Pre-service Education on FP and AYSRH Session II, Topic 11 Vasectomy

What is a Vasectomy? A safe and simple surgical procedure. It provides permanent contraception for men who decide they will not want any more children. The procedure involves tying and cutting a segment of the vase deference which carries sperms. It is also known as male sterilization Ask students what they know or have heard about vasectomy. Describe vasectomy as it is stated on the slide.

Vasectomy: Mechanism of action Works by closing off each vas deference keeping sperms out semen. This entails cutting and removing a short piece of each tube and then tying both remaining cut ends of the vas deference. The incision to access the vas is normally done on the scrotum Semen without sperm is ejaculated but it cannot cause pregnancy. Brainstorm how vasectomy works

Vasectomy: Mechanism of Action Adopted from Family Planning A Global Handbook for Providers

Effectiveness of Vasectomy • Vasectomy is very effective at 99.9% with correct use. Use of reliable methods of contraceptive for three months after the procedure is necessary. semen is checked after three months to ensure that it does not have any more sperm Explain that Vasectomy is very effective at 99.9% with correct use.

Effectiveness of Vasectomy In this progression of effectiveness, where would you place Vasectomy or Male sterilization? Less effective More effective Implants Female Sterilization IUDs Progestin-Only Injectables Combined Oral Contraceptives Male Condoms Standard Days Method Female Condoms Spermicides Vasectomy Less effective More effective Explain: The figure on this slide includes a list of contraceptive methods arranged from most effective method at the top to least effective method when commonly used. In this list, spermicides are the least effective method and the most effective methods are female sterilization, implants and IUDs. Ask participants: Where would you put vasectomy on this list? <After participants respond, click the mouse to reveal the answer>.

Advantages Safe and easy to perform Permanent method of contraception. Nothing to remember except to use condoms or another effective method for at least three months after the procedure No supplies needed, and no repeated clinic visits required after no sperm is seen in the semen Ask students to complete a quiz and write the answers to the following questions 1. List 5 advantages of vasectomy 2. List 5 disadvantages of vasectomy Ask students to swap papers for peer marking Give correct answers and show slides 7, 8 and 9 Ask how everyone did.

Advantages contd. Can be tested for effectiveness at any time Does not affect a man’s ability to have sex Increased sexual enjoyment because there is no need to worry about pregnancy No known long-term side effects or health risks More effective and less expensive

Disadvantages Requires minor surgery by a specially trained physician Does not protect against STIs and HIV   Not immediately effective Must be considered as permanent/Irreversible  These should Discomfort for 2-3 days Pain in the scrotum, swelling and bruising which decreases in about 2 – 3 days Brief feeling of faintness after the procedure

Timing for Vasectomy A man can have a vasectomy any time he requests it. There is no medical reason to delay Without any blood tests or routine laboratory tests, blood pressure check, hemoglobin test, cholesterol or liver function, and even if the semen cannot be examined by microscope later to see if it contains sperm Explain to students that: A man can undergo male sterilization procedure any time. Tell the students that according to the scope of work for nurses and midwives they cannot perform Vasectomy, so clients who express desire to have the procedure should be referred to a facility where such services are available.

Who Can Have Vasectomy? Most men can have vasectomy But they may need to wait if: They have problems with genitals such as infections, swellings or lumps, injuries in the penis or scrotum They have other serious health conditions or infections e.g. diarrhea Display Slide

Medical Eligibility Criteria for vasectomy Accept means no medical reason to deny client vasectomy Caution means the procedure can be performed in a routine setting but with extra preparation and precautions, depending on the condition. Delay means postpone vasectomy. These conditions must be treated and resolved before vasectomy can be performed. Give the client another method to use until the procedure can be performed. Flash the slides 12, 13 and 14 which show Medical Eligibility Criteria for male sterilization to determine who can and who cannot use the method

Medical Eligibility Criteria for vasectomy (continued) Special means special arrangements should be made to perform the procedure in a setting with an experienced surgeon and staff, equipment to provide general anesthesia, and other backup medical support. For these conditions, the capacity to decide on the most appropriate procedure and anesthesia regimen also is needed. Give the client a backup method to use until the procedure can be performed.

Medical Eligibility Criteria for Vasectomy (continued) WHO Category Conditions (Selected Examples) A = Accept Sickle cell disease, mild hypertension, clients at risk of HIV or STIs C = Caution Young men, varicocele, hydrocele, previous surgery, depressive mental disorders, diabetes D = Delay Systemic infections such as diarrhea, local infection of the penis or scrotum – balanitis, scrotal skin infection or ulcers, sexually transmitted infections, elephantiasis, Intra scrotal mass S - Special Undescended testis or cryptorchidism, Inguinal hernia, coagulation disorders Source: WHO MEC 5th Edition

Warning Signs of Complications When these complications occur the client must return to hospital immediately. Severe bleeding or blood clot after the procedure. bleeding under the skin that may cause swelling or redness of the wound that becomes worse Signs of severe infection: Redness, heat, swelling, and pain at the incision site, pus at the incision site, Severe scrotal or testicular pains that lasts for months, For pain give analgesics after ruling out infection and for infection give antibiotics and scrotal support. Tell students that: Although they do not perform vasectomy and that they are not expected to manage complications, it is important that they know the signs of complications. This is to ensure that they can alert clients to seek immediate consultation when any of these complications occur or immediately refer these clients to facilities that can manage these complications. Enumerate the warning signs as presented.

Counteracting Misconceptions on Vasectomy Does not remove testicles it is not castration. No change in sexual behavior and sexual desire Does not cause hormonal imbalance – the “men will continue being a men grow beard, maintain his deep voice etc.” -Does not cause a man to grow fat or become weak, less masculine or less productive. -Does not cause any diseases later in life. --Sperm do not build up in the body Ask students the misconceptions on Vasectomy. What are the common misconceptions about Vasectomy? Refer to the points earlier written on the black board on the information they know and had heard about vasectomy. For each of the information, get the consensus of students whether this is a fact or a misconception. For each of the misconceptions, call a participant at random to correct/counter the misconception

Counseling for Informed Consent To give informed consent to vasectomy, the client must understand the following points: Temporary contraceptives also are available to the client. Voluntary vasectomy is a surgical procedure. There are certain risks of the procedure as well as benefits. (Both risks and benefits must be explained in a way that the client can understand.) If successful, the procedure will prevent the client from ever having any more children. The procedure is considered permanent and probably cannot be reversed. The client can decide against the procedure at any time before it takes place (without losing rights to other medical, health, or other services or benefits). The procedure does not protect against sexually transmitted infections, including HIV. Explain that: Counseling must cover all 7 points of informed consent. In some programs the client and the counselor sign an informed consent form. To give informed consent to vasectomy, the client must understand the following points: 1. Temporary contraceptives also are available to the client. 2. Voluntary vasectomy is a surgical procedure. 3. There are certain risks of the procedure as well as benefits. (Both risks and benefits must be explained in a way that the client can understand.) 4. If successful, the procedure will prevent the client from ever having any more children. 5. The procedure is considered permanent and probably cannot be reversed. 6. The client can decide against the procedure at any time before it takes place (without losing rights to other medical, health, or other services or benefits). 7. The procedure does not protect against sexually transmitted infections, including HIV. Divide students into small groups of three. Provide students with Handout #1 Explain that each group will roleplay the two scenarios on the handout Ask the members of each group to choose who will play the role of client, provider, or observer. The observer will observe the role play, using the roleplay checklist and then make suggestions for improvement. Explain that each participant will play each role during the activity. Allow 10 minutes for each roleplay Reconvene the group and ask the observer from each group to report on what they observed.

Summary A man considering sterilization should think carefully: “Could I want more children in the future?” Health care providers can help the client think about this question and make an informed choice. If the answer is “Yes, I could want more children,” another family planning method would be a better choice.