Man Requesting A Vasectomy — Free SCA Practice Case

Character Overview: You are Dean, a 32-year-old software developer. You have been married for two years. You and your wife agreed early in your relationship that you do not want children, and you both still feel that way — but you have not specifically discussed a vasectomy with her. She takes the contraceptive pill and has recently missed a few doses, which has worried you about an unplanned pregnancy, and that is what has prompted you to look into this now. You feel a vasectomy is the responsible option. You are aware it is permanent. Nobody is pressuring you — this is your own decision. You want to understand how it is done, the recovery, and the risks. You are thoughtful and will engage well with a proper discussion.

Opening Sentence: "Hi Doctor. I've been thinking about getting a vasectomy and I wanted to talk it through with you. My wife and I don't want children — we agreed that early on — and she's missed a few pills recently, which has made me think we need something more reliable."

History if Asked (Data Gathering Phase)

• ●Why now: "My wife's missed a few pills recently. It made me realise we're relying on something that can go wrong, and I'd rather take responsibility for it myself."
• ●The decision: "We agreed from early on that we don't want children. That hasn't changed for either of us."
• ●Whether he's discussed it with his wife: "We've talked about not wanting children, but I haven't actually said 'I'm going to have a vasectomy'. I suppose I assumed she'd be fine with it."
• ●Pressure: "Nobody's pushing me into this. It's entirely my own decision."
• ●His understanding: "I know it's permanent. I don't really know how it's done, how long the recovery is, or what can go wrong."
• ●What he wants: "Information, really — and then to be referred if it's the right thing."

ICE — Ideas, Concerns, Expectations

The patient does not volunteer this information unprompted. These responses surface only when the candidate directly explores his perspective.

• ●Ideas: Dean believes a vasectomy is the most responsible and reliable form of contraception for their situation. "I think it's the responsible thing — the most reliable option, and it takes the burden off my wife."
• ●Concerns: His dominant concern is the risk of an unplanned pregnancy given the missed pills; if explored, he is also mildly anxious about the procedure itself and whether it will affect him sexually. "The unplanned pregnancy risk is what worries me. And, if I'm honest, I wonder whether it changes anything… you know, sexually."
• ●Expectations: He wants clear information and, if appropriate, a referral. "I want to understand it properly and then get referred."

If Asked — Decision, Risk-of-Regret, and Suitability Screen

The patient answers these only when directly asked.

• ●If asked about children (existing or wanted): "No children, and we don't want any. That's been settled between us for years."
• ●If asked how he would feel if his circumstances or relationship changed: "I've thought about it. I'd still not want children — I'm confident about that."
• ●If asked about his relationship and whether there is any conflict: "We're solid. No problems between us."
• ●If asked about other contraceptive options considered (including LARC for his wife): "We haven't really looked at anything else. She's just always been on the pill."
• ●If asked about previous scrotal/testicular surgery, infection, hernia repair, or undescended testis: "Nothing at all — no operations, no problems down there."
• ●If asked about bleeding disorders or anticoagulants: "No, nothing like that."
• ●If asked about general health, medication, and allergies: "I'm fit and well, nothing regular, no allergies."
• ●If asked about smoking, alcohol, and occupation: "I don't smoke or drink. Desk job — software developer."
• ●If asked about STI risk: "We're monogamous, no concerns there."
• ●If asked what he understands about reversal: "I assumed you could reverse it if you really had to. Is that not right?" (A misconception to correct.)
• ●If asked about his understanding of when it becomes effective: "I'd assumed it works straight away, to be honest." (A second misconception to correct.)

Responses to Management (The Negotiation Phase)

• ●If the Doctor explains it should be regarded as permanent and reversal is unreliable: "So I shouldn't count on it being reversible at all? That's important — I'd assumed it was a safety net." (The tested point is emphasising permanence and correcting the reversal misconception.)
• ●If the Doctor explains it is not immediately effective — key: "It doesn't work straight away? So we'd still need contraception until a test confirms it's worked? I had no idea." (The tested point is explaining the need for continued contraception until post-vasectomy semen analysis confirms clearance.)
• ●If the Doctor explains the late failure rate — key: "So even after it's confirmed, there's still a very small chance? About one in two thousand?" (The tested point is quoting and explaining the recognised late-failure risk.)
• ●If the Doctor explains his wife's consent is not required — key: "So legally it's my decision and she doesn't have to consent? I'd still want to talk to her about it properly." (The tested point is the correct legal/ethical position, while encouraging discussion.)
• ●If the Doctor discusses alternatives: "We hadn't considered a coil or an implant for her. Worth thinking about, though I'd still rather it was me."
• ●If the Doctor addresses his sexual-function worry: "So it doesn't affect erections, testosterone, or how sex feels? That's reassuring."