While the client's wishes should be paramount, he should understand that young age is a risk factor for regret.

However, the incidence of regret even with young age at time of vasectomy remains low. Counseling is important to minimize the potential for regret.

Rationale: Age and number of living children are not medical reasons to restrict access to vasectomy according to WHO Medical Eligibility Criteria (302). However, age and number of living children are important considerations for the counseling process. Clarke and Gregson found that men who requested vasectomy reversal were younger at the time of sterilization than controls (41).

Other factors that have been associated with vasectomy regret are remarriage or a change in partner, death of one or more children after the procedure, improvement in financial status, and, more rarely, psychological problems with infertility or other physical problems. However, vasectomy has not been shown to physically cause adverse health effects (see Question 5) (178).

Rationale: Various types of doctors, including general medical practitioners, general surgeons, other specialists (such as obstetrician-gynecologists), and paramedical professionals can receive training to perform vasectomy (14).

It is important to recognize that a vasectomized man may still be at risk of acquiring or transmitting STDs and may need to use a back-up method (e.g., condom) to protect himself and his partner(s).

Rationale: It may take several months for the vas to clear the sperm contained in them at the time of vasectomy. This time varies from man to man. Therefore a back-up method for pregnancy prevention (e.g., condoms, DMPA for partner) will need to be used for at least 12 weeks or 20 ejaculations (30).

The client should be encouraged to return promptly if he has any problems (e.g., bleeding, swelling, fever, pain) or at any time he has questions or concerns.

Rationale: The follow-up examination should take place between 7 and 14 days after surgery. Clients should receive counseling on warning signs and reasons to return for follow-up.

A large study also found no association between vasectomy and other health effects including cardiovascular disease.

Rationale: Based on biological and epidemiological evidence, it is unlikely that vasectomy causes prostate cancer or any other long-term health effects such as cardiovascular disease.

A recent study and two earlier studies also examined the association between vasectomy and prostate cancer. Zhu et al. used a population-based case-control design in a population where vasectomy was common (323). No association was found. Massey et al. and Sidney et al. both used a cohort study design. The former used a retrospective cohort of 10,590 vasectomized men (184), while the latter used a prospective cohort with a mean follow-up period of 6.8 years among 5,119 vasectomized men (249). Neither study found an association between prostate cancer and vasectomy. Giovannucci et al. found odds ratios of 1.56 and 1.66, respectively, in two separate cohort studies (96, 97). However, the biological explanation for the association has not been accepted by experts as likely (96, 97, 115, 184, 249, 322).

Recommendation: Vasectomy does not affect normal sexual function. After a vasectomy, the man's body continues to produce male hormones that help the man to have erections, sex drive/feeling, and ejaculation. A man may even feel his sex drive is increased because he no longer worries about getting his partner pregnant.

Rationale: Vasectomy only involves the occlusion of two small ducts, not the removal of any glands or organs. Therefore, it does not interfere with the functions of the testes—testosterone production and spermatogenesis (60).

Although reports have found sperm in the ejaculate in more than 67% of the men who had undergone vasectomy reversal, the percent of successes, as measured by pregnancies among their partners, ranged from 16% to 85%, with over half of the studies reporting that less than 50% of the wives achieved intrauterine pregnancy.

Rationale: A vasectomy reversal is an extremely complex operation that should be performed by highly trained and experienced surgeons. Microsurgical techniques require approximately 40 hours of intensive training in addition to frequent practice before a surgeon is proficient. Vasectomy reversal may be performed using micro- or macrosurgical techniques, each with its own advantages and disadvantages.