Expand male services: Add no-scalpel vasectomy

Looking for a way to get more men involved in family planning? One Colorado health department has accomplished that goal by offering low-cost no-scalpel vasectomies (NSVs).

Since November 1999, more than 10 such male sterilization procedures have been performed at the Jefferson County Department of Health and Environment in Golden, CO. The county health department is the first in its state to offer the service.1

The department had long considered expanding its services for men past the traditional sports and employment physicals and clinics for sexually transmitted diseases and HIV/AIDS, says Mark Johnson, MD, MPH, executive director of the county health department. The impetus for the NSV program came from the state health department, which offered to pay for the provider training and furnish supplemental funding to offset patients’ costs for the procedure, he explains.

"We took a look at this, decided it was really an opportunity to expand the treatment of modalities that we do have for males, and got involved," he says.

Training for the Colorado NSV program is part of a two-year project coordinated by AVSC International of New York City, a nonprofit organization dedicated to making reproductive health care accessible to women and men around the world. AVSC pioneered the introduction of NSV in the United States in 1988 following its 1985 visit to China to learn the vasectomy technique developed by Li Shunqiang, MD.2 The NSV technique is less invasive, less painful, heals more quickly, and has fewer complications than the traditional vasectomy procedure. (Read more about NSV and its U.S. introduction in Contraceptive Technology Update, March 1998, p. 29, and April 1999, p. 46.)

Funded by The David and Lucile Packard Foundation of Los Altos, CA, AVSC is working in Colorado, Idaho, Tennessee, and Florida, says Daria Teutonico, AVSC program manager.

"We are working in anywhere from three to seven counties in each state, depending on the needs of the state health departments," says Teutonico. "AVSC provides training on vasectomy counseling, clinical training on the no-scalpel vasectomy procedure, and training on social marketing."

In addition, AVSC helps the health departments set up the vasectomy services and works with them in developing and implementing a social marketing campaign for the new procedure, says Teutonico.

Implementing the service

Johnson and fellow department provider Wendy Hearn, NP, underwent the provider training, while Julie White, RN, participated in sessions on NSV counseling and marketing issues. Johnson, who had performed traditional vasectomies prior to his administrative post, did a proctorship at the Golden clinic under one of AVSC’s training physicians before offering the procedure.

An NSV procedure is broken into three office visits at the Golden department, says Johnson. The first visit includes the initial counseling required for informed consent, while the second includes the actual NSV procedure. A third visit entails testing of a sperm specimen to ensure the procedure has proven effective. NSV procedures are usually scheduled on Fridays to allow patients to recuperate over the weekend. AVSC patient literature recommends that men not do heavy physical labor for at least 48 hours after an NSV procedure. Many men have their vasectomies on Friday so they can take it easy over the weekend and go back to work on Monday, the literature states.

The county health department offers the procedure on a sliding scale fee basis, with the full price set at $75. The state provided the department with $100 funding for each of five clients in 1999, with the same amount available through June 2000. The department hopes to continue such funding in the future, says Johnson.

At the Jefferson County facility, an active media relations campaign that draws on newspaper, radio, and television news has spread the word on the availability of the service, says Johnson. Posters in the department’s five clinics have helped, as has information distributed by local Planned Parenthood organizations, he notes. "We have had good reception of the men who have come in. Almost all of them have said they were ready for this but couldn’t afford it."

As with conventional vasectomy, no-scalpel vasectomy must be considered a permanent form of contraception, even though improved microsurgical techniques offer better chances of restoring fertility. The initial counseling session gives patients time to consider their decision, he notes.

Counseling helps eliminate myths about vasectomy. Many men incorrectly believe that vasectomy will cause impotence or cancer or result in weakened physical strength, weight gain, or development of a higher-pitched voice.3 Providers can explain that sterilization has no effect on masculine physical traits or normal sexual functions, and it can even improve sexual pleasure by reducing anxiety about accidental pregnancy.3 Still, be prepared if some patients may have a change of heart prior to the sterilization procedure.

"We have had probably four who have backed out or who are still waiting," Johnson notes. "We have had them scheduled twice, and they have said they are not quite ready."

References

1. Nicholson K. Jeffco Health Department offers low-cost vasectomies. Denver Post, Feb. 8, 2000:B-01.

2. Haws JM. Study shows many U.S. doctors now use NSV. AVSC News 1998; 36:3.

3. Keller S. Counseling encourages voluntary choice. Network 1997; 18:18-20.

AVSC International, 79 Madison Ave., New York, NY 10016. Telephone: (212) 561-8000. Fax: (212) 779-9439. E-mail: info@avsc.org. Web: www.avsc.org. The Web site offers easy-to-read information on conventional and no-scalpel vasectomy methods and features a state-by-state listing of providers who offer no-scalpel vasectomies.