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  • Title: Status of male contraception.
    Author: Davis JE.
    Journal: Obstet Gynecol Annu; 1977; 6():355-69. PubMed ID: 337192.
    Abstract:
    This chapter outlines the currently acceptable methods of male contraception, the recent advances in understanding vasectomy and its effects, and the latest results with reanastomosis along with recent studies in the use, acceptability, and efficacy of condoms. The chapter also discusses experimental techniques and the acceptance of contraceptive responsibility by the male. The condom, 1 of the oldest reliable male methods of contraception, is receiving new attention today. It is reliable, relatively inexpensive, light, compact, and disposable. The condom requires no medical examination, supervision, or follow-up; has no side effects; offers physical postcoital evidence of effectiveness; provides protection against venereal disease; and allows the male to share actively in family planning. In the US, where all contraceptives, sterilization, and abortion have in recent years become major means of fertility control, condom sales and use have not increased substantially. For the most part, condom advertising of the future will emphasize family planning rather than the prevention of venereal disease. Attractive packaging and colored condoms, already well known in Europe and Asia, are expected to increase sales in the US. It is estimated that approximately 250,000 vasectomies have been performed annually in the US since 1969. Preoperative counseling is very important since vasectomy must be considered a permanent and irreversible operation. Complications of vasectomy include hematoma, infection, epididymitis, granuloma, recanalization, failure, hydrocele, and vasocutaneous adhesions. Prospective studies on men undergoing vasectomy have shown that both sperm agglutinating and sperm immobilizing antibodies are demonstrable after vasectomy. Some of the experimental approaches described are promising; others are effective but irreversible; and still others are temporary but affect libido and potency. The methods are classified according to the mechanisms and the agents by which contraception could be achieved: interruption of spermatogenesis (interference with cell division, interference with testicular vasculature, interference with hormonal milieu, interference with steroid action, specific inhibitors of meiosis, specific inhibitors of follicle stimulating hormone (FSH) secretion, and inhibition of binding of FSH and luteinizing hormone (LH) to receptors); interference with spermatozoa maturation (antiandrogen, alpha-Chlorohydrin); and interference with spermatozoa transport (vas occlusive devices, diversion of sperm, altered ejaculation, copper wire implants, sperm immobilization, and interference with lysis of semen). Studies of Presser reveal that as the intelligence quotient and understanding of the couple increases, male contraceptive methods become more popular. In sum, it appears that the condom and vasectomy will continue as the major methods of controlling male fertility. The possibility of using androgen gestagen combinations to disrupt spermatogenesis has possibilities for short-term development.
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