What is the Best Way to Undergo a Permanent Method of Birth Control?

Vasectomy is considered to be a minimally invasive, safe and reliable method of effecting birth control.  Although vasectomy reversal surgery is feasible, vasectomy is considered to be a permanent means of eliminating sperm from the ejaculate.    

The vasectomy procedue has been performed for several decades in the US and seems to keep gaining in popularity.   Incentives for men to undergo a vasectomy include: taking control of one’s financial future, a man taking responsibility for his role in family planning,  and the fact that tubal ligation, the female equivalent of vasectomy, is considered to be a major surgical procedure as it requires invading a major body cavity.   

So what prevents more men who have decided that they do not wish to father any more children from taking that next step?

For some men it is simply anxiety.   Previous experience with soccer or softball injuries to the family jewels as well as years of safeguarding what’s betweens one’s legs naturally gives men some pause before undertaking an alteration to the reproductive plumbing.    For many men, the conviction to get their vasectomy done is enough to get them through, but for some, a little more help may be needed.

It is therefore interesting to know that different urologists take different approaches to addressing this problem.    Most urologists will take efforts to education patients as to the process of vasectomy, how the procedure works and what to expect afterwards and in so doing, address patient questions and concerns.   However there is a variation among doctors who perform vasectomy as to what to offer in terms of addressing patient anxiety through medication.

Sedation prior to Vasectomy

Many physicians prefer to only perform office vasectomy with their patient awake, under straight local and without any form of sedation.   Some don’t even want their patients listening to music.   They feel that they can calm and if necessary, distract their patient with conversation.   By speaking to the patient, they feel the can also ensure patient cooperation if it is needed.    

In contrast, some urologists routinely offer their patients the opportunity to take a sedative such as an Ativan , a Xanax or a Valium pill before hand, while others only offer it upon patient request.   Less commonly, physicians will also offer the patient the option of going to sleep for their vasectomy with the help of an anesthesiologist, while some doctors prefer to limit performing the procedure to being performed completely awake in their office.

In my practice I recognize that not all men are created equal.     Some men are simply more anxious than others.   I generally review information about the procedure,  instructions for preparation before the procedure and post procedure instructions with all patients.  Patients are then engaged on whether they want to have the procedure with straight local, take a pill to help manage their anxiety or even go to sleep with the help of an anesthesiologist.    I find men to be very capable of deciding for themselves what their needs are.    One caveat, however:  in my practice, any patient that takes any medication beyond straight local must have someone drive them home. 

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