Hi All,so I received my consent form from the surgeon who done my vasectomy.I taught I’d post this as I’m sure like me many guys didn’t properly read it on the day or have never been able to get hold of the original.
So here it goes.
It is your right to make informed decisions about your healthcare and it’s our intention to provide you with complete information about a vasectomy.It is then your responsibility to consider all the available options to you,including the risks and benefits,and then make what you believe is the best choice for you.
1.I the undersigned request that (doctors name)perform a vasectomy on me.It has been explained to me that the purpose of a vasectomy is to provide permanent sterility and that I will no longer be able to father a child after effective vasectomy.
2 I am aware that a vasectomy is not immediately effective and that I must continue to use other forms of contraception until a semen test has proven my vasectomy has been a success.
3 I am aware that I may have to provide a second semen sample if sperm are present in the first and that I may have to do a third sample.
4 It has been explained to me that the risk of early failure exists,approximately 1 in 1500 cases.In this case my vasectomy would have to be redone at no cost to me.
5 it has been explained to me that despite having a successful vasectomy a small risk of late failure exists.This occurs in approximately 1 in 2000 to 3000 cases.
6 I am aware that small metal clips will be left in my scrotum as part of the procedure.
7 I am aware that with any operation there are risks.In the case of vasectomy possible complications include,but are not limited to the following:
Inflammation in the testicle/Epididymis/Vas deferens (1 in 20)
Chronic Post Vasectomy Pain (1 in 2000 will be severe enough to require intervention)
Nodule formation-sperm granuloma (1 in 4 )
Bleeding in the scrotum that may require drainage in hospital (<1 in 1000)
Impaired blood flow resulting in loss of testicle (rare)
Failure to achieve sterility
Emotional reactions that may interfere with sexual function (rare)
I understand and accept the risks that accompany a vasectomy.I am aware that these or other conditions may require further tests or procedures that are not covered as part of my vasectomy fee and they will be at my expense.