Vasectomy services are still taboo in some hospitals due to religion

Covid-19 has decimated vasectomy services which have been particularly hard hit with very few hospitals being able to commit to performing the service in a reasonable time. Dr John O’Keefe describes how the service is still taboo in some Irish hospitals

In Ireland, as in the UK, Canada, and Australia, virtually all vasectomies are performed by specially-trained GPs. In the US, it’s mostly urologists. Funding of vasectomy in Ireland is quite anomalous. All men with a full medical card can have a vasectomy, free of charge, by a contracted GP. Perhaps not surprisingly, there is no uniformity. Some of the HSE-contracted GPs can only do GMS vasectomies for men who live in a certain area. For instance, one GP in Athlone can do them for men who live east of the Shannon, but not for those on the west. Other GPs have an annual numerical limit — usually completed by March — with an associated waiting list. Others have neither geographical nor numerical limits and can do men from anywhere.

Men with GP Visit Cards must pay for a vasectomy, as do those without any GMS card. All are, however, entitled to have a vasectomy performed as a public patient in a public hospital.

A small number of men requesting vasectomy will need to have it done with a general anaesthetic, in a hospital setting. This is usually because of:

  • Previous scrotal surgery making the vas inaccessible.
  • Very tiny or conversely exceptionally large vasa.
  • Sheer terror of local anaesthetic surgery.

To attempt to find out how available vasectomy is in our public hospitals, I sent a short questionnaire to all urologists working in public hospitals with a urology department, asking six questions. The replies are as follows.

Question 1
Does your hospital provide a vasectomy service, and if so, how many in 2019?
(The year 2020 was not included because of Covid-19).
Some larger hospitals do, with the notable exceptions of St Vincent’s and the Mater in Dublin. I have no results from Blanchardstown. Drogheda used to do them, but not now. Most do 10-a-year or less, with the notable exceptions of Beaumont and Loughlinstown hospitals, who performed 25 and 20 respectively.

So, in theory, the following hospitals do provide a vasectomy service to public patients:

  • Beaumont Hospital
  • Cork University Hospital
  • Galway University Hospital
  • Loughlinstown Hospital
  • St James’s Hospital
  • Tallaght Hospital
  • Waterford Regional Hospital

Question 2
Are they done with general or local anaesthetic?
Here the answers were identical — all were done with general anaesthetic.

Question 3
Are they done by consultants, registrars or SHOs?
Most by either consultant alone, or a registrar under supervision.

Question 4
Time interval in 2019 between OPD request being received, and the operation being performed?
Here is where there were some pleasant surprises, and some not so pleasant. Loughlinstown, Naas and Waterford Hospitals were unique, each with a highly acceptable approximate three-month gap between request and operation. Beaumont came next — with one year — followed by Cork at 18 months. All other hospitals had waiting times longer than two years, with the result that these men were referred to the NTPF. Here a man on an excessively long waiting list can be referred to a private hospital, to have the operation performed there free of charge to him. Not so to the taxpayer, as this costs over €2,000 per procedure.

Question 5
What is estimated current time interval between OPD request and operation?
Here the answers were nearly all identical. Covid-19 has changed everything, and nobody had any idea.

Question 6
What is your estimate as to the cost to the HSE of a hospital vasectomy?
In 2016, Mr Ted McDermott, a urologist in Tallaght Hospital, did a detailed analysis of the cost of vasectomy there at just over €2,000. All the urologists who answered this survey estimated that the cost in their hospital would be approximately that now.

Discussion
The pleasant surprise was finding that three hospitals had acceptable intervals between referral and actual surgery. Long may it continue.

However, with Covid-19, not to mention the recent cyber-attacks, it does look like no hospital will be doing public vasectomies in the foreseeable future. What was not a surprise was finding that, even in 2020, a religious ethos still prevails in some public hospitals. Vasectomy is taboo there.

So, it would currently seem a waste of time referring a man to a public hospital for a vasectomy.

He will just end up, two or more years later, being looked after by the NTPF, at a cost of over €2,000 to the taxpayer.

There is a solution. All the political parties are giving lip service to the provision of contraception free of charge to the consumer.

The Greens wants the government to ‘set out a timeline for the development of a scheme for universal free contraception in the lifetime of this government’.

Fianna Fáil: “Free contraception for women is a goal we support, and we hope to make significant progress on it over the next five years.” One can only surmise that this includes vasectomy.

Fine Gael: “Fine Gael is committed to delivering free contraception over a phased period beginning with women aged 17 to 25.”

Labour: “We want a universal system for free contraception for all women.”

Sinn Féin: “We advocate providing contraceptives and emergency contraception free of charge to all.”

That seems clear enough, although none specifically mention vasectomy, which for women, is the safest and by far the most reliable contraceptive method. However, absolutely nothing at all is being done to implement any of this.

Private vasectomy by a GP costs a very reasonable €500 — what I just paid to get my car, a VW Golf, serviced. There are specifically trained GPs in most parts of the country willing and able to provide this service, and more can be trained, if necessary, but nothing is happening.

Instead, the HSE is content to put men on a two-year + waiting list, then pay over €2,000 to have the vasectomy performed by NTPF. You could not make it up. (Actually….Ed)

It has been repeatedly proven by medical statisticians that vasectomy is, by far, the most cost-effective long-term contraceptive method available.

Other counties recognise this, and fund vasectomy services for all. To happen here, it would need some planning and structure. This would incorporate some of the following:

  • A universal central contract for providers.
  • A proven standard of training in vasectomy.
  • Suitable premises for providing the service.
  • Audit of performance.

All of these, except for a universal contract, exist now, albeit on a voluntary as opposed to statutory basis. All the GPs providing vasectomy services operate to current UK standards, or similar.

Less than 1% of men requesting vasectomy need a GA, the other 99%+ can be looked after by a GP. If this were properly organised, then hospitals could easily cope with this tiny number, and none would need NTPF referral.

All this will need political input. All the major parties in and out of government are in favour.

The service would save, not cost, a lot of money. Hospital urologists would be delighted not to have unnecessary minor surgery that is better done elsewhere clogging up their system.
It seems a no-brainer, but, alas, nothing is being done.

You can find further details on www.vasectomy.ie.

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