Vasectomy Pre-Assessment
Questionnaire
This confidential questionnaire guides you through everything you need to know, screens for clinical suitability, and prepares you for direct booking or a short consultation. It takes approximately 8–10 minutes.
8–10 minutes
Confidential & Secure
Clinically reviewed
Consultant Urological Surgeon
Vasectomy Pre-Assessment
Questionnaire
This confidential questionnaire guides you through everything you need to know, screens for clinical suitability, and prepares you for direct booking or a short consultation. It takes approximately 8–10 minutes.
Details Fertility &
Decision Counselling
& Education Decision
Commitment Booking
Preference Medical
History Scrotal
History Lifestyle Declaration
Personal Details
Your contact information helps us prepare your records and reach you to confirm your appointment.
Fertility Status & Decision Context
Understanding your current family situation helps us support your decision appropriately.
For example: female sterilisation, long-acting reversible contraception (LARC).
Counselling & Education
Please read each section carefully. Tap any heading to expand the full information. You will confirm your understanding on the next step.
Vasectomy involves dividing and sealing the vas deferens — the tubes that carry sperm — so that sperm can no longer be released during ejaculation. Hormone production and sexual function are not affected.
You should approach this decision as if it cannot be undone. The procedure is classified as a permanent method of contraception, and planning for reversal as a fallback is strongly discouraged.
Reversal is technically possible, but comes with important caveats:
- Requires specialist microsurgery — significantly more complex than vasectomy itself
- Not routinely available on the NHS — usually self-funded privately
- Expensive — typically £3,500–£5,000 or more
- Success rates decline with time since vasectomy
- Technical success does not guarantee pregnancy
Vasectomy does not take effect immediately. Sperm stored in the reproductive tract can remain for several months.
You must continue using contraception until a semen test — usually around 12 weeks after the procedure — confirms no sperm are present. We will arrange this test for you.
- Day-case procedure, typically 15–20 minutes
- Performed under local anaesthesia — you are awake but the area is fully numb
- Usually via no-scalpel technique — a small puncture, not an incision
- Occasionally a small incision is needed if anatomy is difficult
- Return to desk work typically within 2–3 days; physical work within 5–7 days
- Sexual activity usually resumed after approximately one week
Around 6 in 100 men later regret vasectomy — most commonly following a relationship change or unexpected bereavement.
Long-term testicular or scrotal discomfort is reported in 5–15% of men. Around 5% may need further treatment.
Very rarely the vas deferens rejoins spontaneously. The semen test at 12 weeks detects this.
A blood collection in the scrotum occurs in around 1–2% of cases, usually resolving without intervention.
If you feel unsure at any stage, you are encouraged to pause and seek further discussion before proceeding. There is no pressure to continue today.
Decision Commitment
Please confirm each statement below. All six must be ticked before you can continue. This forms part of your informed consent record.
Booking Preference
Having confirmed the above, how would you like to proceed? A consultation is always available if you have remaining questions.
What Happens After You Submit?
Clinic days: Monday (morning & afternoon) · Thursday (afternoon) · Friday (afternoon)
Medical History
This information ensures the procedure is safe for you and allows appropriate planning.
Includes: warfarin, rivaroxaban, apixaban, clopidogrel, prescribed aspirin, or similar.
Urological & Scrotal History
Previous scrotal conditions or surgery can affect the approach to vasectomy. Please answer honestly — all information is confidential.
Tick all that apply:
Lifestyle & General Health
A few final background questions to complete your pre-assessment profile.
Helps us give appropriate post-procedure recovery advice.
Final Declaration & Consent
Please read and confirm the declaration below. This forms part of your pre-assessment record.
Declaration
By submitting this questionnaire, I confirm that:
- The information I have provided is accurate and complete to the best of my knowledge
- I have read and understood the information about vasectomy, including its permanence, risks, and post-procedure requirements
- I understand this questionnaire does not constitute binding consent to surgery — formal written consent will be taken on the day of the procedure
- I am making this decision freely and without pressure from any other person
- I understand I may withdraw at any time before the procedure without any effect on my care
Your data is held securely and confidentially by Best Life Healthcare Ltd (CQC registered, Co. no. 06711746) in accordance with UK GDPR and the Data Protection Act 2018. It will not be shared without your consent except where required by law.
Questionnaire Submitted
Thank you for completing your vasectomy pre-assessment. Our clinical team will review your responses and send you a direct booking link within one working day.