Male permanent contraception (vasectomy) in Birmingham: how it works, NHS access and what to expect

A vasectomy blocks, seals or cuts the two tubes (the vasa deferentia) that carry sperm from the testicles. The NHS says that afterwards you can still ejaculate but the semen contains no sperm. The NHS says there is no evidence that it affects long-term sexual performance or enjoyment.

The NHS says vasectomy may suit someone who already has children and does not want more, or who does not want children. The BAUS leaflet is more cautious: it says that vasectomy is not recommended in men who have not had any children, that it is not appropriate during a partner's pregnancy or within the first six months after a birth, and that anyone with doubts should not go ahead. The two sources agree that the decision should be firm because reversal is unreliable.

The NHS says to make an appointment with a GP surgery if you are thinking about a vasectomy, and that you may also be able to use a sexual health clinic. A nurse or doctor explains what is involved and the risks, and if it is right for you, you are referred to a hospital or clinic, with a likely waiting list. A few weeks before the procedure there may be a check-up of your health, by phone or in person. The NHS also says you can choose to pay privately.

The Birmingham and Solihull ICB publishes a vasectomy policy on its website. It says the local NHS will fund vasectomy where the patient, and where possible the partner, has given fully informed consent and been told that reversal is not available on the NHS and has poor success rates; where minimally invasive vasectomy under local anaesthetic in a commissioned community clinic is the first choice; and where the patient understands the follow-up and semen analysis. It says an inpatient procedure under general anaesthetic is funded only in listed circumstances: an allergy to local anaesthetic, anticoagulant or antiplatelet treatment with a high bleeding risk, or anatomy that prevents the tubes being felt and mobilised, such as large hydroceles or varicoceles. The policy text refers to the former clinical commissioning groups, so confirm current arrangements with a GP.

The NHS says vasectomy is done at a GP surgery, sexual health clinic or hospital, and that the doctor numbs the scrotum with local anaesthetic, makes a small cut, seals, blocks or cuts the sperm ducts, and closes the cut, usually with dissolvable stitches. NHS pages give slightly different durations: about 15 to 20 minutes on one page and about 30 minutes on another. The ICB page says about 15 minutes.

The ICB describes two techniques. A conventional vasectomy uses a scalpel to make two small cuts in the scrotal skin, with a section of each tube removed and the ends tied or sealed with heat. A no-scalpel vasectomy uses a tiny puncture instead, which the ICB says involves little bleeding and no stitches and is thought to be less painful and less likely to cause complications. BAUS notes that local anaesthetic is injected on each side and feels like a bee sting, that you may feel some tugging discomfort when each tube is handled, and that general anaesthetic is normally suggested if the tubes are hard to feel or you struggle with injections.

• Before: the NHS says you may be asked to shave the scrotum a few days earlier, shower on the morning, wear tight-fitting underwear, and have painkillers at home. You cannot safely drive home.

• First week: testicle pain and swelling are common for around a week; ibuprofen or paracetamol helps. Erections may feel painful at first and there may be some blood in the semen.

• Support: wear tight-fitting underwear for about a week; BAUS mentions a scrotal support, ice packs (not directly on skin) and avoiding heavy lifting for the first few weeks.

• Activity: the NHS says to avoid sport and heavy lifting for as long as the clinician advises, usually 1 to 2 weeks, and to wait at least 2 to 7 days before sex or masturbation. Return to work is possible within 24 hours.

• Driving: the NHS says not to drive until you can safely do an emergency stop; check with your insurer.

• Contraception: use another method until a doctor confirms the vasectomy has worked, which the NHS says usually takes around 12 weeks.

BAUS explains that some sperm are already past the blocked point after surgery and must be cleared by ejaculation, on average 20 to 30 ejaculations. At least 12 weeks after the operation you provide a semen sample for microscopic examination. If no sperm are seen you receive the all-clear; if a few remain you give another sample a few weeks later. BAUS puts early failure, where sperm persist, at about 1 in 250 and late failure, where the tubes rejoin after clear tests, at about 1 in 2000. The ICB policy requires that you are told about post-procedure semen analysis beforehand. BAUS asks you to read the instructions for producing and delivering the specimen very carefully.

The NHS lists mild bruising, small harmless yellow lumps made of sperm (sperm granulomas) and infection, and describes post-vasectomy pain syndrome as an uncommon long-term testicular pain treated with anti-inflammatory medicine, nerve-pain medicines or, for some, surgery. BAUS says there is no evidence that vasectomy causes long-term health risks such as testicular or prostate cancer. The NHS advises an urgent GP appointment or NHS 111 if pain and swelling suddenly worsen or do not improve after a few days, you have a high temperature, blood, pus or liquid leaks from the wound, or a lump in the scrotum keeps growing.

Reversal is a different matter. The NHS says it is sometimes possible but not usually available on the NHS and does not always work, and the ICB says reversal is rarely funded because success rates are not high and fertility is not guaranteed. Anyone considering a vasectomy should treat it as permanent.

• The doctor should be registered with the General Medical Council, and the clinic with the Care Quality Commission.

• Ask which technique is used, how many vasectomies the clinician performs and what their failure rate is.

• Ask what the quote includes: consultation, procedure, follow-up, the post-operative semen analysis and treatment of any complication. No private price was found in the sources read, so none is given here.

• Ask how semen samples are collected, who reports the result and how you are told.

• Read the consent form beforehand and make sure irreversibility has been discussed.