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Apart from the use of condoms, vasectomy is the only method of birth control that is the responsibility of the man. Vasectomy is more cost effective, less invasive and has a lower failure rate than sterilization in women. The general practitioner (GP) plays a very important role when a couple or an individual consults them about a vasectomy referral. Bearing in mind the poor pregnancy rate of vasectomy reversal and the potential cost, some men may want to have information about sperm storage. Cryo-storage would allow artificial insemination of their current partner or of a new partner. Vasectomy operative techniques described in this chapter include: open-ended vasectomy, fascial imposition, and Pro-Vas. The chapter explains that the man may experience a small amount of pain and discomfort during and after the procedure and that usually paracetamol is sufficient for pain relief.
There is evidence of contraception from the land of the pharaohs. Mantras were believed to produce sterility in both men and women, just like prayers of intercession in the Christian Church in Europe. A major change in approaches to contraception came about as an accidental result of venereal disease. From the mid-nineteenth century, the arrival of rubber meant the first condoms were produced of the new material. Sexual health became an important part of consideration for companies producing contraceptives and suddenly condoms could be bought in most places in the world from open shelves in chemists and supermarkets, sold in brightly coloured packets. The invention of a female condom has also enabled a woman to make yet another form of choice if she wished to prevent both pregnancy and disease. Vasectomy and sterilization operations are available and accessible across the globe.
Vasectomy is typically performed as an outpatient procedure using local anesthetics. The technique employed for occlusion of the vasal lumina may influence the incidence of recanalization. Suture ligature, still the common method employed worldwide, may result in necrosis and sloughing of the cut end distal to the ligature. Hematoma is the common complication of vasectomy, with an average incidence of 2%. Sperm granulomas form when sperm leak from the testicular end of the vas. Sperm are highly antigenic, and an intense inflammatory reaction occurs when sperm escape outside the reproductive epithelium. The concept of male hormonal manipulation for contraception predated the era of female hormonal contraception by 20 years. Progestins have been used in multiple small studies for suppression of spermatogenesis and testosterone production in men. Along with hormonal manipulation, immunocontraception appears to offer reasonable hope for a nonsurgical contraceptive option in men.
Male or female sterilisation is chosen by almost 50% of British couples in their 40s as their main method of contraception. Of these, 15% of men and 12% of women choose either vasectomy or tubal occlusion. Vasectomy is the most effective contraceptive method available, with failures now quoted as having a life-time risk of one in 2000 after two azoospermic samples taken 2-4 weeks apart at least 8 weeks after the procedure. Mirenai (Schering), the levonorgestrel-releasing intrauterine system (LNG-IUS), is an ideal contraceptive method for the older woman. Epidemiological data support the prescribing of combined hormonal contraceptives (CHCs) to non-smoking, normal-weight, low-risk women who do not suffer from migraine until the menopause. The median age of the menopause in Western women who do not smoke is 51.3 years. Symptoms of the menopause are often masked in women using CHCs but some may complain of vasomotor symptoms in the hormone-free week.
The need for reliable, safe, and reversible contraception has become more evident, and the duration of their use has increased as many women opt to delay childbearing into the late third and fourth decades. Many psychosocial and economic factors will continue to affect women's contraceptive decision-making and undoubtedly will continue to influence rates of tubal sterilization. Vasectomy, like tubal sterilization, should be considered an irreversible sterilization procedure. The oral contraceptive pill is a common form of contraception in the USA. Numerous societal, biological, psychological, and legal factors must be considered when counseling women about their reproductive health. As with any physician-patient encounter, careful documentation must accompany any discussion regarding reproduction and contraceptive choices. Discussions regarding reproductive health, contraception, and sterilization must make the clear distinction between contraception and protection from sexually transmitted disease (STDs). Broad categories of assisted fertilization include hormonal assistance designed to induce ovulation and in vitro fertilization.
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