Vasectomy and Vasovasostomy (Reversal Surgery)

Description

Alternative Names

Male Contraception

As many as 40% of couples seeking vasectomy have experienced a failure with their previous method of nonpermanent birth control. Such failures can occur from misplacement of a diaphragm, an incorrectly implanted IUD, or noncompliance with an oral contraception regimen. Couples who are unsure about permanent sterility should still consider other methods and improving their use.

Withdrawal

Withdrawal before ejaculation is a form of natural contraception, but it is extremely risky and most people find it unsatisfactory. If used on a regular basis, the average risk for pregnancy is 24%.

Condoms

The only other form of male contraception currently available is the condom. However, the average rate of pregnancy for couples that rely only on condoms for protection is still 12%. And in adolescents the risk with condoms is even higher, 18%. Even for those who use a good-quality condom correctly, the annual risk for pregnancy is 3%. The condom should be put on before intercourse when the penis is erect, long before ejaculation, since the male can discharge sufficient semen to cause pregnancy before ejaculation occurs. (Even after a vasectomy, men who are not in a monogamous relationship with an HIV-negative partner should always wear a condom during sex for protection against sexually transmitted diseases. Vasectomy is not protective.)

Click the icon to see an illustrated series detailing how to apply a condom.

Condom Materials.

• Latex. Condoms made of latex rubber are the most common types. When they are contoured for better fit and contain a spermicide they can provide fairly effective protection. Some people are allergic to latex, however, and in some cases the reaction can be very dangerous. The latex smell may also be unpleasant for some people.
• Polyurethane. Polyurethane condoms (Avanti, eZ-on) are now available. It is hoped that eventually they will prove to be superior to latex in a number of ways, including strength, sensitivity, and durability. At this point, they have good acceptance by couples but have a higher breakage rate (6% to 7.2%) compared to the latex condom (1.1% to 2%). Other synthetic materials are under investigation.
• Animal Membranes. Condoms made from animal membrane can prevent pregnancy, but sexually transmitted infections can permeate them.
• Lubricants, Lubricants can be used to prevent tearing. Petroleum-based products (such as Vaseline and baby oil) and vegetable oils should not be used because they can corrode the condom.

Spermicides. Some condoms come prelubricated with sperm-killing substances called spermicides. The standard active ingredient in spermicides in the US is nonoxynol-9, which attacks the surface of the sperm cell. These spermicidal-coated condoms, however, are no longer recommended for a number of reasons. Side effects include irritation of the vagina or penis, particularly if used often or in large amounts. Its use may also promote yeast and urinary tract infections in women. Evidence now strongly suggests that nonoxynol-9 does not provide any additional protection against sexually-transmitted diseases. In fact, research now suggests that it actually increases the risk for HIV in women, possibly by causing injury in the vaginal area. Spermicides are no longer recommended for use with male condoms.

A heat activated, microbe-fighting gel may offer an effective alternative but is still undergoing early testing.

Hormonal Contraceptives for Men

Researchers are currently at work on hormonal contraceptives that reduce levels of sperm. Hormonal contraception for men is more complicated than for women and research is still very preliminary.

Progestins. Much of the research is focusing on progestins, derivatives of progesterone, a primary family hormone, which in men interfere with sperm production. Studies generally are testing progestins (e.g., desogestrel, etonogestrel, or levonorgestrel) with addition of testosterone to maintain normal male hormone levels. There is a typical delay of two to three months before infertility is achieved. Sperm production returns to normal when the agents are stopped. Studies are promising but there are some significant side effects, including acne, weight gain, and reductions in HDL cholesterol.

Prolactin. Prolactin, a hormone in both men and women, is also being investigated. In men, it can reduce sperm production.

Gossypol

Gossypol, a yellow pigment extracted from the roots, seeds, and stems of the cotton plant, has been used in China, African, and Brazil as a male contraceptive. Cotton root was also used as folk medicine in the American South to treat menstrual pain and to induce abortions. The chemical destroys the lining of tubules in the testicles where sperm are produced, thereby inhibiting their formation. A 2000 Brazilian study reported that a male oral contraceptive derived from gossypol suppressed sperm production within up to 16 weeks. In men who were taking lower doses, sperm production returned in most of them within a year after they stopped taking the contraceptive. Gossypol does not appear to reduce sexual desire or frequency of intercourse. In about 20% of men, sperm production does not come back, so it should be considered as potentially permanent birth control. It also may not be effective in some men, since small numbers of sperm may survive. Researchers are investigating gossypol-derived compounds that may have less toxicity. No one should take any so-called natural gossypol product without consultation with a physician.

Reversible Vas Occlusion

Some attempts have been made to develop procedures that block sperm flow in the vas deferens using various drugs or materials but which are reversible. To date, none have been totally effective as a male contraceptive.A promising method uses a substance called styrene maleic anhydride, or SMA (Risug). This substance is injected in the vas deferens. It coats the walls and blocks the tube. It is removed by flushing the vas deferens with a solvent. It is mostly being investigated overseas.