Contraception

Vasectomy – Male contraception

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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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Contraception – Male condom

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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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Contraception – Hormonal implant (Implanon)

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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)

Combined oral contraceptives (COC) pills

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The reason for practicing contraception (or birth control) is to prevent an unplanned pregnancy. Most methods of contraception enable sexually active couples to temporarily avoid pregnancy. Permanent birth control is accomplished through sterilization. There are many types of birth control methods that are currently available. There is no perfect method at the moment. Each has its own advantages and disadvantages. Be sure you know and understand the different types of birth control available to you, the risks and benefits of each, and any side effects, so that you can make an informed choice.

Read moreCombined oral contraceptives (COC) pills

Post-Natal Care – what to expect

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Most women stay in the hospital for 24 to 48 hours after giving birth (or 3 to 4 nights after a caesarean section). This will depend on the condition of the mother and baby.
The physical changes that occur with pregnancy usually resolve by the end of 6 weeks, although some may resolve much earlier than this. It is important to know all these changes, as it will help you cope better and lessen your worries. Emotional sup¬port and much needed help from your spouse and family members is equally important to assist you in facing these changes and coping with the arrival of a new member into the family. You will also get lots of advice from friends and relatives who visit you – some may be conflicting and may be harmful. There are many ways of doing things with no particular hard and fast rules on what is best for you. It is best to avoid traditional or Chinese herbs during this period. In the end, it is all boils down to common sense and you have to decide what is best for you and your baby. Do some reading and ask your doctor or midwife about your recovery during the postnatal period

Read morePost-Natal Care – what to expect