Perform a physical examination to screen for contraindications and to verify that normal anatomy exists. It is essential to palpate and isolate each vas deferens during the pre-procedure counseling visit, so that you know it can be done during the procedure. A pre-vasectomy visit documentation template is available (.doc).
Contraindications requiring treatment prior to vasectomy
Local untreated infection (cellulitis, urinary tract infection, epididymitis, orchitis, prostatitis, sexually transmitted infection)
Systemic infection or gastroenteritis
Contraindications requiring referral to an urologist
Large varicocele
Dilated, tortuous testicular veins within the spermatic cord in the scrotum. Large varicoceles can make isolation of the vas deferens difficult, and can increase the risk of bleeding in vasectomy.
Large hydrocele
An accumulation of fluid within a layer of tunica vaginalis in the scrotum.
History of significant scrotal injury
Coagulopathy
Platelet disorders such as hemophilias, von Willebrand Disease, etc.
Intrascrotal mass
Cryptorchidism
A developmental defect in which the testis fails to descend completely into the scrotum.
Unrepaired inguinal hernia
Obtain written informed consent, using this University of Michigan vasectomy consent form (PDF). Some providers choose to defer consent until the day of the procedure.
You may offer a short- to mid-acting benzodiazepines to be taken one to two hours prior to the procedure. This offers mild anxiolysis. These medications also act as muscle relaxants, which makes it easier to grasp and manipulate the vas during the procedure. The patient is instructed to have another person drive him to and from the appointment if such medication is used.