As a vasectomy surgeon, “Will it hurt?” is the commonest question I am asked. Unlike female patients who will be bolstered by reassuring discussions with supportive friends prior to hospital attendance, men are likely to be enduring swollen-testicle jokes texted by work colleagues while in the waiting room. By the time we begin operating, they are up to high doh.
Vasectomy is the most effective method of contraception in the UK. The 20-minute procedure comprises an injection of local anaesthetic into the scrotum and the removal of a short section of the vas deferens (sperm tube) on each side. Having recently retired, and reflecting on my career, I am struck by what I have learned about those who opt to undertake this intimate surgical procedure.
Fear factor
Fear is a major issue for men, both before and during a vasectomy. In my experience, responding to “Will this hurt?” by attempting to explain the process in greater detail does little to reduce anxiety; proceeding with the operation while being firmly reassuring is much more effective. It is important however to identify the exceptionally anxious patient whose unpredictable reflexes are likely to hinder the procedure or halt it completely. One such man pulled both knees up suddenly during the operation, causing the needle to go through my finger. Another gentleman attempted to push myself and the support worker away by hitting us. Fainting is fairly routine, but it is challenging trying to manoeuvre an unconscious 16 stone man when both staff in the room are under five feet four.
Vocal local and other forms of distraction
Given that patients are awake throughout the operation, the staff dispense a hefty dose of ‘vocal local’, otherwise known as distraction chat. This is generally led by the brilliant healthcare support workers whose seemingly limitless conversation topics, endless patience and good humour have staved off many a patient’s panic attack.
When I started operating on male patients, having spent a decade working predominantly with women, I assumed I would need to alter the content of my ‘putting patients at ease’ chat to encompass more typically manly interests. I was wrong. I discovered that men are equally happy to talk about their family, holiday plans and the latest Love Island eviction. However, unlike most female patients, they like to tell jokes during the procedure. Following some particularly funny tales I have had to pause operating until I could control my shaking scalpel hand. It makes for an entertaining morning.
The radio is playing in the background as an additional distraction. I’m not sure if this adds to or detracts from patients’ general discomfort, but it has precipitated interesting conversations about suitable tunes to accompany the procedure. One patient who was an amateur musician arrived with a pre-prepared vasectomy playlist containing such songs as Great balls of fire and The first cut is the deepest. He had clearly given it some thought.
Adherence to guidance, or head in the sand?
To maximise patient outcomes, considerable time is spent ensuring that patients are provided with comprehensive pre- and post-operative guidance on the importance of shaving their genital area, wearing supportive underwear, and post-op rest. Adherence to this guidance can often, in my experience, be predicted by the patient’s occupation. Police and teachers, for example, are very good at following instruction and arriving prepared. Nuclear submarine commanders and members of the military, even better. Farmers are generally less compliant, but they are stoical with a high pain threshold and unlikely to return, even if complications occur.
However, a large proportion of men adopt an entirely different preparation strategy: the ‘head in the sand’ approach. This casual non-adherence to guidance is typified by the patient whose operation is cancelled because they failed to shave, or who returns to the clinic with post-operative complications resulting in time off work because they played a round of golf the day after the operation. Is this akin to men’s tendency to ignore DIY instructions? Or is fear the underlying factor? Perhaps we as healthcare professionals have something to learn here.
Change in demeanour
Ultimately, the process is fast and efficient. Think of an organised conveyer belt of fearful, reluctant men arriving on one side, and relieved, self-satisfied men leaving on the other. The difference in demeanour between the two is marked. This is perhaps typified by the commonest comment made to me by men leaving the operating room:
“That wasn’t nearly as bad as I expected, doc.”
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