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Clinic-based vasectomy: How to do it successfully
Want to drive more men toward your family planning clinic? You may want to consider adding clinic-based vasectomies. The Women’s Health Care Clinic at Harbor-University of California Los Angeles (UCLA) Medical Center in Torrance has found success in steering its program in this direction.
While the Women’s Health Care Clinic has been seeing male patients for some time, the addition of vasectomy services has resulted in more men coming through the clinic’s doors, says Kim Burtle, RN, CNM, director of clinical services at the clinic.
"Our male numbers are increasing," she notes. "That means that it is now common to see male patients in the clinic, and that is reassuring to the new male patient."
Since the first vasectomy procedure was performed in December 2002, male patient numbers have grown steadily, Burtle reports. With appointment availability now running two months out, the clinic hopes to expand its vasectomy services soon, she says. The approximate charge for the procedure is $312, Burtle says
Why add services?
The clinic provides services under California’s Family PACT (Planning, Access, Care, and Treatment) Program, which offers family planning reproductive health services to low-income women and men. In January 2000, Family PACT was expanded statewide to provide more services to men, including reproductive health exams; contraceptive methods, including barrier methods, vasectomy, and fertility evaluation; sexually transmitted infection screening and treatment; HIV screening; and education and counseling.1 In fiscal year 1999-2000, more than 95,000 male clients in the state were served under Family PACT, which represents 8% of all clients served.1
While the clinic’s previous Family PACT covered vasectomy service, its nearest referral was located about 20 miles away, says Burtle. The distance represented a barrier for the clinic’s patients, most of whom are Hispanic and financially disadvantaged, Burtle notes. As part of the Harbor-UCLA Medical Center, the clinic contacted the center’s urology department and Richard Reznichek, MD, MHA, director of the urology clinics at Harbor-UCLA Medical Center and assistant clinical professor at UCLA, expressed interest in working with the clinic.
Men who are interested in a vasectomy at the clinic go through a series of three visits, explains Reznichek. The first visit includes a counseling visit, which takes about 45-60 minutes and is performed by a specially trained staff member, says Burtle. The counseling covers the risks involved with vasectomy, the permanency of the procedure, what the procedure will entail, and pre- and postoperative instructions. The consent form is signed at this visit, and the patient is provided take-home educational material.
The second visit includes an exam by Reznichek, accompanied by urology residents. They review the points covered in the first counseling session, check to see that the consent form has been signed, then perform a physical exam. Patients are provided an instruction form that covers information for both pre-and post-vasectomy, and they are given appointment times for the actual procedure.
Prior to the vasectomy procedure, the consent to sterilization is reviewed by the physician who then completes and signs the physician’s statement portion. Following the procedure, the patient returns for a postoperative sperm check, which is performed by a clinic employee, explains Burtle. Patients call prior to obtaining specimens to make sure an employee is on site. They then bring specimens in and wait until a microscopic examination is performed for the results.
While no-scalpel vasectomy is the technique used for sterilization, Reznichek says men are more interested in how the procedure will affect them than how it is performed. The clinicians take time to cover such questions as:
The clinicians explain that local anesthetic will be used for the procedure. Men are advised to bring a jock strap to wear after the procedure for support, and they are encouraged to use an ice pack to help reduce swelling.
The clinicians explain that the procedure does not change a man’s sexual drive; erections and climaxes will be the same. Vasectomy does not affect masculinity; there is no change in a man’s beard, voice, or any other male trait. Men do not lose their strength as a result of the procedure. Men are advised that they can have sex as soon as it is comfortable, but protection must be used until an examination of the sperm finds that sterility has been achieved.
How hard is it to add vasectomy services? According to Burtle, the clinic has not increased its staffing. The vasectomy clinic does use one extra health worker during its three- to four-hour session, which usually includes three procedures and three to four pre-operative exams. While the clinic’s outreach coordinator does promote the vasectomy service during community presentations, word of mouth from clinic female patients and fliers posted in the facility have helped to bring men in for the procedure, she notes.
"I think it is so important for patients to have the choice of the best contraceptive method that meets their needs," says Burtle. "Adding this procedure has helped the Women’s Health Care Clinic to have a full range of contraceptive methods/services."
1. Treat J, Ramirez A, Llewelyn L, et al. Men in the family planning clinic? The Family PACT experience. Presented at the 129th Annual Meeting of the American Public Health Association. Atlanta; October 2001.
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