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Male Contraception: Urology Division, Surgery Department Medical Faculty, University of Sumatera Utara

Male contraceptive methods include condoms, withdrawal, and periodic abstinence. Condoms have typical first-year failure rates of 3-14% while withdrawal and periodic abstinence have higher failure rates around 19-20%. Research into new male contraceptives focuses on hormonal methods to suppress sperm production, barrier methods, antisperm vaccines, and inhibiting sperm-egg interactions. Vasectomy is a common permanent surgical method that has a low risk of complications but couples should continue using other contraception for some time after the procedure to confirm effectiveness. Vasectomy reversals have over a 90% success rate depending on the surgery and time since original vasectomy.

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98 views22 pages

Male Contraception: Urology Division, Surgery Department Medical Faculty, University of Sumatera Utara

Male contraceptive methods include condoms, withdrawal, and periodic abstinence. Condoms have typical first-year failure rates of 3-14% while withdrawal and periodic abstinence have higher failure rates around 19-20%. Research into new male contraceptives focuses on hormonal methods to suppress sperm production, barrier methods, antisperm vaccines, and inhibiting sperm-egg interactions. Vasectomy is a common permanent surgical method that has a low risk of complications but couples should continue using other contraception for some time after the procedure to confirm effectiveness. Vasectomy reversals have over a 90% success rate depending on the surgery and time since original vasectomy.

Uploaded by

Winson Chitra
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPT, PDF, TXT or read online on Scribd
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MALE CONTRACEPTION

Urology Division, Surgery Department Medical Faculty, University of Sumatera Utara

MALE CONTRACEPTION

male contraceptive method : - condoms - periodic abstinence - withdrawl Typical 1st-year failure rates : - withdrawl 19% - periodic abstinence 20% - condoms 3 14%

Definition

Thin sheaths of rubber, vinyl or natural products which may be treated with a spermicide for added protection. They are placed on the penis once it is erect Condoms deiffer in such qualities as shape, color, lubrication, thickness, texture and addition of spermicide (usually nonoxynol-9)

Types
Latex (rubber) Plastic (vinyl) Natural (animal products)

Research : - prevent sperm production (use of androgen, progesteron, GnRH) - interfere with the ability of sperm to mature and carry out fertilization by using an epididymal approach to create a hostile environment for sperms - produce better barrier methods - produce of antisperm contraceptive vaccine - inhibit sperm-egg interactions

Use of existing male contraceptives in developed region

Use of existing male contraceptives in developing region

Hormonal male contraception

Based on suppression of gonadotrophin & the use of testosterone substitution to maintain male sexual function & bone mineralization & to prevent muscle wasting Research : - testosterone monotherapy - androgen/progestin combination - testosterone with GnRH analogues - selective androgen and progestin receptor modulation

VASECTOMY

Is an effective method of permanent male surgical sterilization Before the procedure, the couple should be given accurate information about the benefit & risks

Surgical techniques

various techniques no-scalpel vasectomy the least invasive approach to the vas cauterization of the lumen of the vas & fascial interposition most effective occlusion technique

Complications

Acute local complications : - haematoma, wound infection, epididymitis 5% cases Long term complications : - chronic testicular pain, epididymal tubal damage

Vasectomy does not significantly alter spermatogenesis & Leydig cell function Volume of ejaculate unchanged Rate of prostate cancer could not increased

Vasectomy failure
Effective occlusion technique risk of recanalization < 1% No motile spermatozoa 3 mo later Persistent motility sign of vasectomy failure need to repeat the procedure Long term recanalization may occur (rare)

Counseling

It should be considered irreversible It has a low complication rate. However, because vasectomy is an elective operation even small risks should be explained as men may wish to consider these before giving their consent It has a low, but existing, failure rate Couples should be advised to continue with other effective contraception until clearance is achieved

All available data indicate that vasectomy is safe & not associated with any serious, long term side effect Fascial interposition & cauterization seem to give a higher efficacy

Vasectomy reversal

Success rate > 90%, depend on : - the time elapsed after vasectomy - type of vasectomy (open ended or sealed) - type of reversal (vasovasostomy or vasoepididymostomy) - unilateral or bilateral

Conclusions

The most cost-effective approach to treatment of post-vasectomy infertility is microsurgical reversal. This also has the highest chance of delivery Couples can have a family after successful vasectomy reversal. There is no need for hormonal treatment of the female partner, with its associated risks of ovarian hyperstimulation and multiple pregnancies

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