Vasectomy: a guidelines-based approach to male surgical contraception

Fertil Steril. 2021 Jun;115(6):1365-1368. doi: 10.1016/j.fertnstert.2021.03.045. Epub 2021 Apr 18.


Except for condom use, vasectomy is the only approved form of male contraception. The American Urological Association published guidelines on vasectomy in 2012, which clearly outlined patient counseling, vasectomy techniques to maximize successful occlusion, and postvasectomy care. However, there are certainly areas of further improvement to be addressed. Vasectomy is severely underutilized compared with tubal ligation for sterilization, likely due to lack of patient awareness. Although the majority of vasectomies are performed in the office with local anesthesia, some patients are still routinely prescribed narcotics for postprocedural pain, despite the well-described opioid pandemic. Finally, although patients are counseled on the necessity of a postvasectomy semen analysis to confirm sterility prior to the discontinuation of alternative contraceptives, more than 50% of men do not complete this test. Therefore, alternative strategies must be pursued to improve patient compliance.

Keywords: Male contraception; postvasectomy semen analysis; vasectomy.

Publication types

  • Review

MeSH terms

  • Clinical Decision-Making
  • Counseling
  • Fertility*
  • Humans
  • Male
  • Men's Health*
  • Patient Satisfaction
  • Patient Selection
  • Postoperative Complications / etiology
  • Semen Analysis
  • Treatment Outcome
  • Vasectomy* / adverse effects