Vasectomy – Male contraception

The aim of a vasectomy is to prevent sperm from reaching the semen by disconnecting the sperm duct. The resulting ejaculate is therefore sperm-free, eliminating the risk of pregnancy. Sort of like a cheap shark fin soup without the shark fins (sperms).

Vasectomy is the contraception of choice for 6%–8% of married couples worldwide. Vasectomy is a minor procedure that provides effective and permanent contraception. In fact, it is far more effective than many other methods of contraception, including female sterilization.

Prior to a vasectomy, it is important and both husband and wife be present together to be counseled by a specialist on the implications of the procedure. It is important that the completeness of family is ascertained and that both husband and wife had discussed beforehand and agreed that it is the husband who should undergo a vasectomy to attain permanent contraception.

A vasectomy typically takes 20-30 minutes and is done under local anaesthesia (LA) with or without sedation or under general anaesthesia if the patient is squeamish about pain. After LA is administered, a small nick is done on the scrotum. The sperm duct or vas deferens is exposed and cut with 1-2cm of the duct removed. Then, the ends will be diathermized (using heat to destroy tissue) to close the channel of the duct and they will be bent upon itself and tied. After that, the two tied ends are buried in different tissue planes to reduce the chances of them rejoining.

After a vasectomy, patients should take plenty of fluids as well as take the pain killers provided. He should rest at home, limit activity, and wear a scrotal support for the next 48 hours. He must see his urologist if there is any pain or swelling of the scrotum or fever.

It is important to note that vasectomy does not provide immediate sterility! It is important to use another form of contraception until after occlusion of vas is confirmed by the absence of sperms or rare non-motile sperm on post-vasectomy semen analysis done at 8 to 16 weeks or after 25 ejaculations after the surgery. Patients should refrain from ejaculation for approximately one week after vasectomy.

Some short-term surgical complications are 1-2% risk of blood clot formation, and infection. On the other hand, the most common long-term complication of a vasectomy is chronic scrotal pain that affects 1-2% of men. The risk of pregnancy after a vasectomy is 1 in 2000 for men who have post-vasectomy azoospermia which is caused by spontaneous re-canalization of the sperm duct.

Around 3-6% of men who have undergone vasectomy may opt for a reversal later in life for various reasons. Unlike vasectomy, a vasectomy reversal is a procedure that is much more technically challenging, requiring the use of an operating microscope. In addition to this, the result of vasectomy reversals after 10 years is poor at about 39%. Besides vasectomy reversal, other options for fertility after vasectomy include sperm retrieval with in vitro fertilization. These options are not only expensive, but they also may not always be successful. Hence, pre-vasectomy counseling is of utmost importance.

Article contributed and written by

Dr Peter Ng (Consultant Urologist)

Dr Beatrice Chua Yoong Ni

Subang Jaya Medical Centre

References and further reading:

https://www.urologyhealth.org/urology-a-z/v/vasectomy

https://www.auanet.org/guidelines/vasectomy-guideline

https://theconversation.com/explainer-how-does-a-vasectomy-work-and-can-it-be-reversed-110780

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4854082/

 

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Lower Urinary Tract Infection (Lower UTI, cystitis)

Infection of the lower urinary tract occurs when the inner lining of the bladder becomes infected and the urine is full of bacteria. In pregnancy, 5 – 10% of women have bacteria in their bladder and some will have no symptoms at all.

How common?

Up to 40 – 50% of women will have at least one attack in their lifetime and 25% will have recurrences.

Causes

  • Bacteria can reach the bladder from the genital and anal area, or through the bloodstream.
  • Injury to the urethra or the bladder.
  • Prolonged use of a urinary catheter to empty the bladder, such as during childbirth or surgery.

Risk factors

  • Sexual activity.
  • Infection in other parts of the genitourinary system.
  • Pregnancy.
  • Poor hygiene.
  • Menopause.
  • Diabetes mellitus.
  • Underlying abnormalities of the urinary tract, such as tumours, calculi (stones), and strictures.
  • Incomplete bladder emptying.
  • During or after major surgery

Read moreLower Urinary Tract Infection (Lower UTI, cystitis)

Contraception – Male condom

The main purpose of contraception (or birth control) is to prevent an unplanned pregnancy. You should know and understand the different types of methods available to you, the risks and benefits of each, and any possible side effects, so that both you and your partner can able to make an informed choice. Contraception can be broadly divided into:

  1. Temporary or permanent methods – permanent birth control is accomplished through sterilization (tying or removal of the fallopian tubes) or hysterectomy (removal of womb / uterus). The rest of the methods are classified as temporary or reversible.
  2. Short term or long-term methods – short term methods are condoms and oral pills. Long term methods are injectables, intrauterine device and hormonal implants.

The condom is a sheath that looks like a small, elongated balloon and is usually made of thin latex rubber, polyurethane or natural membranes. The man wears this sheath over the erect penis during intercourse. The sheath will prevent the sperm from being deposited in the vagina following ejaculation. The condom may also be effective in preventing spread of some sexually transmitted infections (STIs) such as human immunodeficiency virus (HIV), chlamydia, gonorrhoea, genital warts etc. It is the only form of temporary birth control available for men.

Advantages

  • Generally effective for contraceptive use (88-98%), provided it is use in a proper and consistent way.
  • It is readily available, inexpensive, and easy to use. Women can buy and carry condoms.
  • No medical consultation is required to start using it. It can be purchase easily and widely available.
  • It provides good protection against some STIs.
  • There are no systemic side effects from condom use.
  • Since the condom prevent the deposition of semen in the vagina, the woman will have less leaking (discharge) following intercourse.

Disadvantages

  • There is a need for the condom to be available and the extra time and effort required to put in on prior to intercourse. This may decrease the spontaneity of sex for some couples.
  • It may lessen the women or male’s sensation since the penis does not touch the vaginal walls directly.
  • It may irritate the woman’s vagina due to the friction from the condom. The lubricant may or may not help in relieving it.
  • Some women or men can be allergic to the material used to manufacture the condom.
  • The condom may break or leak, resulting in unplanned pregnancy

General instructions for use

  • There are many brands of condoms and you should try to find the best fit for you. You should check the expiry date before using it. Be careful when opening the condom packet. You should not use teeth, sharp fingernails, scissors, or other sharp instruments to open it as these may damage the condom. Push the condom to one side and gently tear along the corner or edge. It should be easy to open the pack.
  • Once you remove the condom from the pack, check for defects such as holes, tears or if it feels unusual (stickiness), do not use it. Open another pack and repeat the steps above. You should not unroll the condom to check it because this could damage it and make it difficult to put it on.
    Use a new condom for every act of intercourse. Put the condom on after the penis is erect and before any contact is made between the penis and any part of the partner’s body.
  • If using a spermicide, put some inside the condom tip.
  • The teat end should be pointing up and you should always pinch the tip enough to leave a small space for semen to collect when you start rolling the rim of the condom over the penis until the base. The pinching will make sure to eliminate any air in the tip to help keep the condom from breaking.
  • If you are using water-based lubricant, you may put more on the outside of the condom.
  • After ejaculation and before the penis gets soft, hold the rim of the condom, and carefully withdraw the penis.
  • To remove the condom, gently pull it off the penis and make sure the semen does not spill out.
  • Dispose it in a proper way. Because condoms may cause problems in sewers, do not flush it down the toilet.
  • If the condom breaks, there is a chance you can become pregnant. You should consider taking emergency contraception or see your doctor immediately for advice. You should also get tested for STIs if you are not sure of your partner’s infective status.

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Colposcopy

This is a microscopic examination of the cervix, vagina, or vulva. It is used to diagnose potential abnormalities of these areas, which sometimes cannot be seen with the naked eyes. The colposcope can magnify the tissue by up to 30 times, thus making it clearer and much more accurate in terms of surface evaluation. Therefore, the biopsy of the abnormal areas performed with a colposcopic examination is more accurate than those done without the use of a colposcope.

Why do I need a colposcopy evaluation?

  • It is usually recommended if you have an abnormal Pap smear (Thin Prep) test or when pre-cancerous lesion is suspected in the vagina or labia area.

Read moreColposcopy

First visit to the gynaecologist – what you should know

Health screening as a person ages is especially important. It should be your top priority even if you are healthy. In women, this will include a visit to the gynaecologist’s clinic and will help in identifying if the woman has increased risks for developing a disease or already has the disease or condition that was not previously known about. Early identification of risks factors can help in counselling and instituting remedial or preventive measures to reduce that risk. This may in fact help to prevent the disease from occurring. Likewise, early detection of disease and starting treatment as soon as possible will results in a better outcome and lower the risks of complications. For example, many women with ovarian cancer do not have symptoms until it is too late. However, prompt diagnosis at an early stage of ovarian cancer will give excellent outcome with surgery alone and may not even need chemotherapy at all.
Many women feel nervous or even afraid to see the gynaecologist, especially if it is their first visit. Seeing a gynaecologist is just like seeing any other doctor in other specialities such as your dentist or general practitioner. They are there to help you and you should take this as an opportunity to seek their help in taking care of your health.

Read moreFirst visit to the gynaecologist – what you should know

Contraception – Hormonal implant (Implanon)

The main purpose of contraception (or birth control) is to prevent an unplanned pregnancy. You should know and understand the different types of methods available to you, the risks and benefits of each, and any possible side effects so that both you and your partner can able to make an informed choice. Contraception can be broadly divided into:

  1. Temporary or permanent methods – permanent birth control is accomplished through sterilization (tying or removal of the fallopian tubes) or hysterectomy (removal of womb/uterus). The rest of the methods are classified as temporary or reversible.
  2. Short term or long-term methods – short term methods are condoms and oral pills. Long term methods are injectables, intrauterine device and hormonal implants.

Hormone implant currently available is Implanon NXT®. It consists of a single plastic rod measuring 4 cm and contain a progestogen hormone called etonogestrel. Implanon is inserted surgically, just under the skin of the upper arm. The implant will release a minute amount of this hormone every day for 3 years. It works by preventing the monthly ovulation (the release of an egg from the ovary) during your menstrual cycle. It also thickens the vaginal mucus to prevent sperm from reaching the egg (fertilization). Continuous effect of the hormone will thin out the lining of the uterus (womb) to prevent attachment of a fertilized egg. Implanon does not contain any oestrogen.

Read moreContraception – Hormonal implant (Implanon)

Trichomoniasis

Trichomoniasis (or Trichomonas vaginalis, TV) is an infection of the vagina and is caused by a parasite (a flagellate protozoan) that lives in the lower genitourinary tract. The disorder can involve the vagina, urethra and bladder in women. In men, it can affect the prostate gland and urethra.

 

Symptoms and signs

The symptoms varies from women to women. Some may not have any symptoms at all and may not be aware of this infection. Infected men may have no symptoms as well. Typical symptoms are:

  • Vaginal discharge which is foul-smelling, frothy and it is most noticeable after sexual intercourse or after menses.  The discharge color may be greenish or yellowish.
  • Vaginal itching and discomfort.
  • Redness of the vaginal lips (the labia) and vagina.
  • Painful urination especially if the labia is inflamed and the urine touches the surrounding area.

Causes

This is due to a parasite called Trichomonas vaginalis. The transmission from person to person is almost exclusively via sexual intercourse. It may live in its host without producing symptoms. Since it is usually transmitted sexually, both the sexual partners must receive treatment to eliminate it completely.

Complications

Read moreTrichomoniasis

Endometrial Hyperplasia

Endometrial hyperplasia is an overgrowth of endometrial tissue (which is the inner lining of the uterus which shed every month as menstrual blood flow). It is not cancerous. However, there is a form of severe hyperplasia which can be precancerous (especially when there is presence of abnormal cells called atypia). Classification of the hyperplasia includes:

  1. simple or complex (adenomatous) hyperplasia without atypia, or
  2. simple or complex (adenomatous) hyperplasia with atypia.

Patients who have endometrial hyperplasia without atypia usually respond well to progestogen therapy and are not at increased risk for uterine cancer. The progression of hyperplasia to endometrial cancer increases as the abnormal cells (atypia) of the hyperplasia develops.

Read moreEndometrial Hyperplasia