KONTRASEPSI

NON HORMONAL
Dr. H. Undang Gani, SpOG.

Depart. of Obstetrics & Gynecology

Faculty of Medicine, Jend. Achmad Yani University
CIMAHI

1
 OVERVIEW
 Natural family planning has a high failure
rate
 There are several options available to
identify the fertile period of the cycle
 Some women with religious and moral
objections to artificial forms of
contraception would find this method ideal

2
 DEFINISI

Suatu usaha-usaha untuk mencegah

terjadinya kehamilan yang bersifat
sementara atau menetap dengan cara
menggunakan metode-metode, zat kimia,
penghalang, operatif dan alat yang
dimasukan ke dalam rahim sehingga tidak
terjadi proses kehamilan

3
 CARA/ALAT

1. Senggama Terputus
2. Metode Barrier : kondom, diafragma
3. AKDR
4. Spermisida
5. Metode Amenore Laktasi (MAL)
6. Keluarga Berencana Alamiah (KBA)
7. Kontrasepsi Mantap
4
SENGGAMA TERPUTUS

5
 PROFIL
 Metode KB tradisional
 Pria mengeluarkan alat kelaminnya
(penis) dari vagina sebelum pria
mencapai ejakulasi

6
 CARA KERJA
Alat kelamin (penis) dikeluarkan
sebelum ejakulasi sehingga
sperma tidak masuk ke dalam
vagina dan kehamilan dapat
dicegah

7
 Keuntungan

Kontrasepsi:
 Efektif bila dilakukan dengan benar

 Tidak mengganggu produksi ASI

 Metode pendukung KB lainnya

 Tidak ada efek samping

 Dapat digunakan setiap waktu

 Tidak membutuhkan biaya

8
Nonkontrasepsi

 Meningkatkan keterlibatan pria dalam KB

 Bagi pasangan terjadinya hubungan yang
lebih dekat dan dalam

9
METODE BARRIER

10
KONDOM

11
 PROFIL
 Mencegah kehamilan + PMS
 Efektif bila dipakai dgn benar
 Dapat dipakai bersama
kontrasepsi lain u/ mencegah
PMS

12
 CARA KERJA

 Menghalangi pertemuan
sperma dgn telur
 Mencegah penularan
mikroorganisme

13
 MANFAAT
 Efektif bila dipakai dg benar
(2-12 kehamilan per 100 per
tahun)
 Tidak mengganggu ASI
 Tidak mempengaruhi
sistemik
 Murah dan dpt dibeli scr
umum
14
DIAFRAGMA
15
 CARA KERJA

Menahan sperma agar

tidak mendapat akses
mencapai sal reproduksi
bag atas dan sbg alat
tempat spermisida

16
 MANFAAT
 Efektif bila dipakai dgn
benar
 Tidak mengganggu :
 Prod. ASI
 Hub. Seks
 Kesehatan klien
 Tidak mempengaruhi
sistemik

17
AKDR

18
100 million users worldwide
IUDs Around the World

19
 PROFIL

 AKDR merupakan rangka plastik yang

fleksibel
 Diliputi oleh Cu dan disimpan di
dalam uterus melewati vagina
 Biasanya mempunyai satu atau dua
benang sehingga pasien dapat
mengontrol dengan merabanya
 Jenis IUD: Lippes Loop, Copper T,
Tcu-380A, MLCu-375 (multiload),
Nova T, Progestasert and LNG-20
20
JENIS

 CuT-380A
 NOVA T

 LL

 Nova T

 Multiload 375

21
 CARA KERJA

 Mencegah pertemuan sperma dan

ovum dengan cara mengganggu
pergerakan sperma ke alat
reproduksi wanita
 Menurunkan kemampuan sperma
untuk melakukan fertilisasi ovum
 Mencegah implantasi ovum yang
telah dibuahi pada endometrium

22
KEUNTUNGAN
 Efektivitas tinggi (0,6-08 %
dalam tahun pertama)
 Efektif segera
 Jangka panjang (bisa 10 tahun)
 Tidak mempengaruhi :
 Hub. Seks
 Kualitas & Vol. ASI
 Hormonal
 Dpt segera dipasang pasca
salin/abortus
 Dpt digunakan sampai
menopause
23
 KERUGIAN
 Efek samping :
 Perubahan siklus haid
 Haid  lama, banyak
 Haid lebih nyeri, kram perut
 Spotting
 Komplikasi :
 Sakit, kejang 3-5 hr pasca insersi
 Perdarahan berat saat haid
 Risiko perforasi uterus
 Tidak mencegah PMS
24
 KERUGIAN
• Kerugian :
– PID mudah terjadi pada pengguna IUD,
mengarah ke infertilitas
– Bisa mengalami translokasi spontan,
mengurangi efektivitas, bisa terjadi
kehamilan

25
 Memasukkan lengan AKDR CuT380A
di dalam kemasan steril
Menggunakan leher biru pada tabung
inserter sebagai tanda kedalaman
kavum uteri

26
 TEKNIK
PEMASANGAN CuT 380A
 Pencegahan Infeksi
 Persiapan peralatan dan instrumen
 Bivalve speculum
 Tenakulum
 Sonde uterus
 Forseps
 Gunting
 Mangkuk larutan antiseptik
 Sarung tangan steril/DDT
 Cairan antiseptik
 Kain kassa atau kapas
 Copper T 380A IUD 27
Memasukkan lengan AKDR CuT380A
di dalam kemasan steril
Memasukkan pendorong ke dalam
tabung

28
 Memasukkan lengan AKDR CuT380A
di dalam kemasan steril
Posisi AKDR pada waktu akan melipat
lengannya

29
 Memasukkan lengan AKDR CuT380A
di dalam kemasan steril
Memasukkan lengan AKDR yang sudah
terlipat ke dalam tabung inserter

30
 Memasukkan lengan AKDR CuT380A
di dalam kemasan steril
Menggunakan leher biru pada tabung
inserter sebagai tanda kedalaman
kavum uteri

31
 Memasukkan lengan AKDR CuT380A
di dalam kemasan steril
Lengan AKDR yang sudah masuk dalam
tabung inserter

32
Pemasangan AKDR CuT 380A
Memasang AKDR setinggi mungkin
sampai puncak kavum uteri

33
Pemasangan AKDR CuT 380A
AKDR sudah terpasang dalam uterus

34
Pencabutan AKDR CuT 380A
Pencabutan AKDR CuT380A

35
 Waktu Penggunaan
 Setiap waktu
 Pasca salin
 Pasca abortus
 1-5 hr pasca coitus yg tdk
dilindungi

36
SPERMISIDA
37
 PROFIL
 Bahan kimia (non oksinol-9)
digunakan untuk menon-
aktifkan atau membunuh
sperma
 Dikemas dlm bentuk :
 Aerosol (busa)
 Tablet vaginal, suppositoria
 Krim

38
 CARA KERJA
 Menyebabkan sel
membran sperma
terpecah
 Memperlambat
pergerakan sperma
 Menurunkan kemampuan
pembuahan sel
39
 METODE
AMENOREA
LAKTASI
(MAL)

40
 PROFIL
 Mengandalkan pemberian ASI
 MAL sebagai kontrasepsi bila :
 Menyusui secara penuh (full breast feeding)
 Belum haid
 Umur bayi < 6 bulan
 Efektif sampai 6 bulan
 Harus dilanjutkan dengan pemakaian
kontrasepsi lain
 Cara kerja : Penundaan/penekanan ovulasi

41
KEUNTUNGAN
 Efektifitas tinggi (98%)
 Segera efektif
 Tidak mengganggu senggama
 Tidak ada efek samping secara
sistemik
 Tidak perlu pengawasan medis
 Tidak perlu obat atau alat
 Tanpa biaya

42
KEUNTUNGAN
 Untuk bayi
 Mendapat kekebalan pasif
 Sumber asupan gizi yang terbaik dan
sempurna untuk tumbuh kembang bayi
yang optimal
 Terhindar dari keterpaparan terhadap
kontaminasi dari air, susu lain atau
formula atau alat minum yang dipakai

 Untuk Ibu
 Mengurangi perdarahan pasca
persalinan
 Mengurangi risiko anemia
 Meningkatkan hubungan psikologik ibu
dan bayi
43
 Konsesus Bellagio (1988) untuk
mencapai mencapai keefektifan 98%
 Ibu harus menyusui secara penuh atau hampir penuh
(hanya sesekali diberi 1-2 teguk air/minuman pada upacara
adat/agama)
 Perdarahan sebelum 56 hari pasca persalinan dapat
diabaikan (belum dianggap haid)
 Bayi menghisap secara langsung
 Menyusui dimulai dari ½ sampai 1 jam setelah bayi lahir
 Kolostrum diberikan kepada bayi
 Pola menyusui on demand dan dari kedua payudara
 Sering menyusui selama 24 jam termasuk malam hari
 Hindari jarak menyusui > 4 jam

44
 METODE
KELUARGA
BERENCANA
ALAMIAH
(KBA)

45
 PROFIL
 Menghindari senggama
pada masa subur
perempuan
 Perempuan harus belajar
mengetahui kapan masa
suburnya berlangsung
 Efektif bila dipakai
dengan tertib
 Tidak ada efek samping

46
 METODE
 Metode Lendir Serviks
(Metode Ovulasi
Billing/MOB atau
metode dua hari
mukosa serviks
 Metode Simtomtermal
 Metode Sistem Kalender
atau Pantang Berkala
 Metode Suhu Basal

47
CARA KERJA
Senggama dihindari pada masa
subur yaitu pada fase siklus
menstruasi di mana
kemungkinan terjadi
konsepsi/kehamilan

48
 MANFAAT
 Dapat digunakan untuk
menghindari kehamilan
 Tidak ada risiko kesehatan yang
berhubungan dengan kontrasepsi
 Tidak ada efek samping sistemik
 Murah atau tanpa biaya

49
 Metode Lendir Serviks Billings
Metode Ovulasi Billings (MOB)

 Masa subur  memantau lendir serviks

yang keluar dari vagina
 Pengamatan dilakukan sepanjang hari &
ambil kesimpulan pada malam hari
 Periksa lendir dengan jari tangan atau tisu
di luar vagina dan perhatikan
perubahan perasaan kering-basah

50
 Metode Suhu Basal (MSB)
 Ukur suhu tubuh pada waktu yang hampir sama setiap pagi
(sebelum bangkit dari tempat tidur) dan catat pada kartu MSB.
 Pakai catatan suhu pada kartu MSB untuk 10 hari I dari siklus
haid untuk menentukan suhu tertinggi dari suhu yang “normal,
rendah”
 Abaikan setiap suhu tinggi yang disebabkan oleh demam atau
gangguan lain
 Tarik garis pada 0,05-0,1oC di atas suhu tertinggi dari 10 hari
tersebut. Ini dinamakan Garis Pelindung (Cover Line) atau
Garis Suhu
 Masa Tidak Subur mulai pada sore hari setelah hari ke-3
berturut-turut suhu berada di atas garis pelindung (Aturan
Perubahan Suhu)

51
 Basal Body Temperature Chart
Temp.
(Celsius)
37.1
37.0
36.9
36.8
36.7
36.6
36.5
36.4
36.3
36.2
36.1
36.0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27

Day
52
 Voluntary Surgical
Contraception for Women
Tubal Occlusion
Dr. H. Undang Gani, SpOG.

Depart. of Obstetrics & Gynecology

Faculty of Medicine, Jend. Achmad Yani Univercity
CIMAHI
53
 Tubal Occlusion: Most Popular
Contraceptive Method Globally

Female: 170 million

Source: Church and Geller 1990.

54
 Types of Tubal Occlusion
 Postpartum

 Minilaparotomy (Infraumbilical)

 Interval

 Minilaparotomy

 Laparoscopy

55
56
 Tubal Occlusion: Client Issues
 The client should make the decision for sterilization
voluntarily.
 The client has the right to change her mind anytime
prior to the procedure.
 The client should understand that voluntary sterilization
(VS) is a permanent (not easily reversible) method.
 No incentives should be given to clients to accept VS.
 A standard consent form must be signed by the client
before the VS procedure.
 Spousal consent is not required.

57
 Tubal Occlusion: Mechanism of
Action

By blocking the
fallopian tubes (tying
and cutting, rings, clips
or electrocautery),
sperm are prevented
from reaching ova and
causing fertilization.

58
 Tubal Occlusion: Contraceptive
Benefits
 Highly effective (0.51 pregnancies per 100 women during
first year of use)
 Effective immediately
 Permanent
 Does not interfere with intercourse
 Good for client if pregnancy would pose a serious health risk
 Simple surgery, usually done under local anesthesia
 No long-term side effects
 No change in sexual function (no effect on hormone
production by ovaries)
1
Trussell et al 1998.
59
 Tubal Occlusion:
Noncontraceptive Benefits

 Does not interfere with breastfeeding

 Decreased risk of ovarian cancer

60
 Tubal Occlusion: Decreased
Risk of Ovarian Cancer
 39% decrease in risk compared to clients
without tubal occlusion
 Decrease in risk does not depend upon

method of sterilization
 Risk remains low 25 years after surgery

Source: Green et al 1997.

61
 Tubal Occlusion: Limitations
 Must be considered permanent (success of reversal cannot be
guaranteed)
 Client may regret later (age < 35)
 Small risk of complications
 Short-term discomfort and pain following procedure
 Requires trained physician (gynecologist or surgeon for
laparoscopy)
 Slightly decreased long-term effectiveness
 Increased risk of ectopic pregnancy
 Does not protect against STDs (e.g., HBV, HIV/AIDS)

62
 Tubal Occlusion: Long-Term
Effectiveness by Age Group

Age Group Cumulative Failure Rate1

18–33 2.6
> 34 0.7
All ages 1.8

1
Pregnancies per 100 women over 10 years
Source: CREST Study 1996. 63
 Tubal Occlusion: Long-Term
Effectiveness by Method
Failure Rate1
Method 1 Year 10 Years
Unipolar coagulation 0.02 0.81
Postpartum partial 0.01 0.75
salpingectomy
Silicone band application 0.62 1.72
Interval partial 0.75 2.01
salpingectomy
Bipolar coagulation 0.35 2.48
Spring clip application 1.82 3.65
1
Pregnancies per 100 procedures
Source: CREST Study 1996. 64
 How Effective Is Tubal
Occlusion?
Method Pregnancies per 100
Women-Years
Laparoscopy
Ring 0.0–0.6 (N=15 studies)
Coagulation 0.1–1.3 (N=14 studies)
Clip 0.0–0.7 (N=4 studies)
Minilaparotomy
Pomeroy 0.2–0.8 (N=4 studies)

Source: Church and Geller 1990.

65
 CREST Study: Summary of
Results 1

Risk of pregnancy:
 higher than previously found in year 1

 less than 2% over 10 years of use (18.5/1000

procedures)
 highest in women under 30

 lowest for postpartum partial salpingectomy (8

per 100 procedures)
 highest for spring clip (37 per 100 procedures)

1
CREST 1996.
66
 CREST Study: Summary of
Results continued
1

Ectopic pregnancy:
 1 in 3 pregnancies following VS is
ectopic
 10 year cumulative risk = 7.3/1000
procedures
 Risk in women under 30 is twice as high

 Rate of ectopic pregnancy in years 4–10

is three times as high as in years 1–3
1
CREST 1996.
67
 Who Can Use Tubal Occlusion
Women:
 Who are age > 22 and < 45

 Who want highly effective, permanent protection against

pregnancy
 For whom pregnancy would pose a serious health risk

 Who are postpartum

 Who are postabortion

 Who are breastfeeding (within 48 hours or after 6 weeks)

 Who are certain they have achieved their desired family size

 Who understand and voluntarily consent to procedure

68
 Tubal Occlusion: Who May
Require Additional Counseling
Women:
 Who cannot withstand surgery

 Who are uncertain of their desire for

future fertility
 Who do not give voluntary, informed

consent

69
 Tubal Occlusion: Conditions
Requiring Precautions (WHO
Class 3)
 Unexplained vaginal bleeding (until evaluated)
 Acute pelvic infection
 Acute systemic infection (e.g., cold, flu, gastroenteritis,
viral hepatitis)
 Anemia (Hb < 7 g/dl)
 Abdominal skin infection
 Cancer of the genital tract
 Deep venous thrombosis

Source: WHO 1996.

70
 Tubal Occlusion: Conditions
Requiring an Experienced
Clinician with Full Backup
 Diabetes
 Symptomatic heart disease
 High blood pressure (> 160/100 or with vascular disease)
 Coagulation (clotting) disorders
 Overweight (> 80 kg/176 lb if H/W ratio not normal)
 Abdominal or umbilical hernia
 Multiple lower abdominal incisions/scars

71
 Complications of
Laparoscopic Sterilization
Short-term
 Occur in less than 1% of all procedures

 Directly related to surgical expertise

Long-term
 Decreased long-term effectiveness

72
Tubal Occlusion: Intra-operative
Complications
Minilaparotomy and Laparoscopy:
 Uterine perforation

 Bleeding from mesoslpinx

 Convulsion and toxic reactions to local anesthesia

 Injury to urinary bladder

 Respiratory depression or arrest

 Injury to intra-abdominal viscera

Laparoscopy (primarily):
 Gas or air embolism

 Vasovagal attack

73
Tubal Occlusion: Immediate
Postoperative Complications
 Pain at infection site
 Superficial bleeding (skin edges or
subcutaneously)
 Postoperative fever
 Wound infection
 Gas embolism with laparoscopy (very rare)
 Hematoma (subcutaneous)

74
 When to Perform
Tubal Occlusion Procedure
 Anytime during the menstrual cycle you can be reasonably
sure the client is not pregnant
 Days 6–13 of menstrual cycle (proliferative phase
preferred)
 Postpartum: Within 2 days or after 6 weeks
If delivered at home and immunized (tetanus toxoid), can
be performed under antibiotic cover (if no sepsis).
 Postabortion: immediately or within 7 days, provided no
evidence of pelvic infection

75
 Tubal Occlusion: Anesthesia
 Local anesthesia of choice
 General–only in select cases
 obese

 associated (documented) pelvic pathology

 allergy to local anesthesia

 medical problems

76
 Tubal Occlusion: Client
Instructions
 Keep operative site dry for 2 days. Resume normal
activities gradually.
 Avoid sexual intercourse for 1 week or until comfortable.
 Avoid heavy lifting and hard work for 1 week.
 For pain take 1 or 2 analgesic tablets every 4 to 6 hours.
 Schedule a routine followup visit between 7–14 days.
 Return after 1 week if nonabsorbable stitches used.

77
 Tubal Occlusion: General
Information
 Shoulder pain during 12–24 hours after laparoscopy is
common due to gas (CO2 or air) under diaphragm.
 Tubal occlusion is effective from time operation is
complete.
 Menstrual periods will resume as usual.
 Use a condom if at risk for STDs (e.g., HBV, HIV/AIDS).

78
 Warning Signs for
Tubal Occlusion Clients
Return to clinic if following problems occur :
 Fever (greater than 38°C or 100.4°F)

 Dizziness with fainting

 Persistent or increased abdominal pain

 Bleeding or fluid coming from the incision

 Signs or symptoms of pregnancy

79
 Tubal Occlusion:
Mobile Programs (Camps)
 Counseling and followup should be the same as
at fixed sites.
 All recommended infection prevention practices
should be followed.
 Followup for short-term and long-term
complications must be available.

80
 Tubal Occlusion:
Common Medical Barriers

 Age restrictions (young and old)

 Provider bias
 Who can provide:
 Specialists only

 Physicians only

81
82
 Voluntary Surgical
Contraception for Men
Vasectomy

83
 Vasectomy: Global Use

Male: 43 million

Source: Church and Geller 1990.

84
 Vasectomy in the US

 Third most popular contraceptive method

 Used by 13% of married couples of
reproductive age
 Use growing three times faster than oral
contraceptive pill use

Source: Liskin, Benoit and Blackburn 1992.

85
86
 Types of Vasectomy

 No-scalpel technique
(preferred)
 Incisional

87
 Incisional Vasectomy
 1 or 2 incisions in the scrotum
 99% of operations occur under local anesthesia
 Different methods of occlusion can be used
 Ligation

 Cautery

 Combination

88
 No-Scalpel Vasectomy

 Developed in China, introduced in US in 1988

 Improved anesthesia
 Clinician holds tubes in place under skin
 One puncture
 No stitches needed

89
 Incisional Vasectomy:
Complications After Procedure in
US
1
Complication Rate
Hematoma 1.95
Infection 3.48

1
Per 100 vasectomies; 65,155 cases
Source: Kendrick et al 1987.
90
 No-Scalpel Vasectomy
Failure rate:
 0.2B0.4%

Complications
 Hematoma

 Infection

 Epididymitis

Overall < 2%
Mortality < 0.001%
Source: Carignan 1995.
91
 No-Scalpel Vasectomy:
Complications After Procedure in
China
Complication Rate1
Hematoma 0.09
Infection 0.91

1
Per 100 vasectomies; 179,741 cases
Source: Li et al 1991.
92
 Comparison of No-Scalpel
Vasectomy and Incisional
Approach
Thailand

Complications
Method Cases Number Rate1
No- 680 32 0.4
scalpel
Incisional 523 163 3.1

1
Per 100 vasectomies
2
2 hematoma (surgical drainage not required); 1 infection
3
9 hematoma (2 required surgical drainage); 7 infection
Source: Nirapathpongporn et al 1990.
93
 Advantages of NSV over
Incisional Vasectomy
Advantages of NSV
Entry technique Reduces risk of bleeding and hematoma.
Anesthetic method Does not cause swelling at the injection
and puncture site. Provides regional block
of vasal nerves, which reduces discomfort.
Instruments Vas is secured externally.
Skin closure Not needed.
Damage to tissue Less damage.
Complications Fewer complications.
Time for procedure Requires less time.

Source: AVSC International 1997.

94
 Vasectomy: Client Issues
 The client should make the decision for sterilization
voluntarily.
 The client has the right to change his mind anytime prior
to the procedure.
 The client should understand that voluntary sterilization
(VS) is a permanent (not easily reversible) method.
 No incentives should be given to clients to accept VS.
 A standard consent form must be signed by the client
before the procedure.
 Spousal consent is not required.

95
 Vasectomy: Mechanism of
Action
By blocking the vas deferens
(ejaculatory duct), sperm are
not present in the ejaculate.

96
 Vasectomy: Contraceptive
Benefits
 Highly effective (0.1B0.15 pregnancies per 100 women
during the first year of use)
 Permanent
 Does not interfere with intercourse
 Good for couples if pregnancy or tubal occlusion
would pose a serious health risk to the woman
 Simple surgery done under local anesthesia
 No long-term side effects
 No change in sexual function (no effect on hormone
production by testes)

97
 Vasectomy: Noncontraceptive
Benefits
 Doesnot interfere with woman
breastfeeding

98
 Vasectomy: Limitations
 Must be considered permanent (not reversible)
 Client may regret later
 Delayed effectiveness (requires up to 3 months or 20
ejaculations)
 Risks and side effects of minor surgery, especially if
general anesthesia is used
 Short-term discomfort/pain following procedure
 Requires trained physician
 Does not protect against STDs (e.g., HBV, HIV/AIDS)

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 Vasectomy: Long-Term
Reproductive Health Effects

 Prostate cancer: slight increased risk reported, but

newer studies fail to support this information
 Testicular cancer: no association based on several
studies
 Cardiovascular disease: no association based on
studies
 HIV transmission: no data to support decreased rate
of transmission

Source: Pollack 1993.

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 Who Can Use Vasectomy
Men:
 Of any reproductive age (usually #50)

 Who want a highly effective, permanent contraceptive

method
 Whose wives have age, parity or health problems that might

pose a serious health risk if they become pregnant

 Who understand and voluntarily consent to the procedure

 Who are certain they have achieved their desired family size

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Vasectomy: Who May Require
Additional Counseling

Men:
 Who are uncertain of their desire for future
fertility
 Who do not give voluntary, informed consent

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 Vasectomy: Condition Requiring
Precautions (WHO Class 3)

 Local skin or scrotal infection

 Acute genital tract infection
 Acute systemic infection (e.g., cold, flu,
gastroenteritis, viral hepatitis)
 Symptomatic heart disease or clotting disorders,
diabetes1
Appropriate precautions include delay of procedure until condition
improves or resolves.

1
Procedure may need to be done in a high-level facility.
Source: WHO 1996.
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 Vasectomy: Conditions
Requiring an Experienced
Clinician and Full Backup
 Large varicocele  Intrascrotal mass (until
 Inguinal hernia cause determined)
 Filariasis  Undescended testes and
 Scar tissue proven fertility
 Cryptorchdism (if bilateral
 Previous scrotal surgery
and proven fertility)
 AIDS-related disease

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 Vasectomy: US Demographic
Data
Site:
 75% performed in physician's examining room
 21% in clinics

 3% in ambulatory surgical centers

Provider:
 72% performed by urologists

 28% by general practitioners

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 Vasectomy: Postoperative
Problems
 Wound infection
 Hematoma

 Granuloma

 Excessive swelling

 Pain at incision site

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Vasectomy: Client Instructions

 Keep bandage on for 3 days.

 Do not pull or scratch wound while healing.
 You may bathe after 24 hours but do not let
the wound get wet. After 3 days you may
wash the wound with soap and water.
 Wear a scrotal support, keep the operative
site dry and rest for 2 days.

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 Vasectomy: Client Instructions
continued
 For pain take 1 or 2 analgesic tablets every 4 to 6 hours
and apply ice packs.
 Avoid heavy lifting and hard work for 3 days.
 Avoid sexual intercourse for 2 or 3 days or until
comfortable.
 Use condoms or another family planning method for 3

months or 20 ejaculations.
 Return after 1 week if nonabsorbable stitches used.
 Return for a semen test 3 months after the operation.

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Vasectomy: General Information

 Vasectomy does not provide protection from pregnancy

until after 3 months, 20 ejaculations or when no sperm
are seen in a microscopically examined semen
specimen.
 Vasectomy will not affect sexual performance because
the testes still function normally.
 Vasectomy does not provide protection against STDs,
including AIDS. If either partner is at risk, the couple
should use condoms even after vasectomy.

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Warning Signs for Vasectomy
Clients

Return to clinical if following problems occur:

 Fever (greater than 38BC or 100.4BF)

 Bleeding or fluid coming from the incision

 A very painful or swollen scrotum

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 Vasectomy: Program
Requirements
 Adequate training in counseling and client assessment
(history and physical exam)
 Competent providers trained to operate on awake or
lightly sedated clients
 Steady supply of sterile or high-level disinfected
instruments, gloves and equipment
 Use of internationally recommended infection
prevention practices
 Availability of emergency equipment/drugs
 Referral centers for major problems

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Vasectomy: Common Medical
Barriers
 Age restrictions (young and old)
 Parity restrictions (less than two living children, no male child)
 Marital status/spousal consent requirements
 Provider bias
 Process hurdles
 Who can provide:
 Specialists only

 Physicians only

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THANK YOU

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