Station 75
Kevin O’Brien
Age: 32 year old male
Full Case
Patient’s Data
Patient’s Name: Kevin O’Brien
Age: 32-year-old male
Past Medical History:
- None recorded
Drug and Allergy History:
- Not currently on any medication
- No know drug allergy
Recent Consultation:
- No recent consultations recorded
Patient booked a routine video appointment to discuss concerns.
Patient's Story (Role player’s brief)
Patient’s Story
Opening Statement: “Hi doctor, I’ve been thinking about getting a vasectomy and wanted to talk it through with you.”
You are Kevin, a 32-year-old man seeking a vasectomy. You and your wife have been married for two years and agreed early in your relationship that you didn’t want to have children. However, you haven’t specifically discussed the vasectomy with her. You feel that choosing to have a vasectomy would be a responsible way to prevent any unintended pregnancies.
If asked about any external pressures to make this decision: Deny any pressure from anyone and confirm that this is your own decision. You are aware that a vasectomy is a permanent procedure, but you would like to know more about how it is done, the recovery process, and any potential risks involved.
Social History: You do not smoke or drink alcohol. You work as a software developer.
You live with your wife.
Ideas: You believe that a vasectomy is the most responsible method of contraception given that you and your wife have agreed not to have children.
Concerns: You are concerned because your wife, who is on the contraceptive pill, has recently missed a few doses and you’re worried about the possibility of an unplanned pregnancy.
Expectations: You are hoping for clear information about the vasectomy procedure, its risks, and how to go about getting it done.
Say NO to any other questions asked outside of the details already provided in the scenario. Accept anything offered to you by the doctor.
Marking Scheme
Data Gathering and Diagnosis
- Explore the reason behind the patient’s request for a vasectomy (establish whether the decision is based on personal conviction, mutual agreement with his partner, or external pressure)
- Ask if he has discussed the vasectomy with his partner and how she feels about it
- Ask what the patient already knows about vasectomy and whether he understands the risks and permanence of the procedure
- Ask about the nature of his relationship with his wife, including any current issues or underlying conflict
- Ask if other contraceptive methods have been used previously and whether reversible options, such as long-acting contraception for his wife, have been considered
- Ask about long-term considerations, whether he is confident he will never want children, and how he might feel if his circumstances or relationship were to change
- Ask about his occupation and whether there are any current issues at work
- Explore his ideas, concerns, and expectations (ICE)
Example of explanation to patient
Thanks for sharing that, Kevin. It’s helpful to understand where you’re coming from. A vasectomy is a common and effective form of permanent contraception, and it’s good that you’re thinking it through carefully.
Just to clarify, a vasectomy involves a minor surgical procedure that cuts or seals the tubes that carry sperm. It’s usually done under local anaesthetic and takes about 15–30 minutes. Most men recover quickly, although some may have mild discomfort or swelling for a few days. Serious complications are rare, but like any procedure, there are some small risks, such as infection or long-term testicular discomfort (post-vasectomy pain syndrome).
It’s important to remember that a vasectomy does not work immediately. You will need to use effective contraception until the absence of sperm is confirmed by post-vasectomy semen test- which is usually done around12 weeks after the procedure.
You mentioned that you’re aware it’s permanent, and I just want to emphasise that reversal is a complex and often unsuccessful procedure. It’s also not usually available on the NHS, so anyone considering reversal would need to pursue it privately, and even then, success is not guaranteed.
One of the key things we discuss before referring is making sure that you feel confident about this decision, especially as it’s intended to be permanent. You mentioned that you and your wife agreed not to have children, which is helpful, but it might also be worth having a clear conversation with her specifically about the vasectomy, to make sure you’re both on the same page.
Sometimes people’s circumstances or feelings about children can change over time, after a relationship change, for example. So, we encourage patients to really think about the long-term impact before proceeding.
We can also talk through other contraceptive options, such as condoms or longer-acting reversible contraception for your wife, if you would like to keep your options open for now.
If, after thinking it through, you feel ready to go ahead, I can refer you to a local sexual health clinic where they’ll provide more detailed counselling and arrange the procedure. You don’t need to decide right now, you can go away, think it over, and we can always revisit this.
Does that all make sense so far? Are there any questions or worries you’d like to talk through?
Management
Management
- Explain that a vasectomy is a permanent form of male sterilisation, which involves cutting or sealing the tubes that carry sperm from the testicles
- Emphasise that reversal is complex, expensive, and not always successful. In addition, the NHS does not routinely offer reversal procedure.
- Inform the patient that vasectomy is not immediately effective; he will need to continue using effective contraception until a post-vasectomy semen analysis (PVSA) confirms azoospermia
- Advise that PVSA is usually performed around 12 weeks after the procedure.
- Highlight the importance of involving his partner in the decision-making process
- Explain that although the final decision lies with him, it is essential to have an open and honest discussion with his wife, given the permanent nature of the procedure
- Inform the patient about alternative contraceptive methods, including reversible options such as condoms or long-acting reversible contraception (LARC) for his partner (e.g., intrauterine devices or implants)
- Advise that if he chooses to proceed, the procedure can be arranged through a local sexual health clinic or vasectomy service.
- Advise the patient he does not need to make the decision immediately and can return to discuss further if needed
- Offer to arrange a follow-up consultation to allow further discussion or to proceed with referral if he is ready.
Learning point from this station:
This case highlights the importance of shared decision-making and thorough exploration of patient understanding when considering permanent procedures such as vasectomy.
While the decision ultimately rests with the patient, clinicians have a duty to ensure that choices are well-informed, voluntary, and based on realistic expectations about effectiveness, irreversibility, and potential life changes. It is also essential to explore the role of the partner, clarify that NHS does not fund reversal procedures, and discuss reversible alternatives. Sensitive, non-judgemental communication fosters trust, supports autonomy, and ensures ethical, patient-centred care.