Vasectomy: replacing the preoperative outpatient appointment with a DVD.

To cite: Davies A, Fleming C. J Fam Plann Reprod Health Care 2014;40:61–63. WHY WAS CHANGE NEEDED? Fourteen percent of couples in the UK use vasectomy as their method of contraception. Accessing vasectomy services should be made as easy and patientfriendly as possible. Unlike many surgical procedures, it is the patient who decides that it is indicated, not the surgeon. Most men requesting vasectomy are healthy and there are few for whom the procedure is not suitable. Men can assess their own suitability for the procedure with a simple questionnaire, and do not normally need to be examined beforehand. Although the operation carries slight potential for litigation, it has a low risk of serious complications and in most cases the decision on the risk/benefit balance is made by the patient, not a clinician. Preoperative counselling for vasectomy is mostly about providing information. Therefore it could be argued that men wanting a vasectomy should not routinely need to see a clinician preoperatively, and that requiring them to do so does not enhance the patient pathway. Attending an outpatient appointment is inconvenient for the patient, requiring time off work, travel to the clinic, and potentially causing apprehension. The Aneurin Bevan Health Board receives around 900 referrals per annum for vasectomy and most of these are selfreferrals. Traditionally we have used structured, preoperative counselling in community-based clinic by doctors and more recently nurses. In a pilot survey, most patients in these clinics thought the information could be provided just as effectively by a DVD.