All men can have vasectomy. No medical conditions prevent a man from using vasectomy. This checklist asks the client about known medical conditions that may limit when, where, or how the vasectomy procedure should be performed. Ask the client the questions below. If he answers "no" to all of the questions, then the vasectomy procedure can be performed in a routine setting without delay. If he answers "yes" to a question below, follow the instructions, which recommend caution, delay, or special arrangements.

In the checklist below:

• Caution means the procedure can be performed in a routine setting but with extra preparation and precautions, depending on the condition.
• Delay means postpone vasectomy. These conditions must be treated and resolved before vasectomy can be performed. Give the client another method to use until the procedure can be performed.
• Special means special arrangements should be made to perform the procedure in a setting with an experienced surgeon and staff, equipment to provide general anesthesia, and other backup medical support. For these conditions, the capacity to decide on the most appropriate procedure and anesthesia regimen also is needed. Give the client a backup method* to use until the procedure can be performed.

1.    Do you have any problems with your genitals, such as infections, swelling, injuries, or lumps on your penis or scrotum? If so, what problems?

NO   YES If he has any of the following, use caution:

• Previous scrotal injury
• Swollen scrotum due to swollen veins or membranes in the spermatic cord or testes (large varicocele or hydrocele)
• Undescended testicle—one side only. (Vasectomy is performed only on the normal side. Then, if any sperm are present in a semen sample after 3 months, the other side must be done, too.)

If he has any of the following, delay vasectomy:

• Active sexually transmitted infection
• Swollen, tender (inflamed) tip of the penis, sperm ducts (epididymis), or testicles
• Scrotal skin infection or a mass in the scrotum

If he has any of the following, make special arrangements:

• Hernia in the groin. (If able, the provider can perform the vasectomy at the same time as repairing the hernia. If this is not possible, the hernia should be repaired first.)
• Undescended testicles—both sides

2.    Do you have any other conditions or infections? If so, what?

NO   YES If he has the following, use caution:

• Diabetes
• Depression
• Young age
• Lupus with positive (or unknown) antiphospholipid antibodies or on immunosuppressive treatment

If he has any of the following, delay vasectomy:

• Systemic infection or gastroenteritis
• Filariasis or elephantiasis

If he has any of the following, make special arrangements:

• HIV with advanced or severe clinical disease (see Vasectomy for Men Living With HIV, below)
• Blood fails to clot (coagulation disorders)
• Lupus with severe thrombocytopenia

* Backup methods include abstinence, male and female condoms, spermicides, and withdrawal. Tell him that spermicides and withdrawal are the least effective contraceptive methods. If possible, give him condoms.