Vasectomy: Tools for Providers

Vasectomy:
INFO
Tools for Providers
REPORTS
INFO Project
Center for Communication
Programs
©2008 Profamilia
Vasectomy is male sterilization. It is a good method for the man who does not want
children, or wants no more children.
Counseling
Men or couples need to think carefully before choosing vasectomy. Health care providers
Clients About
can help by providing complete and accurate information. They can ask questions that
help men think about the decision. They can explain the procedure and encourage men
Vasectomy
and their partners to ask their own questions and to express any fears or concerns about
vasectomy. Providers should make sure that men understand how a vasectomy works
and should correct any misunderstandings. Providers must not pressure men to make a
decision, and programs should not offer rewards.
In some programs the client and the counselor sign an informed consent form. To give
informed consent to vasectomy, the client must fully understand the form. The provider is
responsible for making sure that the client understands the form.
Key Points: Give Clients This Information
• Vasectomy is permanent. A single operation leads to lifelong contraception.
• Vasectomy is effective. Vasectomy is among the most effective contraceptive methods.
It is not 100% effective, however. A small proportion of vasectomies fail. The partner of a
man who has had a vasectomy can become pregnant if the vasectomy did not work.
• Vasectomy is safe: Vasectomy involves minor surgery lasting about 15 minutes, and
few men have complications.1 Vasectomy does not affect a man’s sexual performance.
Vasectomy has no known long-term health risks: It does not increase the risk of heart
disease, testicular cancer, or prostate cancer.
• Vasectomy does not work immediately. The couple must use another contraceptive
method for 3 months before relying on the vasectomy.
• The scrotum hurts for a few days after the vasectomy, and then usually the pain goes
away. A few men have pain that lasts for months or years.2
• Vasectomy does not protect against sexually transmitted infections (STIs),
including HIV.
,
1 If a man wants to know the risk of complications: On average 3% to 4% of men have an infection at the
opening to the scrotum, and 2% have hematomas (blood collecting and clotting in the scrotum) (1, 16, 17).
2 If a man wants to know the risk of chronic pain: 1% to 6% of men say that chronic pain affected
Reports
their lives or prompted them to see a health care provider (2, 9, 11, 13, 14).
See companion
Population
June 2008 • Issue No. 18
asectomy: Reaching
“V Out to New Users”

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How to Use This Report
Family planning providers can use the checklists and tables in this report to:
• Counsel clients about vasectomy and ensure that they make an informed choice (see pp. 1-3);
INFO
• Identify men with conditions that require a delay or special consideration before they can have a
vasectomy (see p. 4);
REPORTS
• Explain the vasectomy procedure (see p. 5);
• Try to make sure that the client’s decision for vasectomy is well-considered and his own (see p. 6);
• Explain to a man what he should do before and after the vasectomy (see pp. 5 and 7).
This report accompanies Population Reports, “Vasectomy: Reaching Out to New Users.” It also
complements the information provided in the chapter on vasectomy in Family Planning: A Global
Handbook for Providers, available at: http://www.fphandbook.org. To request print copies of the
Handbook, contact: Orders, Center for Communication Programs, Johns Hopkins Bloomberg School of
Public Health, 111 Market Place, Suite 310, Baltimore, MD 21202, USA (E-mail: orders@jhuccp.org).
Questions to Help
This report was prepared by Robert Lande
and Adrienne Kols, MA. Research assistance
the Client Choose
by Seth Rosenblatt, MA, MPH. Edited by
Ward Rinehart. Designed by Prographics, Inc.
These are suggested questions to help the client make a
free and informed choice of vasectomy.
The INFO Project appreciates the assistance of
the following reviewers: Jean Ahlborg, Gloria Coe,
• Do you think you might want more children in the future?
Margarita Diaz, Mohammad Eslami, Stephen
Goldstein, Douglas Huber, Roy Jacobstein,
• If not, do you think you could change your mind later? What
Michel Labrecque, and David Sokal.
might change your mind? For example, suppose one of your
children died, or you lost your wife and married again.
Suggested citation: Lande R., and Kols A.
“Vasectomy: Tools for Providers.” INFO Reports,
No. 18. Baltimore, Johns Hopkins Bloomberg
• What have you heard about vasectomy that concerns you?
School of Public Health, The INFO Project,
June 2008.
• Does your partner have preferences about family planning
or concerns about vasectomy? Does your partner want
Available online:
more children in the future?
http://www.infoforhealth.org/inforeports/
• Have you also considered reversible methods or female
sterilization? For example, the IUD and implants are
reversible methods for women that can be used for many
years. Like vasectomy, female sterilization is intended to
be a permanent method. (See the companion Population
INFO Project
Reports issue for a comparison of vasectomy and female
Center for Communication Programs
sterilization.)
Johns Hopkins Bloomberg
School of Public Health
Sources: RCOG 2004 (15); WHO and Johns Hopkins Bloomberg School
111 Market Place, Suite 310
of Public Health 2007 (18)
Baltimore, Maryland 21202 USA
410-659-6300
410-659-6266 (fax)
www.infoforhealth.org
Who May Regret Having a Vasectomy?
infoproject@jhuccp.org
In general, people most likely to regret sterilization:
Jane T. Bertrand, PhD, MBA, Professor and
Director, Center for Communication Programs
• Are young,
• Have few or no children,
Earle Lawrence, Project Director, INFO Project
• Have just lost a child,
Heather Johnson, Production Manager
• Are not married,
INFO Reports is designed to provide
• Are having marital problems, or
an accurate and authoritative overview of important
developments in family planning and related health
• Have a partner who opposes sterilization.
issues. The opinions expressed herein are those of
None of these characteristics rules out sterilization, but health
the authors and do not necessarily refl ect the views
care providers should make especially sure that people with
of the U.S. Agency for International Development
(USAID) or Johns Hopkins University.
these characteristics make informed, thoughtful choices.
Source: WHO and Johns Hopkins Bloomberg School of Public Health 2007 (18)
Published with support from USAID, Global, GH/PRH/PEC,
under the terms of Grant No. GPH-A-00-02-00003-00.
Cover Photo
In Colombia a man consults with a doctor from Profamilia about having a vasectomy.
Providers need to ensure that men make a free and informed choice of vasectomy.
2

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Responding to Common Myths, Rumors, and Misperceptions
Myth/Rumor/Misperception
Suggested Response
Vasectomy is different from castration. Vasectomy works by cutting
Castration
and blocking the tubes that carry sperm from the testicles to the penis.
Misperception: “Vasectomy is like
Vasectomy does not remove the testicles, whereas castration does.
castration.”
(Show the client the illustration on p. 5 to explain the difference.)
Vasectomy does not affect a man’s ability to have and enjoy sex. After a
Sexual performance and masculinity
vasectomy the testicles continue to produce the same amount of the male
Rumors: “Vasectomy:
sex hormone (testosterone). This means erections are as hard and last as
• decreases sexual desire
long as before. Sexual desire also remains the same. The only difference
• causes impotence
is that the semen does not contain sperm. Because sperm make up only a
• hinders ejaculation
tiny portion of the fl uid released at ejaculation, the semen looks the same.
• prevents orgasm
After a vasectomy many couples enjoy sex even more because they do
• reduces sexual pleasure
not have to worry about pregnancy or about forgetting to take a pill or use
• causes a man’s voice to sound
a condom, for example.
like a woman’s
• shrinks the testicles.”
After vasectomy a man looks and feels the same as before. A vasectomy
Health problems
does not cause the man to lose strength, so he can work as hard as
Rumors: “Vasectomy causes weakness,
before. It does not cause weight gain or hair loss or other health problems.
backaches, weight gain, hair loss, poor
vision, leg pains, or mental impairments.”
Cancer
Vasectomy does not increase the risk of prostate cancer or testicular
Myth: “Vasectomy causes prostate cancer
cancer. Large, well-designed studies have shown this.
or testicular cancer.”
All men—whether or not they have vasectomies—produce sperm that
Retention of sperm
Myth: “After a vasectomy sperm
are not ejaculated. These sperm are broken down and absorbed back
accumulates in the body and causes
into the body. This is a normal process. Absorbing sperm does not cause
complications.”
health problems.
After a vasectomy some sperm are left in the tubes. For 3 months a
Protection
couple must use another kind of contraception, such as condoms or pills.
Misperception: “Vasectomy begins
If the program offers semen analysis after vasectomies, providers should
protecting against pregnancy immediately
remind the man to come back for the test in 3 months. The test will make
after the procedure.”
sure that the vasectomy is working.
Before starting the vasectomy, the provider injects a local anesthetic.
The prick of the anesthesia needle may be painful. Almost all men say
they felt no pain or only mild pain during the vasectomy procedures.
Pain and discomfort
Myth: “A vasectomy is very painful.”
There may be a slight pulling sensation. Once the anesthesia wears off,
men may feel some pain or discomfort. Ordinary pain medicines and cold
packs will help and are usually all that is needed. For almost all men the
pain and soreness last only a few days.
Vasectomy should be considered permanent. Reversal surgery is diffi cult
Reversal
and expensive, and it can be hard to fi nd. Reversing vasectomy is hard
Misperception: “It is easy to reverse
to do, and success cannot be guaranteed. If there is a chance that you
a vasectomy, so that a man can be
might change your mind about having more children, or you are not
fertile again.”
absolutely certain now, you should think about using a different method
of contraception.
Note: For more information on the myths and the facts regarding vasectomy, visit the Contraceptive Myths and Counseling Messages Database
(www.jhuccp.org/myths). The database collects counseling messages from the fi eld that family planning providers can use to refute myths.
The database is available from the Center for Communication Programs at the Johns Hopkins Bloomberg School of Public Health.
3

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Medical Eligibility Criteria Checklist for
Vasectomy
All men can have vasectomy. No medical conditions prevent a man from using vasectomy. This checklist
asks the client about known medical conditions that may limit when, where, or how the vasectomy should be
INFO performed. Ask the client the questions below. If he answers “no” to all of the questions, then the vasectomy
REPORTS
can be performed in a routine setting without delay. If he answers “yes” to a question below, follow the
instructions, which recommend caution, delay, or special arrangements.
In the checklist below:
• Caution means the vasectomy can be performed in a routine setting but with extra preparation and
•
precautions, depending on the condition.
• Delay means postpone vasectomy. These conditions must be treated and resolved before vasectomy can
•
be performed. Give the couple another method to use until the vasectomy can be performed.
• Special means special arrangements should be made to perform the vasectomy in a setting with an
•
experienced surgeon and staff, equipment to provide general anesthesia, and other backup medical
support. For these conditions, the capacity to decide on the most appropriate procedure and anesthesia
regimen also is needed. Give the couple another method to use until the vasectomy can be performed.
1. Do you have any problems with your genitals, such as
infections, swelling, injuries, or lumps on your penis or
Vasectomy
scrotum? If so, what problems?
❏ NO ❏ YES:
for Men with
4 If he has any of the following, use
If he has any of the following, use caution
caution:
HIV or AIDS
• Previous scrotal injury
•
• Men who are infected with
• Swollen scrotum due to swollen veins or membranes in the
HIV, have AIDS, or are on
spermatic cord or testes (large varicocele or hydrocele)
antiretroviral (ARV) therapy
• Undescended testicle—one side only (Vasectomy is
can safely have a vasectomy.
performed only on the normal side. Then, if any sperm are
present in a semen sample after 3 months, the other side
• Special arrangements
must be done, too.)
are needed to perform a
4 If he has any of the following, delay vasectomy:
vasectomy on a man with
AIDS. Vasectomy should be
• Active sexually transmitted infection
performed in a setting with an
• Swollen, tender (infl amed) tip of the penis, sperm ducts
experienced surgeon and staff,
(epididymis), or testicles
and other backup medical
• Scrotal skin infection or a mass in the scrotum
support should be available.
4 If he has any of the following, make special arrangements:
• Vasectomy does not prevent
• Hernia in the groin (If able, the provider can perform the
transmission of HIV or other
vasectomy at the same time as repairing the hernia. If this
STIs. Men with vasectomies
is not possible, the hernia should be repaired fi rst.)
can be infected, and they
• Undescended testicles—both sides
can transmit infections.
2. Do you have any other conditions or infections?
• Urge these men to use
If so, what?
condoms in addition to
❏ NO ❏ YES:
vasectomy. Used consistently
4 If he has any of the following, use
If he has any of the following, use caution
caution:
and correctly, condoms help
prevent transmission of HIV
• Diabetes
and other STIs.
• Depression
• Young age,
No one should be coerced
4 If he has any of the following,
If he has any of the following, delay vasectomy:
or pressured into getting a
vasectomy, and that includes
• Systemic infection or gastroenteritis
men with HIV or AIDS.
• Filariasis or elephantiasis
4 If he has any of the following, make special arrangements:
• AIDS (see Quick Look)
• Blood fails to clot (coagulation disorders)
Source: WHO and Johns Hopkins Bloomberg School of Public Health 2007 (18)
4

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Explain the Vasectomy
Urethra
Seminal vesicles
Procedure
Tube through which
Where sperm are mixed
semen is released
with semen (the fl uid
from the body. Urine
released through the
These instructions should be explained to the client
is released through
penis during orgasm).
when scheduling the vasectomy. If possible, give
the same tube.
him a printed copy.
Prostate
4
Organ that
Note: Adapt these instructions for use in your
produces
facility.
some of the
4
4
fl uid in semen
Before you come for the vasectomy, consult
with your doctor if you are taking aspirin, other
4
Vas deferens
pain medication, or anti-infl ammatory drugs. Bathe
2 thin tubes
or shower the day of the vasectomy. Do not drink
that carry
alcohol 1-2 days before your vasectomy. Wear
sperm from the
underwear that fi rmly supports the scrotum.
testicles to the
4
4
seminal vesicles.
At the health care facility the health care provider
Vasectomy
will help you get comfortable on the procedure
involves cutting
table. The provider will clean the scrotum, the lower
or blocking these
part of the penis, the lower abdomen, and the
tubes so that no
thighs near the scrotum. The hair on the scrotum
Scrotum
Testicles
sperm enters the
may be clipped short or shaved.
Sack of thin loose skin
Organs that
semen.
containing the testicles
produce sperm
To perform the vasectomy, the provider feels through
the skin of the scrotum and fi nds the two tubes that
Use the illustration above to explain how a vasectomy works. The brown parallel
carry sperm. Anesthetic is injected with a needle and lines indicate where the tubes are blocked. After vasectomy sperm cannot reach
syringe. This will prevent pain during the vasectomy. the seminal vesicles, where it would mix with semen. Source: WHO and Johns
(The prick of the needle may be a little painful.)
Hopkins Bloomberg School of Public Health 2007 (18)
You will stay awake throughout the vasectomy. The
provider makes a puncture or small incisions in the
scrotum and draws a part of the vas through it (see
illustrations). The provider blocks each vas, returns
it to the scrotum, and closes the opening in the
scrotum with a bandage or sutures. The small scar
on the scrotum will disappear in time. Usually, the
whole procedure takes less than 30 minutes.
After the vasectomy you will rest 15 to 30
minutes before leaving the clinic. The provider will
explain what to do after the vasectomy. You will
be reminded that the vasectomy is not effective
immediately. You and your partner need to use a
temporary contraceptive method for 3 months. (If
the facility will provide temporary methods, tell the
client.)
Sources: EngenderHealth 2003 (3); Fallis 2006 (5); Hatcher et
al. 2004 (6); Labrecque 2008 (8); Lu 2008 (10); Marie Stopes
International 2007 (12); WHO and Johns Hopkins Bloomberg
School of Public Health 2007 (18)
Use these illustrations to explain no-scalpel vasectomy: The provider fi nds
the vas through the scrotum and grasps it with a ringed clamp. The provider
punctures the scrotum with dissecting forceps rather than making an incision with
a scalpel, and then widens the puncture by opening the forceps (left). After pulling
the vas through the puncture with the forceps, the provider grasps the vas with
the ringed clamp and prepares to block the vas (right). © 2003 EngenderHealth.
Used with permission.
5

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A Provider’s Guide for Assessing a
Client’s Decision to Have a Vasectomy
INFO
REPORTS
How to Use This Guide
Part of the responsibility of the provider performing a vasectomy is to verify that the client has
made an informed and voluntary decision for the vasectomy. This simple aid can help the provider
check the client’s readiness for permanent contraception before the operation. The assessment
should be made before starting the vasectomy.
Use of this guide does not substitute for client counseling, which should come much earlier. If it
is required, make sure that the client has signed an informed consent form before conducting this
assessment.
Good judgment is needed when using this guide (or any other) and when interpreting the results.
For example, if a client’s answers all fall in the “go” category, but he is unduly nervous, and his
agitation does not appear to be related to a fear of surgery, the provider or another staff member
should take time to determine what is causing his anxiety before performing the vasectomy.
STOP
CAUTION
Ask the client these
Should not have the
Needs more
GO
questions:
vasectomy now
counseling
Signs of a sound decision
WHO made the
Someone else
Client decided
Client and partner
decision for the
(but partner objects)
(or client, if single)
vasectomy?
WHEN did the client
Now
Recently
Some time ago
decide not to have
more children?
WHY did the client
Pressure from
Belief that permanent
Desire to have no
choose permanent
someone else
method can be
more children
contraception?
reversed
HOW did the client
While upset or under
Without enough
After consideration and full
decide?
stress
consideration or
information
information
WHAT does the
Does not know that it:
Has some
Knows that it:
client know about
• Is permanent
misunderstandings
• Is permanent
vasectomy?
• Is a surgical method about vasectomy
• Is a surgical method
• Means he cannot
• Means he cannot have
have more children
more children
WHAT does the
Would prefer another
Has little knowledge
Knows of other methods,
client know or
method if available
of other methods or
but prefers permanent
think about other
their availability
contraception
contraceptive
methods?
Source: EngenderHealth 2007 (4) (Figure 4-3, p. 32)
6

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Sample Post-Vasectomy
Instructions for Clients
These instructions should be explained to the client. If possible,
Return to the clinic or call:
give him a printed copy.
• If you have a fever within one week after the vasectomy.
Note: Adapt these instructions for use in your facility.
• If there is any bleeding or pus in the wound.
• A little pain, bruising, or swelling in the scrotum is normal. It
usually goes away in a few days.
• If there is pain or swelling around the wound that gets worse
or does not go away.
• Put cold compresses on the scrotum for the fi rst four hours, if
possible. To decrease any pain, you can take a pain reliever
• If your partner ever misses a period or thinks she is pregnant.
such as paracetamol every four to six hours. Do not take
(This is very important: It may mean the operation has failed
aspirin, however. Aspirin might lengthen bleeding.
and your partner is pregnant.)
• Wear a snug undergarment or scrotal support for at least two
• In three months for a semen analysis (if available). Come back
days after surgery. This will make you more comfortable.
on or about: __________________________________ [date]
• Rest at home. You can return to your normal activities after
You can collect a semen sample by masturbating into a clean
one or two days. Avoid physical work and strenuous exercise
container or from a condom used during intercourse. Collect
for at least 48 hours. This will let the wound heal quickly.
the sample on the day of the visit, and bring it with you to
your appointment.
• Keep the puncture/incision clean and dry for two to three days.
Instead of bathing, clean yourself with a towel.
• Any time that you have any questions or concerns.
• Keep the bandage on for three days after the vasectomy. After Clinic name and address: ______________________________
you take off the bandage, you may wash the scrotum with
___________________________________________________
soap and water.
Phone:_____________________________________________
• You may have sex with your partner as soon as it is
comfortable for you. This is usually two or three days after the
Sources: EngenderHealth 2007 (4); Jhpiego 2003 (7); WHO and Johns Hopkins
operation. If you have pain during ejaculation and it persists
Bloomberg School of Public Health 2007 (18)
after the fi rst few times, please come back to the clinic.
• Remember: Vasectomy does not protect you or your partner
from sexually transmitted infections (STIs), including HIV,
which causes AIDS. You can reduce your risk of getting an STI
Semen Analysis Appointment Card
by using condoms or by limiting sex to one person who does
not have an STI.
Your appointment for a semen analysis is:
✃
• Remember: Vasectomy does not work immediately. For the
Day and date: _____________________________
next three months your partner could still get pregnant. You
must use condoms or your partner must use another family
planning method for three months after the vasectomy. You
Time: ___________________________________
can stop using another method and rely on your vasectomy
on the following date: ______________________________
Place: ___________________________________
• If you can obtain a semen analysis at three months, you can
rely on your vasectomy if the test shows no sperm in your
semen. (Tell the client whether your facility offers semen
Providers can copy and cut out this appointment
testing.)
card for clients.
7

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Sources
The links included in the sources
G.N. Early and late morbidity after
were up-to-date at the time of
vasectomy: A comparison of chronic
publication.
scrotal pain at 1 and 10 years. BJU
INFO
International 93(4): 571-574. Mar.
REPORTS
1. AWSARE, N.S., KRISHNAN,
2004.
J., BOUSTEAD, G.B., HANBURY,
12. MARIE STOPES INTERNA-
D.C., and MCNICHOLAS, T.A.
TIONAL. Vasectomy Your questions
Complications of vasectomy. Annals
answered. Marie Stopes Interna-
of the Royal College of Surgeons of
tional, 2007. (Available: http://www.
Subscribing to INFO Publications
England 87(6): 406-410. Nov. 2005.
vasectomyinfo.com.au/)
There are three ways that you can make sure to
2. CHOE, J.M. and KIRKEMO, A.K.
13. MCMAHON, A.J., BUCKLEY, J.,
receive future INFO publications:
Questionnaire-based outcomes study
TAYLOR, A., LLOYD, S.N., DEANE,
of nononcological post-vasectomy
R.F., and KIRK, D. Chronic testicular
1. By e-mail: To receive publications fastest,
complications. Journal of Urology
pain following vasectomy. British
please send an e-mail message with “Electronic
subscription to INFO publications” in the
155(4): 1284-1286. Apr. 1996.
Journal of Urology 69(2): 188-191.
“Subject” line to orders@jhuccp.org and include
3. ENGENDERHEALTH. No-scalpel
Feb. 1992.
your full name, complete mailing address, e-mail
vasectomy: An illustrated guide
14. MORRIS, C., MISHRA, K., and
address, and client id (if known; found on top
for surgeons. 3rd ed. New York,
KIRKMAN, R.J. A study to assess the
line of mailing label). We will send you future
EngenderHealth, 2003. 70 p.
prevalence of chronic testicular pain
publications electronically, as e-mail attachments.
(If you would prefer to just receive an e-mail
4. ENGENDERHEALTH. No scalpel
in post-vasectomy men compared to
notifi cation that a new publication has been
vasectomy curriculum: A training
non-vasectomised men. Journal of
posted online, please type “Electronic notifi cation
course for providers, and assistants.
Family Planning and Reproductive
to INFO publications” in the “Subject” line.)
Participant handbook. 2nd ed. New
Health Care 28(3): 142-144. Jul.
York, EngenderHealth, 2007. 165 p.
2002.
2. By surface mail: To receive print copies of INFO
publications, please send an e-mail message
(Available: http://www.acquireproject.
15. ROYAL COLLEGE OF
with “Print subscription to INFO publications”
org/fi leadmin/user_upload/ACQUIRE/
OBSTETRICIANS AND
in the “Subject” line to orders@jhuccp.org and
Publications/NSV_curric_participant_
GYNAECOLOGISTS (RCOG).
include your full name, complete mailing address,
fi nal.pdf)
Sterilisation for women and men:
e-mail address, and client id (if known; found on
5. FALLIS, R. Vasectomy doctor:
what you need to know. London,
top line of mailing label). Alternatively, write to:
Orders, INFO Project, Center for Communication
Before, during and after. <http://www.
RCOG, 2004. (Available: http://www.
Programs, Johns Hopkins Bloomberg School
vasectomydoctor.com/before/>. 2006.
rcog.org.uk/index.asp?PageID=703#
of Public Health, 111 Market Place, Suite 310,
6. HATCHER, R.A., TRUSSELL,
alternatives)
Baltimore, MD 21202, USA.
J., STEWART F., NELSON, A.L.,
16. SCHWINGL, P.J. and GUESS,
CATES, W., GUEST F., and KOWAL,
H.A. Safety and effectiveness of
3. By the INFO Web site: Go to
D. Contraceptive technology. 18th
vasectomy. Fertility and Sterility
http://www.infoforhealth.org/
inforeports/infoelectsub.php
revised ed. New York, Ardent Media,
73(5): 923-936. May 2000.
and follow instructions for subscribing.
2004. 871 p.
17. SOKAL, D., MCMULLEN, S.,
7. JHPIEGO. Reproline. Vasectomy:
GATES, D., and DOMINIK, R. A
Please note: If you do not want to subscribe
Service delivery guidelines. <http://
comparative study of the no scalpel
but wish to order INDIVIDUAL issues of publica-
www.reproline.jhu.edu/english/6read/
and standard incision approaches
tions from the INFO Project, Johns Hopkins
Bloomberg School of Public Health, please send
6multi/sdg/vas.htm>. 2003.
to vasectomy in fi ve countries. The
an e-mail message to: orders@jhuccp.org,
8. LABRECQUE, M. [Carrying out
Male Sterilization Investigator Team.
or go to our online order form at:
vasectomy] Personal communication,
Journal of Urology 162(5): 1621-
http//www.jhuccp.org/orders/, or write to
Apr. 28, 2008.
1625. Nov. 1999.
Orders, INFO Project, Center for Communication
Programs, Johns Hopkins Bloomberg School
9. LESLIE, T.A., ILLING, R.O.,
18. WORLD HEALTH
of Public Health, 111 Market Place, Suite 310,
CRANSTON, D.W., and GUILLE-
ORGANIZATION DEPARTMENT
Baltimore, MD 21202, USA.
BAUD, J. The incidence of chronic
OF REPRODUCTIVE HEALTH
scrotal pain after vasectomy: A
AND RESEARCH (WHO/RHR) and
prospective audit. BJU International
JOHNS HOPKINS BLOOMBERG
100(6): 1330-1333. Dec. 2007.
SCHOOL OF PUBLIC HEALTH/
CENTER FOR COMMUNICATION
Also see the companion Population Reports,
10. LU, E. (Jhpiego) [Training for
PROGRAMS (CCP). Family planning:
“Vasectomy: Reaching Out to New Users,” at
and performing vasectomy] Personal
http://www.populationreports.org/d6/
A global handbook for providers.
communication, Mar. 13, 2008.
Baltimore and Geneva, CCP and
11. MANIKANDAN, R., SRIRANGAM,
WHO, 2007. (Available: www.
S.J., PEARSON, E., and COLLINS,
fphandbook.org)
8
POPULATION REPORTS

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