Consent forms

Vasectomy Information and Consent Form

Vasectomy is the division of the vas deferens on each side in the scrotum, thus preventing the movement of spermatozoa from the testicles to the prostate area, where it is normally added to prostate secretions at the time of ejaculation. It is a surgical procedure, and is conducted under local anaesthesia in our minor operations room, with a doctor and a nurse attending. The vasectomy procedure takes about 30 minutes to perform, after which the patient may return home.

Vasectomy should only be considered by those couples whose family is complete. It is meant to be a permanent (sterilizing) procedure. Microsurgical reversal of vasectomy has a variable rate of achieving pregnancy, around 60%. Patients considering vasectomy should carefully consider the implications of no longer being able to father children, in the context of many possible future events such as the death of a partner or existing children or perhaps an unforseen relationship breakdown.

The procedure is a relatively straightforward one. Complications of vasectomy are uncommon (see vasectomy risks) but may include bleeding and infection early, or persisting ache in the scrotum later, called orchalgia, which usually settles within 3 months. Normal after-effects include some scrotal swelling with bruising, and pain. Patients should rest on the day after the procedure and a few days of light activity is suggested.

Patients are not considered sterile until a semen analysis is conducted 4 months following the vasectomy. Once this has occured and a clearance has been given by the doctor other (existing) forms of contraception may be ceased. It is important to continue contraception until the final clearance is given 4 months postoperatively.

Vasectomy preparation checklist

  1. Shave or clip/hair remover (two nights before)
  2. Signed consent form
  3. Transport afterwards
  4. Arrive ontime: peak-hour traffic
  5. Bring two pairs of supportive Jockey Style Underwear
  6. Read the Vasectomy Information Sheet.

Consent

I have read the above information and the attached information sheet. The nature, purpose and procedure of vasectomy has been explained to me by Dr Valentine. I acknowledge that vasectomy should be approached as an irreversible procedure, agree to have sperm tests 4 months following the procedure, and use alternative contraception until advised by Dr Valentine that it is safe to cease. I/we agree to proceed with the male sterilization by vasectomy.

COVID-19 Vasectomy Consent Addendum

As you would be aware Australia is currently in the midst of the Coronavirus (COVID-19) pandemic. As a result medical and surgical resources in both public and private hospitals are currently being redirected to deal with a potential for large numbers of infected and seriously unwell patients.

Whilst the risk of serious complication following vasectomy is very low, there is a small chance that, should a complication occur (such as serious infection or large haematoma), hospital treatment may be required. Should this occur during the COVID-19 pandemic patients need to be aware that this may increase their risk of contracting COVID-19 and suffering its potential complications (including death). They should also be aware that, over this period, there may be a reduced availability of specialised medical, surgical, and intensive care services.

As a result patients need to be aware and accepting that undergoing an elective vasectomy during the COVID-19 pandemic may carry a higher risk of poor outcome in the unlikely event that, should a complication occur, hospital treatment is required.

Consent

I have read and understood the above information. I agree to proceed with male sterilisation by vasectomy.

Call 1800 827 328 to book an appointment or for any vasectomy enquiries.