Vasectomy: things to consider before deciding, with NHS access in Birmingham

The NHS describes vasectomy, also called male sterilisation, as a permanent method of contraception that stops sperm being ejaculated. BAUS goes further: it says you should regard it as an irreversible procedure, and that if you have any doubt about whether it is right for you, you should not go ahead.

Patient.info, a GP-reviewed patient information site, says it is important to consider situations such as a tragedy in the family or the break-up of a relationship, and that a vasectomy should only be considered where you would not want more children even then. It says it is wise not to make the decision at times of crisis or change, such as after a new baby or termination of pregnancy, or when there are major problems in the relationship, and that there are reversible long-term methods for women that can be considered together.

NHS Wales makes a related point about emotions: if you would find it hard to accept being infertile, or feel anxious or uncomfortable about the procedure, it may not be suitable, and a GP or a contraception or sexual health clinic can talk through all the options. If you are sure, it says, you may feel relieved not to think about contraception again. The sources reviewed give no reliable regret figure, so none is quoted here.

The NHS says to make an appointment with a GP surgery if you are thinking about it, and that you may also be able to use a sexual health clinic. A nurse or doctor can explain what is involved, including the risks, and you may want to discuss it with a partner if you have one.

NHS Wales says your doctor may recommend counselling before agreeing, that you may be more likely to be accepted if you are over 30 and have had children, that a GP can refuse to refer if they believe it is not in your best interests, and that if you are under 30 many surgeons are reluctant in case your circumstances change. It also says that agreement of a partner is not a legal requirement, though it is better if both agree. That page was last updated in 2022 and is adapted from the NHS website, so treat it as indicative of practice, not as current policy.

BAUS adds that vasectomy is not appropriate during pregnancy or within the first six months after the birth of a child, and is not recommended in men who have not had children. These are leaflet statements; individual clinicians apply their own judgement.

After the operation, some sperm remain beyond the point where the tubes are blocked. BAUS says that on average 20 to 30 ejaculations are needed to clear them, and that a semen sample is examined under the microscope at least 12 weeks after surgery; if no sperm are present you are given the all-clear, and if a few remain a further sample is requested a few weeks later. The NHS says you should use another method of contraception until a doctor confirms the vasectomy has been successful, which usually takes around 12 weeks.

BAUS lists early failure (persistent moving sperm at testing) at 1 in 250 patients and late failure, where the ends rejoin after clear counts, at 1 in 2000. Patient.info puts the chance of becoming fertile again at about 1 in 2,500 men. The figures are close but not identical because they come from different sources, which is why they should be treated as approximate.

A vasectomy does not protect against sexually transmitted infections, and the NHS says to use a condom every time you have sex to protect you and your partner against them.

The NHS calls vasectomy usually a very safe type of surgery in which serious side effects are rare. The usual ones are mild bruising and swelling, a small yellow lump on the scrotum from sperm leaking (a sperm granuloma) that is usually harmless and goes away by itself, and infection, which needs antibiotics.

BAUS gives approximate frequencies. Bruising and scrotal swelling with seepage of clear yellow fluid after a few days affects almost all patients. Blood in the semen the first few times affects between 1 in 2 and 1 in 10. Significant bruising needing surgical drainage affects between 1 in 10 and 1 in 50, as does epididymo-orchitis (infection or inflammation of the testicle). It says that troublesome chronic testicular pain severe enough to affect day-to-day activities affects up to 1 to 2%.

Estimates of long-term pain differ by source. Patient.info says the most recent studies show persistent post-vasectomy pain in 0.2% of men, whereas BAUS gives 1 to 2%; the NHS describes it only as an uncommon side effect (post-vasectomy pain syndrome) usually treated with anti-inflammatory medicine or nerve-pain medicines, and sometimes surgery. A sensible conclusion is that long-term pain is uncommon but real, and worth discussing before you consent.

On cancer, BAUS says there is no evidence that vasectomy causes long-term health risks such as testicular or prostate cancer, NHS Wales says there is not enough evidence to be sure whether it increases prostate cancer risk, and Patient.info describes reviews that disagree, one finding no increased risk and a later one finding a small increase in diagnosis but not in deaths. Speak to a GP about any concern.

Reversal is a different operation, usually done privately. The NHS says it is not usually available on the NHS and does not always work. The Birmingham and Solihull ICB lists reversal of male sterilisation as not routinely commissioned and says it is rarely funded because success rates are not very high and fertility return is not guaranteed.

Quoted success rates vary by source and by how long ago the vasectomy was done. NHS Wales says that if reversal is done within 10 years the success rate is about 55%, falling to 25% after more than 10 years. Patient.info quotes pregnancy rates falling from 75% within 3 years to under 10% after more than 20 years. These are not comparable measures and neither should be read as a personal prediction.

NHS Wales says IVF using sperm retrieved from the testicles may be possible, but may not be available on the NHS, is not always successful, and can be expensive privately; it says sperm stored in a sperm bank cannot be relied on to bring about a pregnancy either.

The ICB vasectomy policy page says it funds vasectomy where the patient, and where possible the partner, has given fully informed consent for permanent sterilisation and has been told reversal is not available on the NHS and has poor success rates; where minimally invasive vasectomy under local anaesthetic is the first choice in a commissioned community clinic setting; and where the patient has been told about follow-up and post-procedure semen analysis.

It lists the circumstances in which an inpatient procedure under general anaesthetic is funded: allergy to local anaesthetic, anticoagulant or antiplatelet treatment with a high bleeding risk, anatomical abnormalities such as an inability to feel and move both vasa or large hydroceles or varicoceles, and previous trauma that has scarred the scrotum. Others need an individual funding request supported by the ICB.

The same page named a community vasectomy service run by the British Pregnancy Advisory Service in south Birmingham at the time it was read, and said referral could be by self-referral. The page uses the older term CCG and services change, so confirm what is currently commissioned with a GP or the ICB; this guide neither recommends nor rates that or any other provider.

The NHS says there is usually a waiting list, and NHS Wales says waits can be several months depending on where you live.

The NHS says you can choose to pay privately. No price is given here because none was found in a source suitable for quoting; prices vary and the quote should state exactly what it includes.

• Is the doctor on the GMC register and the provider registered with the CQC?

• Which technique is used, which anaesthetic, and who performs the procedure on the day?

• Does the written quote include the pre-procedure discussion, the operation, the semen tests and any repeat test?

• What are the provider's own figures for early failure, haematoma, infection and chronic pain, and how are post-vasectomy semen results followed up?

• What happens if a complication needs treatment, and who do I contact out of hours?

• What consent process is used, and is there time to think before signing?

The NHS says it is common to have testicle pain and swelling for about a week, that tight-fitting underwear for about a week helps, that return to work within 24 hours is usually possible, that sport and heavy lifting should be avoided for as long as advised, usually 1 to 2 weeks, and that sexual activity should wait for at least 2 to 7 days. It says to arrange a lift home, because it will not be safe to drive.

The NHS says to ask for an urgent GP appointment or contact NHS 111 if pain and swelling suddenly get worse or are not improving after a few days, if you have a high temperature, if you notice blood, pus or liquid leaking from the wound, or if a lump in the scrotum keeps getting bigger.