contraception. Finally, vasectomy is still far simpler and less invasive than female sterilisation.
"Very few men require counselling pre- and post-vasectomy, and I have not had any instances where a client has regretted having the procedure," states Hammond. "However, vasectomy is considered to be a permanent method of contraception and if reversal is possible, it may not be successful, so you need to be 100% sure of your decision."
What are the risks?
Possible complications include a collection of blood inside the scrotum (haematoma), hard lumps called sperm granulomas (caused by sperm leaking from the tubes), an infection, or long-term testicle pain (you may need further surgery). The vas deferens is a tube that carries sperm out of each testicle. These tubes can also reconnect, but this is very rare.
If you are considering having a vasectomy, remember that, for the majority of patients, it is quick, safe and effective. As one man explains, he was apprehensive prior to his recent procedure at a Marie Stopes Clinic.
"Even as someone who was 100% determined to go through with my vasectomy, I couldn't help but be slightly mindful of what was about to be undertaken," he says.
"Rest assured, it doesn't hurt anywhere near the way you are expecting it to. It is all over with much faster than you are imagining and you will feel considerably less pain than the self-protecting marketing materials are obliged to cite."
It is important for men to be aware that vasectomy is not successful immediately. So you will need to continue using your normal method of contraception until you have had a semen sample (about 12 weeks after the procedure) checked to ensure there are no sperm in it. Once you're informed that the sample is clear, you can stop using contraception.
Conventional versus non-scalpel vasectomy
There are two types of vasectomy surgery. In a conventional vasectomy using a scalpel, the scrotum is numbed with a local anaesthetic. The doctor then makes two small cuts in the skin on each side of your scrotum to reach the vas deferens. Each tube is cut and a small section removed.
The ends of the tubes are then closed, either by tying them or sealing them using heat. The cuts are stitched, usually with dissolvable stitches that go away on their own within about a week.
In a no-scalpel vasectomy, the doctor first numbs the scrotum with local anaesthetic, before making a tiny puncture hole in the skin of your scrotum to reach the tubes. This means they don't need to cut the skin with a scalpel. The tubes are then heat-sealed.
"Vasectomy at Marie Stopes is a simple procedure using a cautery method (non-scalpel) and usually no stitches," says Hammond. "It is minimally invasive and is a one-off appointment where you will stay at the clinic for approximately one hour.
"Semen sample testing is done by post - most men can go back to work after 48 hours. Vasectomy has no effect on a man's sex life; in fact in some cases men have said that it improves their sex life, lessening the fear of an unplanned pregnancy.
"All men will have a pre-op assessment (or consultation) in which they are provided with comprehensive information about the vasectomy procedure, including complications and risks, failure rates, how to prepare for the procedure, pain relief, recovery and resting, and semen testing," she continues.
"They are also provided with a 'Having a Vasectomy' brochure, which includes everything they need to know pre- and post-vasectomy."