BackgroundVasectomy intends to provide permanent contraception by interrupting the vas deferentia via one of several methods. The no-scalpel vasectomy aims to render male sterilisation more acceptable to patients. It is faster and associated with fewer complications. Complications are uncommon, but do exist, most often pain, bleeding, bruising, and infection. Vasectomy is increasingly carried out within a primary care setting. One GP at Marple Cottage Surgery has been performing vasectomies for 5 years.AimThis study aims to ascertain whether vasectomy standards can be achieved within a primary care setting.MethodElectronic patient records and semen analysis data were accessed for procedures performed between April 2013–April 2018, to calculate the failure and complication rates. This was compared to guidelines from relevant advisory bodies.ResultsIn total 910 vasectomies were performed over the period: 5.3% were associated with a complication; 2.0% intraoperative bleeding, 1.5% pain, 0.8% haematoma, 0.7% syncope, and 0.2% infection. Two-thirds (67.3%) of patients provided a semen sample for analysis. The occlusive failure rate was 0.4% and the contraceptive failure rate is 0%.ConclusionComplication rates were low, achieving or exceeding the standards in all domains. The occlusive failure rate is within the <1% American Urological Association acceptable standard and the current contraceptive failure rate is 0%. This is for further analysis with a larger sample size. We are confident that the high standard of vasectomy care can be achieved as the service migrates into primary care.
IntroductionDespite an improvement in the rate of unplanned pregnancies in England, the problem persists, particularly in the teenage population, with a large proportion of these conceptions being attributed to contraceptive failure. The OCP and male condoms remain the most widely used contraceptives, which considering their dependence on user-compliance is worrying. Long-acting reversible contraceptives are an alternative with much lower failure rates, partially attributable to the removal of this concern.MethodsAn audit was carried out at Wellfield Medical Centre in Manchester, one of the areas with persistent high teenage pregnancy rates.ResultsA review of records highlighted that the OCP remained the most commonly prescribed contraceptive in women over the preceding year. LARC accounted for only 29% of the new prescriptions given to 15–24 year olds and 41% of under-35s, with LARC being favoured only in the older population.DiscussionThis was in keeping with the literature, which suggested that social norms and negative experiences of friends and family are accountable, along with a lack of education of LARC compared with other methods. These findings indicate that an improvement in the awareness of safety and efficacy of LARC is necessary, particularly in this young population. This should be initiated in a practice context, but the wider reach of social media may be required to ensure an adequate impact. The skill and ability of providers to counsel women on LARC needs to be addressed, as does an increase in time available for counselling and detailed recording of these discussions.
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