What to expect at a first men's surgical appointment

A first appointment for a men’s surgical procedure, such as circumcision or vasectomy, is mostly a conversation. A clinician takes a history, examines the relevant area, explains the options and risks, and checks that any decision to go ahead is informed and voluntary. This guide describes those steps in general terms from NHS, BAUS and Care Quality Commission pages, plus one provider’s published description of its process. It does not describe any particular clinic, and what happens at a given appointment will vary.

1. Before the appointment

On the NHS the starting point is usually a GP appointment. For vasectomy the NHS says a nurse or doctor explains what is involved and the risks, and answers questions, and that if it is right for you, you are referred to a hospital or clinic. A few weeks before a procedure there may be an appointment, by phone or in person, to check your health and discuss the procedure. For a general anaesthetic the NHS says there is usually a pre-operative assessment a few weeks beforehand, which may include tests such as blood tests or an ECG.

Whatever the route, it helps to have a list of your medicines, allergies and previous operations, and to know what you want to ask. One provider (BPAS) says patients may receive a medical-history questionnaire with their confirmation, and asks them to bring their medicines or prescription.

2. History and the discussion

The BAUS leaflets say that on the day of a procedure a urologist or member of their team reviews your history and medications and discusses the surgery again to confirm consent. They ask you to tell the team about an implanted device such as a stent, joint replacement, pacemaker or heart valve, regular blood-thinning medicine, a present or previous MRSA infection, or a high risk of variant CJD. For vasectomy, BPAS lists history that affects whether a vasectomy can be done safely: bleeding problems, other conditions such as diabetes, past injury or surgery to the scrotum or groin, a history of sexually transmitted infections, problems with erection or ejaculation, a pacemaker, fainting, allergies and current medicines.

The discussion also covers why you are considering the procedure and what the alternatives are. The BAUS circumcision leaflet, for example, lists steroid creams and washes, dorsal slit, frenuloplasty and preputioplasty as alternatives for some conditions. For vasectomy the BAUS leaflet lists other forms of contraception, and says that anyone with doubt about whether it is right should not go ahead.

3. The examination

An examination focuses on the area being treated and, if surgery is planned, on whether the procedure is practical. BPAS describes a brief physical examination for vasectomy that records height, weight and blood pressure, and an examination of the scrotum. It says the surgeon re-checks the history and examines the testicles on the day to make sure the tubes can be found easily. For foreskin problems the examination looks at the foreskin and head of the penis; the NHS lists tight or non-retracting foreskin, recurrent infection and scarring among the reasons for circumcision. An examination should be explained to you beforehand, and you can ask questions at any point.

4. Consent

The NHS says consent to treatment must be voluntary, informed and given by someone with capacity. Voluntary means free from pressure from staff, friends or family. Informed means being given all the information about what the treatment involves, including benefits, risks, reasonable alternatives and what will happen if treatment does not go ahead. The NHS adds that for a major procedure, consent should be secured well in advance so there is time to understand it and ask questions, and that you are entitled to change your mind and withdraw consent before the procedure. Consent can be verbal or written; for an operation it is usually a signed form. BPAS says it gives a copy of the signed form to the patient.

For children, the NHS says someone with parental responsibility may need to give consent for a child up to 16. The position for circumcision in boys is set out in the guide to circumcision in boys.

5. Anaesthesia

The NHS describes local anaesthetic as a medicine that numbs part of the body so you are awake but feel no pain, used for many minor operations. A general anaesthetic means you are asleep, and the NHS says it is used if other types are not suitable. For circumcision the NHS says general anaesthetic is usual, with local or an epidural-type anaesthetic sometimes used; for vasectomy the NHS says local anaesthetic is usual. The BAUS vasectomy leaflet says that local anaesthetic causes some discomfort when injected, like a bee sting, and that you will still feel touch, heat and cold afterwards. If a general anaesthetic is planned, an anaesthetist usually discusses options and pain relief with you. If you are having a general anaesthetic, the NHS says someone needs to take you home and you should not drive for at least 24 hours.

6. Aftercare and follow-up

Ask what recovery to expect and how to reach the team if something is wrong. The BAUS leaflets say you should be given advice about recovery, a copy of the discharge summary with a copy sent to your GP, and information about follow-up. After vasectomy that includes post-vasectomy semen tests at least 12 weeks later, with other contraception continuing until you are told you are clear. The NHS gives typical recovery times: circumcision takes 4 to 6 weeks to heal, and after vasectomy testicle pain and swelling are common for around a week and most people can return to work within 24 hours.

7. Cost and paperwork

If you are paying privately, ask for a written quote that lists the consultation, the procedure, the anaesthetic, the follow-up and any tests, and ask what happens if something unplanned is needed. Prices vary by provider and this guide does not publish any; see the cost guides for vasectomy and adult circumcision, which show what drives quotes and give clearly labelled published examples.

8. Checking a private provider

The Care Quality Commission runs a public search of registered services, and its guidance on choosing cosmetic surgery advises checking that a hospital or clinic is registered, saying an unregistered one may be practising illegally and its insurance may not cover you. That page is about cosmetic surgery, but the habit of checking applies more widely. Its scope-of-registration guidance lists treatment under anaesthesia among the activities where an exception for independent doctors in a consulting room does not apply, so ask the provider how it is registered. Also check that the doctor is on the General Medical Council register, who will operate, and what indemnity and aftercare arrangements exist.

9. Questions worth taking with you

• What is the diagnosis or reason for the procedure, and what else could be done?
• What are the risks, and how likely are they for me?
• Which anaesthetic is planned and who will give it?
• What does recovery involve, and when can I return to work, sport and sex?
• What follow-up is arranged, and who do I call if there is a problem?
• What is the total cost, and what is not included?

BAUS also points patients to a list of suggested questions called “Having An Operation” on the Royal College of Surgeons of England website.

Related reading

• Vasectomy: what the procedure involves
• Circumcision for adults: the procedure
• Local anaesthetic
• General anaesthetic