A Comprehensive Guide to Male Contraception and Sterilization Techniques: From Proper Condom Use to Vasectomy
149. Precautions for using condoms for contraception Condom breakage is the main cause of condom failure. To avoid condom failure, the following precautions should be taken when using condoms for contraception: (1) Choose high-quality products that meet quality standards. Do not use inferior products. (2) Pay attention to the expiration date. If the expiration date has passed or the condom has been improperly stored during transportation or storage, it may break due to latex aging. (3) Before using a condom, check for leaks. The method is to blow air into the condom first, then pinch the opening with one hand and squeeze the body with the other hand to check for leaks. If there are leaks, it should not be used. (4) The timing of condom use should be appropriate. It should be put on after the penis is erect and before contact with the woman's body. Be sure to squeeze the small reservoir at the front of the condom with your fingers to squeeze out the air. If the condom is used before ejaculation, pregnancy may occur because a small amount of sperm may be discharged with secretions before ejaculation. (5) After ejaculation and before the penis softens, be sure to press the top of the condom in time to prevent semen from leaking out.
Contraceptive methods suitable for men include the following: (1) Oral contraceptive: Gossypol, 20 mg once a day, orally for 2 months. When the sperm count is <4 million/ml or azoospermia occurs, the maintenance dose is changed to 150-220 mg/month, divided into 4-8 doses, orally. Occasionally, there may be adverse reactions such as hypokalemia or transient alanine aminotransferase elevation, which should be noted. (2) Penile condom contraceptive: Choose a penile condom of appropriate size and put it on the erect penis before intercourse so that the ejaculated semen is contained in the condom, thus achieving the purpose of contraception. If the penile condom is broken and the semen flows into the vagina, there is no need to panic. A remedial method can be taken, that is, immediately squatting after intercourse, washing the vagina with warm water, and then using contraceptive cream or contraceptive film to kill sperm, which is usually successful. (3) External contraceptive film: The film is a semi-transparent water-soluble film made of benzoylmercuric acid as the main agent and polyethylene as the auxiliary agent, which has a strong spermicidal effect. Instructions for use: First, moisten the glans penis, spread out the medicated film and apply it, then push it deep into the vagina with the penis. Pause the activity, and it will dissolve on its own after 1-2 minutes, then resume intercourse. Sperm will be killed when they come into contact with vaginal secretions containing benzomercury. For those who ejaculate too quickly or prematurely, it is advisable to fold the medicated film into a quarter piece before intercourse and push it deep into the vagina with your fingers. The medicated film will dissolve on its own after 2 minutes, then resume intercourse. This method is safe and reliable, and no adverse reactions have been found. (4) Withdrawal method: The withdrawal method involves immediately withdrawing the penis when ejaculation is imminent during intercourse, so that the semen is discharged outside the vagina to achieve the purpose of contraception. This method often affects the pleasure of sexual life, and the contraceptive effect is not very reliable, so it is not advisable to use it. This is because some semen may have already entered the vagina before the penis is withdrawn.
The basic principle of male hormonal contraception is similar to that of oral contraceptives for women: it inhibits the synthesis and secretion of pituitary gonadotropins through exogenous hormones, thereby suppressing spermatogenesis in the testes. Women have menstrual cycles, typically releasing only one egg per month, while men produce sperm constantly. It is estimated that each gram of testicular tissue in an adult can produce 300-600 sperm per second, and hundreds of millions of sperm per day from both testes. Therefore, using male hormonal contraception is much more difficult, requiring larger doses, longer treatment durations, and inevitably causing some adverse reactions. Male contraceptives based on spermatogenesis inhibition should meet the following four criteria: ① High efficacy, rapid onset of action, and sustained stability in cases of azoospermia or severe oligospermia. ② Complete restoration of fertility after discontinuation, with no impact on offspring health. ③ Minimal side effects and no impact on sexual function. ④ Economical and acceptable to both partners. Based on the types and combinations of hormones used, male hormonal contraception is currently mainly divided into three categories: The first category is the use of testosterone alone. Testosterone is the main androgen secreted by the testes, and now it is possible to artificially synthesize various short-acting or long-acting testosterone products, such as testosterone propionate, testosterone enanthate, and testosterone undecanoate. The other two categories of hormonal contraception combine progestins and androgens, and combine gonadotropin-releasing hormone antagonists or agonists with androgens. Both of these categories have seen promising progress in research.
Suitable sterilization methods for men: Male sterilization is achieved by surgically blocking both vas deferens, preventing sperm from entering the distal vas deferens and thus achieving sterilization. The main methods are as follows: (1) Vas deferens obstruction: Obstruction is created at a certain part of the vas deferens to block sperm transport and achieve sterilization. There are generally two methods in clinical practice. ① Extravagant vas deferens obstruction: U-shaped or V-shaped silver clips or tantalum clips are used to clamp the vas deferens to achieve obstruction. The advantage of this method is that the lumen can be restored after the pressure is removed. ② Intravagant vas deferens obstruction: The vas deferens is surgically cut open, and a packing material is placed into the lumen or directly inserted into the lumen or introduced into the lumen by means of needle and suture to achieve the purpose of obstruction. Commonly used packing materials include nylon thread, catgut, rubber balloon, non-toxic compounds (such as silicone strips), metal objects, etc. If necessary, the packing material in the lumen can be removed to restore the vas deferens passage. (2) Vas deferens injection and packing method: A rapidly coagulating polymer compound (such as sodium morrhuate, formaldehyde, ethanol, etc.) is injected into the lumen of the vas deferens through the scrotal skin using a needle to form a plug, blocking the vas deferens to achieve sterilization. This method is easy to obtain materials, simple to operate, has few complications, is safe and reliable, and is very popular. (3) Vas deferens ligation: also known as male ligation, is a surgical procedure that involves ligating and removing a section of the vas deferens to prevent sperm from meeting the egg, thereby achieving sterilization. This surgery has the advantages of being simple to operate, safe to perform, and reliable in effect. The purpose of the surgery is only to block the sperm's pathway and does not affect the secretion of androgens. Therefore, it has no adverse effects on physical health, secondary sexual characteristics, or sexual function. Surgical indications: Any married man in good health who is practicing family planning and whose spouse agrees may undergo vasectomy.
Contraindications and Postoperative Precautions for Vasectomy (1) Contraindications for Vasectomy ① Those with bleeding disorders, neurosis, mental illness, acute or chronic severe diseases, or those who have lost their fertility. ② Those with chronic inflammation of the testis, epididymis, spermatic cord, or prostate, scrotal dermatitis, eczema, elephantiasis, severe varicocele, giant inguinal hernia, or hydrocele. ③ Those with doubts about the surgery or sexual dysfunction. (2) Postoperative Precautions for Vasectomy ① After surgery, stay in the hospital for observation for 1-2 hours. If there are no abnormalities, you can go home. It is best to take a car or walk slowly, and do not ride a bicycle. After returning home, you should also pay attention to resting more and avoid excessive activity to prevent pain and hematoma. Depending on the nature of your work, you should rest for 7-14 days after surgery. ② Be careful not to remove the gauze at the incision site and do not touch the wound with your hands. Do not take a bath before the wound heals to prevent infection. For individuals with heightened sensitivity, a T-bandage or handkerchief can be used to support the scrotum for about one week to prevent pain. ③ Pay attention to bleeding. If bleeding is observed on the gauze strip within 24 hours after surgery, consult a doctor immediately for examination and treatment. ④ Be aware that many live sperm may remain in the distal end and ampulla of the vas deferens after surgery. Therefore, if the doctor did not administer spermicide to the distal end of the vas deferens during the procedure, contraception should be maintained for two months after surgery to prevent pregnancy. Generally, about 10 more ejaculations will clear away any remaining sperm. For added safety, some doctors recommend discontinuing contraception after 20 ejaculations. Of course, the best approach is to discontinue contraception only after a semen analysis confirms the absence of sperm. ⑤ The scrotal skin heals well; if no sutures were used or subcutaneous sutures were applied, sutures do not need to be removed. If only one suture was applied, it can be removed 4-5 days after surgery. ⑥ Sexual intercourse should be avoided for two weeks after surgery.
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