k.53 male contraception

8/13/2019 k.53 Male Contraception

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MALE CONTRACEPTION

Urology Division, Surgery Department

Medical Faculty,

University of Sumatera Utara


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MALE CONTRACEPTION

male contraceptive method :

- condoms

- periodic abstinence

- withdrawl

Typical 1st-year failure rates :

- withdrawl 19%

- periodic abstinence 20%

- condoms 3 14%


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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)

Definition


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Types

Latex (rubber)

Plastic (vinyl) Natural (animal products)


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Research :

- prevent sperm production (use of androgen,

progesteron, GnRH)

- interfere with the ability of sperm to mature andcarry 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


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Use of existing male

contraceptives in developed

region

Use of existing male

contraceptives in developing

region


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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


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VASECTOMY

Is an effective method of permanent male

surgical sterilization

Before the procedure, the couple should be

given accurate information about the benefit &risks


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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


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Complications

Acute local complications :

- haematoma, wound infection, epididymitis

5% cases

Long term complications :

- chronic testicular pain, epididymal tubal

damage


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Vasectomy does not significantly alter

spermatogenesis & Leydig cell function

Volume of ejaculate unchanged

Rate of prostate cancer could not increased


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Vasectomy failure

Effective occlusion technique risk of

recanalization < 1%

No motile spermatozoa 3 mo later

Persistent motility sign of vasectomy

failureneed to repeat the procedure

Long term recanalization may occur (rare)


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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 menmay wish to consider these before giving theirconsent

It has a low, but existing, failure rate

Couples should be advised to continue withother effective contraception until clearance isachieved


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All available data indicate that vasectomy is

safe & not associated with any serious, long

term side effect

Fascial interposition & cauterization seem togive a higher efficacy


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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


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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, withits associated risks of ovarian hyperstimulation

and multiple pregnancies

Conclusions

k.53 male contraception

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