... the semen. You must continue to use birth control to prevent pregnancy until your semen sample is totally free of sperm. Most men are satisfied with vasectomy. Most couples enjoy not having to use birth control.
... The risk of pregnancy after vasectomy. Obstetrics and Gynecology 2004 ;103:848–850. Jamieson DJ, Kaufman SC, ... regret following vasectomy versus tubal sterilization. Obstetrics and Gynecology 2002 ;99:1073–1079. Selected Resources Vasectomy in ...
Bernie, Aaron M; Osterberg, E Charles; Stahl, Peter J; Ramasamy, Ranjith; Goldstein, Marc
Vasectomy is the most common urological procedure in the United States with 18% of men having a vasectomy before age 45. A significant proportion of vasectomized men ultimately request vasectomy reversal, usually due to divorce and/or remarriage. Vasectomy reversal is a commonly practiced but technically demanding microsurgical procedure that restores patency of the male excurrent ductal system in 80-99.5% of cases and enables unassisted pregnancy in 40-80% of couples. The discrepancy between the anastomotic patency rates and clinical pregnancy rates following vasectomy reversal suggests that some of the biological consequences of vasectomy may not be entirely reversible in all men. Herein we review what is known about the biological sequelae of vasectomy and vasectomy reversal in humans, and provide a succinct overview of the evaluation and surgical management of men desiring vasectomy reversal. PMID:23248768
In 1989, Pro-Pater, a private, nonprofit family planning organization in Brazil, used attractive ads with the message Vasectomy, An Act of Love to promote vasectomy. The number of vasectomies performed/day at Pro-Pater clinics increased from 11 to 20 during the publicity campaign and fell after the ads stopped but continued at higher levels. Word of mouth communication among friends, neighbors, and relatives who had vasectomies maintained these high levels. This type of communication reduced the fear that often involves vasectomies because men hear from men they know and trust that vasectomies are harmless and do not deprive them of potency. In Sao Paulo, the percentage of men familiar with vasectomies and how they are performed increased after the campaign, but in Salvador, knowledge did not increase even though the number of vasectomies in Pro-Pater clinics increased. Organizations in Colombia and Guatemala have also been effective in educating men about vasectomies. These successes were especially relevant in Latin American where machismo has been an obstacle of family planning programs. The no-scalpel technique 1st introduced in China in 1974 reduces the fear of vasectomy and has fewer complications than the conventional technique. Further trained physicians can perform the no-scalpel technique in about 10 minutes compared with 15 minutes for the conventional technique. In 1987 during a 1-day festival in Thailand, physicians averaged 57 no-scalpel vasectomies/day compared with only 33 for conventional vasectomies. This technique has not spread to Guatemala, Brazil, Colombia, the US, and some countries in Asia and Africa. Extensive research does not indicate that vasectomy has an increased risk of testicular cancer, prostate cancer, and myocardial infarction. Physicians are working on ways to improve vasectomy. PMID:12317726
In 1972 the ratio of female sterilization acceptors to vasectomy acceptors in Thailand was 24.5:1; in 1978 the ratio was 2.8:1. Several factors are responsible for this change. First, a national family planning program to support voluntary family planning started in 1970 and lowered the population growth rate from 3.2% in 1973 to 2.1% in 1982. Second, the desired family size in Thailand is 3 and it is generally agreed that the solution is voluntary sterilization as a more cost effective fertility control method. Thirdly, misunderstandings about vasectomy were cleared up through media campaigns which cleared the way for greater acceptance. Fourth, in 1975 special clinics at big hospitals and a mobile unit were set up to perform vasectomies. Lastly, a group of nongovernment organizations has been set up, such as the Thai Association for Voluntary Sterilization, to provide the infrastructure for vasectomy campaigns. Requests for vasectomy reversals have, expectedly, increased as well, usually caused by marriage, child's death, improved finances, and psychosexual health. In a recent study of 32 cases, positive sperm reappearance after vas reanastomosis was found in 71.4% and the pregnancy rate was 52.3%. PMID:12265673
Vasectomy takes place under a local or general anesthesia and lasts about 30 minutes. The physician makes 2 small cuts in each scrotum or one cut in the middle. The surgeon then lifts the vas deferens, removes about 1 cm of the vas, ties the ends, and then cauterizes them with a hot needle. This step prevents sperm (produced in the testicles) from entering the penis. After a vasectomy, a man needs to have 12-15 ejaculations before becoming sterile. He should return to the physician's office about 2 months after the vasectomy to have at least 1 sperm count (preferably 2) to ensure that azoospermia has been achieved. Vasectomy has no effect on libido or performance. Some men claim that vasectomy improves their sex life because they do not need to worry about contraception. Vasectomized men can return to normal sexual activity 4-5 days after the operation, but, until sterility has been achieved, they must use contraception. The body continues to produce sperm in the testicles, but they remain in the blocked tube for about 3 weeks. After 3 weeks, they shrink and the body absorbs them like it absorbs blood after a bruise. Frequent vasectomy problems are bruising and swelling, but they resolve themselves in a couple of days. Men rarely experience bleeding and infection, but when these problems occur, treatment rapidly eliminates them. Build-up of sperm at the operation site occurs sometimes, but these granulomas tend to disappear on their own. Even though physicians may be able to rejoin the vas by microsurgery, return of fertility does not always occur. In fact, only about 5)% of vasectomy reversals result in pregnancy. Men should decide to undergo vasectomy without any pressure. They should consider vasectomy as permanent and irreversible. PMID:8517823
Finger, W R
Vasectomy, surgical sterilization for men, is very safe, has few side effects, and results in reported annual pregnancy rates of less than 1%. However, men in only a few countries widely adopt vasectomy as their contraceptive method of choice even though it is safer and easier to perform than female sterilization. Approximately 45 million men worldwide have been vasectomized, largely in China, Thailand, India, Korea, the UK, Canada, and the US. Vasectomy is not available in many developing countries, and even if it is available and men have heard of it, many have the misconception that vasectomy causes weakness and adversely affects male sexual function. When trying to increase the access, acceptability, and uptake of vasectomy, enough providers must be trained so that their services are readily available, sustained promotional campaigns should encourage method use, and male clinics and services should be available to help men feel comfortable. Competent counseling is essential to success. The myths and facts of vasectomy, the no-scalpel approach, and promotional campaigns are discussed. PMID:12321061
Randall, P E; Ganguli, L; Marcuson, R W
Ninety-four patients undergoing vasectomy as day cases were studied prospectively. An overall infection rate of 32.9% was recorded and, apart from haematoma formation and the nasal carriage of organisms, no factors were found that increased the risk of infection. A preoperative hibiscrub shower did not affect the infection rate, even though it was responsible for a significant reduction in skin flora. This raises the possibility of infection following vasectomy being secondary, not occurring at the time of surgery. PMID:6626903
Schlegel, P N; Goldstein, M
Physicians in China have developed a new technique to perform vasectomies which improves men's acceptance of vasectomy. It is called no-scalpel vasectomy. Before performing the vasectomy, the surgeon should determine whether the patient is indeed interested in permanent sterilization. The surgeon should also gather information on patient's age, marital status, and medical history and perform a physical examination. Counseling should consist of clear, simple language to diminish any fears. The surgeon must inform the patient of alternative nonpermanent means of contraception and stress that vasectomy is essentially irreversible. 2 physicians recommend external spermatic fascia injection using 2-3 ml of 2% plain lidocaine to induce vasal nerve blockage. After properly fixing the vas deferens with a ring clamp, the surgeon pierces the scrotal skin, vas sheath, and vas deferens in the midline with a curved dissecting clamp held at a 45 degree angle from horizontal. The surgeon then rotates the clamp 180 degrees to prepare the vas for cutting. The surgeon cuts out a 1 cm segment and then occludes the ends of the vas. The vas is then returned to the scrotal sac via the same puncture hole. No sutures are needed for the puncture hole. The same procedure is followed for the other vas. Hands-on training requires 10-15 procedures to develop proficiency. The no-scalpel technique takes about 40% less time than conventional techniques. The complication rate for the no-scalpel technique is 0.4 events/100 procedures compared to 3.1/100 procedures for conventional techniques. Both the ring clamp and dissecting clamp were developed in China. These instruments are provided through a company in Georgia and through the Association for Voluntary Surgical Contraception (AVSC). AVSC helps medical institutions coordinate physician training of the no-scalpel technique. PMID:1485070
Kaplan, Andrew I; Rappaport, Jay A
This article explores why the national court system has seen a steady influx of claims alleging practitioners' failure properly to perform vasectomy or ensure sterilization and the manner in which that influx has caused physicians to reassess their methods of practicing medicine in an increasingly litigious environment and make the appropriate and necessary accommodations. Through their experiences as medical malpractice litigators and through the analysis of reported cases, national jury verdicts, and insurance claims made and paid in lawsuits arising from claims regarding the performance of vasectomy, the authors enlighten the reader as to the legal theories and hurdles applicable to such claims and the medical theories most often elucidated and litigated by the patients who bring them. Also offered are suggestions as to the manner in which the practitioner may be proactive in both preventing and defending exposure to malpractice litigation. PMID:19643237
Cilip, Christopher Michael
Development of a noninvasive vasectomy technique may eliminate male fear of complications (incision, bleeding, infection, and scrotal pain) and result in a more popular procedure. These studies build off previous studies that report the ability to thermally target tissue substructures with near infrared laser radiation while maintaining a healthy superficial layer of tissue through active surface cooling. Initial studies showed the ability to increase the working depth compared to that of common dermatological procedures and the translation into an ex vivo canine model targeting the vas deferens in a noninvasive laser vasectomy. Laser and cooling parameter optimization was required to determine the best possible wavelength for a safe transition to an in vivo canine model. Optical clearing agents were investigated as a mechanism to decrease tissue scattering during in vivo procedures to increase optical penetration depth and reduce the overall power required. Optical and thermal computer models were developed to determine the efficacy for a successful transition into a human model. Common clinical imaging modalities (ultrasound, high frequency ultrasound, and optical coherence tomography) were tested as possible candidates for real-time imaging feedback to determine surgical success. Finally, a noninvasive laser vasectomy prototype clamp incorporating laser, cooling, and control in a single package was designed and tested in vivo. Occlusion of the canine vas deferens able to withstand physiological burst pressures measured postoperative was shown during acute and chronic studies. This procedure is ready for azoospermia and recanalization studies in a clinical setting.
Mehta, M; Mckenzie, M
The recent evaluation of a 2-year no-scalpel vasectomy (NSV) training program providing on-site, hands-on training for physicians working in 43 publicly funded health centers in 17 states found that demand for vasectomy in low-income and minority communities in the US increased following the implementation of innovative advertising strategies. The program also provided sites with surgical instruments, training materials, a press kit, and some help with public information activities. Participating clinics used a range of formal and informal advertising strategies, including radio and printed advertisements, to inform potential clients about vasectomy services. Many interested clients presented to clinics to undergo vasectomy once they had been made aware of the service and its availability. Several providers even stated that advertising caused the demand for vasectomy to exceed their capacity to provide services. The provision of low- or no-cost procedures helped to attract new clients. PMID:12321999
Rogstad, K E
The possibility of long-term psychological sequelae of vasectomy is not included in preoperative male sterilization counseling. This article reviews the literature on the psychosexual and social response to vasectomy. The majority of studies have found no negative effects of vasectomy on sexual performance or frequency of sexual intercourse. In general, adverse psychological events are the least common in men who made the decision for vasectomy jointly with their wives. Possible predictors of psychosexual problems include pre-existing emotional instability, excessive concerns about masculinity, confusion of the procedure with castration, and post-surgical complaints. The major predictors of post-sterilization regret among both male and female sterilization acceptors are pre-operative motivation for further child bearing, poor couple communication, high levels of conflict during decision making, and dominance of decision making by one spouse. PMID:12292715
Johnson, J H
Although an estimated 100 million couples who practice contraception have chosen sterilization as their accepted method, the overwhelming majority of the sterilizations were obtained by women even though vasectomy is known to be simpler, safer and cheaper than tubal ligation. In an effort to stimulate new interest in male sterilization an international meeting was held in Sri Lanka in 1982. 66 participants from 25 countries discussed problems related to the acceptance of vasectomy and the delivery of sterilization services. Yearly vasectomy figures have fluctuated widely and are attributed to new simplified female procedures, fluctuating government policies, erratic funding and male chauvinism. Machismo in Central and South America were of particular concern. The use of paramedics to perform vasectomies in areas where there are few overworked doctors was debated. It was concluded that quality services were essential and both physicians and paramedics may have to be used. In Africa neither the population nor the government is interested in male sterilization and contraception is considered woman's business. Several gynecologists are just beginning to introduce the male role in contraception. In Thailand, vasectomy is widely promoted and rewarded, and additional mass market techniques were suggested. Some countries have given cash payments for the procedure, but the conference participants were in favor of more indirect motivational methods. The conference concluded that promoting vasectomy will require more information, education and effort than female sterilization. In particular erroneous fears of castration and impotence must be overcome. Word of mouth communication was judged to be the best way of promoting the success of the procedure. PMID:6680702
McDonald, S W
Since the late 1960s, vasectomy has been a popular and widely used form of contraceptive in Britain for couples who do not want to have any more children. However, throughout the past decade there has been considerable concern about the safety of this procedure. This paper reviews the current opinion on the possible health considerations associated with this operation and shows that the latest news is mostly reassuring. PMID:9231476
... Clinical Trials Resources and Publications What are the risks of vasectomy? Skip sharing on social media links ... occur after surgery and over time. 1 Surgical Risks After surgery, most men have discomfort, bruising, and ...
Mahlow, Jane Caryl
, trap-neuter-and-release. Because of the feline's unique reproductive status as an induced ovulator, vasectomy may have practical advantages over traditional surgical sterilization via castration. To test whether vasectomy can be a useful tool in stray...
Haws, J M; McKenzie, M; Mehta, M; Pollack, A E
A program designed to improve the availability of vasectomy in public-sector clinics trained physicians at 43 facilities in no-scalpel vasectomy between 1993 and 1995. Among the 38 clinics that responded to a follow-up survey in 1996, the number of clinics providing vasectomies rose from 23 to 32, an increase of almost 40%, while the number of vasectomies performed rose by 18%. Seventeen of the 32 clinics performed more vasectomies after the training; 10 of the 17 had not previously provided the procedure. In-depth interviews with staff from seven sites that experienced large caseload increases and from seven that experienced decreases identified three elements for the successful establishment or expansion of vasectomy services-sufficient numbers of trained providers, funds to subsidize vasectomies for men who cannot afford them and activities to raise awareness about the availability of low-cost or free vasectomy. PMID:9258652
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Indications for hydrocele and spermatocele treatment are based on diagnosis with high-resolution ultrasonography. It must be clear whether hydrocele or spermatocele lead to impairment of the patient - asymptomatic findings do not need correction. In case of younger men, the wish for children must be taken into account as both surgical procedures may lead to infertility, especially spermatocele resection may lead to epididymal obstruction. Advantages and disadvantages of the intervention must be discussed with the patient in detail. In men with a planned vasectomy, the physician must be certain that the patient understands the definitive character of this form of contraception. Men who are not aware of this condition or have conflicts with their partners may not be the best candidates for surgical vasectomy. All three treatment options (hydrocelectomy, spermatocele resection, and vasectomy) may be accompanied by fertility preservation procedures (e.g., cryopreservation of semen prior to surgery). Alternatively, the surgery should not be performed if any doubts exist. Postoperative management includes follow-up examinations and in case of vasectomy after 6-12 weeks and several ejaculations at least two semen analysis with proven azoospermia after centrifugation (or <100,000 immotile spermatozoa) should be documented. Compliance of men is best when this follow-up appointment is already scheduled at the time of surgery. PMID:24806800
Hunter, J; Logan, H; Greer, G
Sperm-agglutinating antibodies were present in three (2-6%) of 117 fertile men and in 19 (33-9%) of 56 men who had been vasectomized. Twenty-four of the 56 vasectomized men had been studied before vasectomy; sperm-agglutinating antibodies were present in one (4-3%) compared with eight (33-3%) after vasectomy. No sperm-immobilizing antibodies were detected before vasectomy but were present in 10 (17-9%) of the 56 men after vasectomy. PMID:1010880
Haight, R.G.; Mech, L.D.
Recovering gray wolf (Canis lupus) populations in the Lake Superior region of the United States are prompting state management agencies to consider strategies to control population growth. In addition to wolf removal, vasectomy has been proposed. To predict the population effects of different sterilization and removal strategies, we developed a simulation model of wolf dynamics using simple rules for demography and dispersal. Simulations suggested that the effects of vasectomy and removal in a disjunct population depend largely on the degree of annual immigration. With low immigration, periodic sterilization reduced pup production and resulted in lower rates of territory recolonization. Consequently, average pack size, number of packs, and population size were significantly less than those for an untreated population. Periodically removing a proportion of the population produced roughly the same trends as did sterilization; however, more than twice as many wolves had to be removed than sterilized. With high immigration, periodic sterilization reduced pup production but not territory recolonization and produced only moderate reductions in population size relative to an untreated population. Similar reductions in population size were obtained by periodically removing large numbers of wolves. Our analysis does not address the possible effects of vasectomy on larger wolf populations, but it suggests that the subject should be considered through modeling or field testing.
Labrecque, Michel; Dufresne, Caroline; Barone, Mark A; St-Hilaire, Karine
Background A wide variety of surgical techniques are used to perform vasectomy. The purpose of this systematic review was to assess if any surgical techniques to isolate or occlude the vas are associated with better outcomes in terms of occlusive and contraceptive effectiveness, and complications. Methods We searched MEDLINE (1966-June 2003), EMBASE (1980-June 2003), reference lists of retrieved articles, urology textbooks, and our own files looking for studies comparing two or more vasectomy surgical techniques and reporting on effectiveness and complications. From 2,058 titles or abstracts, two independent reviewers identified 224 as potentially relevant. Full reports of 219 articles were retrieved and final selection was made by the same two independent reviewers using the same criteria as for the initial selection. Discrepancies were resolved by involving a third reviewer. Data were extracted and methodological quality of selected studies was assessed by two independent reviewers. Studies were divided in broad categories (isolation, occlusion, and combined isolation and occlusion techniques) and sub-categories of specific surgical techniques performed. Qualitative analyses and syntheses were done. Results Of 31 comparative studies (37 articles), only four were randomized clinical trials, most studies were observational and retrospective. Overall methodological quality was low. From nine studies on vas isolation, there is good evidence that the no-scalpel vasectomy approach decreases the risk of surgical complications, namely hematoma/bleeding and infection, compared with incisional techniques. Five comparative studies including one high quality randomized clinical trial provided good evidence that fascial interposition (FI) increases the occlusive effectiveness of ligation and excision. Results of 11 comparative studies suggest that FI with cautery of the vas lumen provides the highest level of occlusive effectiveness, even when leaving the testicular end open. Otherwise, firm evidence to support any occlusion technique in terms of increased effectiveness or decreased risk of complications is lacking. Conclusions Current evidence supports no-scalpel vasectomy as the safest surgical approach to isolate the vas when performing vasectomy. Adding FI increases effectiveness beyond ligation and excision alone. Occlusive effectiveness appears to be further improved by combining FI with cautery. Methodologically sound prospective controlled studies should be conducted to evaluate specific occlusion techniques further. PMID:15157272
Gaines, Alexis R; Vidal, Adriana C; Freedland, Stephen J
Several studies have found associations between aggressive prostate cancer (PC) and having a vasectomy. However, findings from two very recent meta-analyses have found that this is not the case. Therefore, the data are mixed. Herein, we detail the controversy between vasectomy and PC risk, particularly aggressive PC, by shedding some light on the molecular pathways, potential risk factors and suggested links for those considering vasectomy and medical professionals who perform it. We conclude by supporting the American Urological Association's position that there is no need to discuss potential prostate cancer risks with patients considering vasectomy given reasonably strong data finding no link between vasectomy and prostate cancer risk. PMID:26402245
Vasectomy is a commonly performed and relatively safe procedure, with low reported rates of psychological morbidity, though there is some variability across studies. Depression following a vasectomy is relatively infrequent. A married man aged 30 developed a chronic depressive episode, lasting four years and resistant to an adequate trial of fluoxetine, following a vasectomy. His depression was heralded by a post-operative panic attack, and was accompanied by medically unexplained symptoms and the attribution of all his symptoms to the procedure – a belief that was shared by his family. Psychological complications of vasectomy have generally been studied under four heads: sexual dysfunction, effects on marital relationships, chronic post-operative pain, and other complications including anxiety and depression. These complications have generally been reported at higher rates in developing countries, and are linked to poor knowledge about the procedure and inadequate pre-operative counseling. The implications of the existing literature for the patient’s current complaints, and the mechanisms and risk factors involved, are discussed in the light of existing research. Suggestions for the prevention and treatment of post-vasectomy depression are also outlined. PMID:25553234
Seamans, Yancy; Harner-Jay, Claudia M
Background Vasectomy is generally considered a safe and effective method of permanent contraception. The historical effectiveness of vasectomy has been questioned by recent research results indicating that the most commonly used method of vasectomy – simple ligation and excision (L and E) – appears to have a relatively high failure rate, with reported pregnancy rates as high as 4%. Updated methods such as fascial interposition (FI) and thermal cautery can lower the rate of failure but may require additional financial investments and may not be appropriate for low-resource clinics. In order to better compare the cost-effectiveness of these different vasectomy methods, we modelled the costs of different vasectomy methods using cost data collected in India, Kenya, and Mexico and effectiveness data from the latest published research. Methods The costs associated with providing vasectomies were determined in each country through interviews with clinic staff. Costs collected were economic, direct, programme costs of fixed vasectomy services but did not include large capital expenses or general recurrent costs for the health care facility. Estimates of the time required to provide service were gained through interviews and training costs were based on the total costs of vasectomy training programmes in each country. Effectiveness data were obtained from recent published studies and comparative cost-effectiveness was determined using cost per couple years of protection (CYP). Results In each country, the labour to provide the vasectomy and follow-up services accounts for the greatest portion of the overall cost. Because each country almost exclusively used one vasectomy method at all of the clinics included in the study, we modelled costs based on the additional material, labour, and training costs required in each country. Using a model of a robust vasectomy program, more effective methods such as FI and thermal cautery reduce the cost per CYP of a vasectomy by $0.08 – $0.55. Conclusion Based on the results presented, more effective methods of vasectomy – including FI, thermal cautery, and thermal cautery combined with FI – are more cost-effective than L and E alone. Analysis shows that for a programme in which a minimum of 20 clients undergo vasectomies per month, the cost per CYP is reduced in all three countries by updated vasectomy methods. PMID:17629921
Background Male involvement in contraceptive use is increasingly becoming a global reproductive health issue. Vasectomy is one of the two male modern contraceptive methods espoused by the National Family Planning Policy in Ghana. Despite these advocacies, there are reports of low patronage of this method in Ghana. This study adhering to RATS guidelines on qualitative research therefore explored the social and cultural factors that may be affecting the low vasectomy uptake in Southern Ghana. Methods The study was conducted in Sefwi Bibiani-Ahwiaso Bekwai (SBAB) District and Komenda-Edina-Eguafo-Abrem (KEEA) Municipal area in the Western and Central regions of Ghana respectively. Twelve Focus Group Discussions were held with both male and female community members. In-depth interviews were also carried out with Community Health Officers (CHOs), Community Health Volunteers (CHVs) and health managers at both the district and regional levels. The discussions and interviews were recorded, transcribed verbatim and analysed using Nvivo 10. Results The study revealed that vasectomy was perceived as an act against God, which was punishable either by death or answerable on judgement day. Vasectomy was also perceived to be a form of castration, which can make men weak and incapable, thereby unable to satisfy their wives sexually, leading to marital conflicts. Women were more concerned about the negative effects of vasectomy on men. Cafalgin and panacin which are locally manufactured analgesics were perceived to have contraceptive abilities and therefore used by men as an alternative to modern contraceptive methods. Conclusions Stigma and the misconceptions in the community may be accounting for the low vasectomy uptake in Ghana despite several advocacy strategies. Women were highly influential in a man's decision on vasectomy. This calls for the need to increase health education to demystify the misconceptions about vasectomy. Vasectomy-related campaign messages should target both men and women. PMID:24885663
Shih, Grace; Dubé, Kate; Sheinbein, Miriam; Borrero, Sonya; Dehlendorf, Christine
Vasectomy has advantages with respect to safety and cost when compared with female sterilization. The reasons underlying the overall low use of vasectomy, particularly among Black and Latinos, have not been adequately explored. The goals of this study were to (a) explore the social context of vasectomy decisions and (b) generate hypotheses about the social factors contributing to differences in vasectomy use by race/ethnicity. Fourteen group and nine couples interviews were conducted. Participants were 37 heterosexual couples aged 25 to 55 years who had reached their desired family size and self-identified as Black, Latino, or White. Participants discussed reasons that men and women would or would not select male sterilization. Reasons to select vasectomy included a desire to care for their current family, sharing contraceptive responsibility, and infidelity. Reasons not to select vasectomy included negative associations with the term sterilization, loss of manhood, and permanence. Misconceptions about vasectomy included misunderstandings about the vasectomy procedure and adverse postvasectomy sexual function. In addition, Black and Latino participants cited perceived ease of reversibility of female sterilization and lack of support around vasectomy as reasons not to choose it. Improving communication and social support for vasectomy, particularly among Black and Latino communities, may improve vasectomy utilization. Misconceptions regarding female and male sterilization should be targeted in counseling sessions to ensure men, women, and couples are making informed contraceptive decisions. PMID:23144022
Xiang, Yu; Luo, Peng; Cao, Yun; Yang, Zheng-Wei
Spermatogenic damage may occur after vasectomy, and the damage is pressure mediated, occurring when the occluded reproductive tract is unable to accommodate additional sperm produced by the testis. This study aimed to determine the long-term effect of vasectomy on spermatogenesis in humans and clarify how the balance between sperm production in the testis and sperm storage in or removal from the tract might be maintained. During inguinal hernia repair, an open biopsy was performed to obtain testicular tissue blocks from 51 Chinese men (aged ?50 years), of whom 25 (control group) had not undergone vasectomy and 26 (vasectomized group) had undergone bilateral vasectomy 22-42 years before. Methacrylate resin-embedded testicular sections were made, and morphometric studies were performed using light microscopy. In addition, sizes of the testis and epididymis were estimated with ultrasonography. The testicular tissue blocks obtained from one control and seven vasectomized men consisted almost completely of connective tissue. In the other 43 men, significant differences were not found between the two groups in the testicular or epididymal size, qualitative histology or quantitative parameters including the mean diameter or volume fraction of the seminiferous tubules. In conclusion, sperm production and sperm storage/removal reached a static equilibrium after vasectomy, likely due to spermatogenic degeneration or less sperm production as a result of aging or due to vasectomy-induced testicular (interstitial) fibrosis. Thus, complications that might occur in association with overproduction of sperm and distension of the tract would disappear or be relieved with time. PMID:23435469
Shang, Yonggang; Han, Guangwei; Li, Jia; Zhao, Jiang; Cui, Dong; Liu, Chengcheng; Yi, Shanhong
Some studies have suggested that vasectomy is associated with the increased risk of prostate cancer, however, this conclusion is not supported by all the published studies. In order to examine the relationship between vasectomy and prostate cancer risk, we conducted a meta-analysis of cohort studies to clarify this controversial association. PubMed and Medline were used to identify the cohort studies that reported the association of vasectomy with prostate cancer risk from 1980 to January 2015. Based on a random effects model, the RR and 95% CI were used to assess the combined risk. In total, 10 cohort studies involving more than 7027 cases and 429914 participants were included. There was no significant relationship between vasectomy and prostate cancer risk, the pooled RR (95%CI) was 1.11[0.98, 1.27] (P = 0.109). In subgroup-analysis, the relationship between vasectomy and prostate cancer risk was not significantly modified by the length of follow-up and population distribution except Americans. Omission of any single study had little effect on the pooled risk estimate. Little evidence of publication bias was found. In conclusion, our meta-analysis suggests that vasectomy is not associated with the increased risk of prostate cancer. More studies based on other populations including the Chinese are needed. PMID:25927401
Shain, R N; Miller, W B; Holden, A E
Multivariate analyses of data from 248 married women scheduled for tubal sterilization and 165 wives of men scheduled for vasectomy indicated that male and female sterilization methods were selected for different reasons and under different circumstances. More specifically, the woman who underwent tubal sterilization was more likely to have perceived that she had greater influence than her husband over the sterilization decision, to have had cesarean section or vaginal delivery in association with sterilization, to have chosen tubal ligation because her spouse refused to undergo the alternative procedure or because it was convenient to combine it with delivery or other surgery, and to have had a spouse who was unwilling to be sterilized because of possible side effects associated with vasectomy. The woman whose husband underwent vasectomy was more likely to have been very fearful of surgery in general or especially fearful of reproductive surgery, to have known many men who already had had a vasectomy, to have perceived that her husband was more strongly motivated than herself to terminate childbearing, to have had a spouse who participated in birth control, and to have chosen vasectomy because it was easier or less expensive or because her physician advised against tubal sterilization. PMID:3967783
Liu, L H; Kang, R; He, J; Zhao, S K; Li, F T; Wan, S P; Zhao, Z G
The results of published literature focusing on the association between vasectomy and the incidence of prostate cancer are often inconsistent. We conducted a meta-analysis to provide a quantitative assessment of the association between vasectomy and the risk of prostate cancer. We identified all cohort studies by searching the PubMed, Embase, and Cochrane Library before August 2014. The quality of the studies was evaluated using the Newcastle-Ottawa Scale checklist. Summary effect estimates with 95% confidence intervals (CI) were derived using a fixed or random effects model, depending on the heterogeneity of the included studies. Nine cohort studies that spanned across two continents involving 1 127 096 participants (ages 20-75) with 7539 cases of prostate cancer cases were included in the meta-analysis. The overall combined relative risks for men with the reference group were 1.08 (95% CI: 0.87-1.34) in a random effects, however, the association was not statistically significant (p = 0.48). Estimates of total effects were generally consistent in the sensitivity and subgroup analyses. No evidence of publication bias was observed. This meta-analysis indicated that vasectomy may not contribute to the risk of prostate cancer. The conclusion might have a far-reaching significance for the public health, especially in countries with high prevalence rates of vasectomy. PMID:26041315
Barazani, Yagil; Kaouk, Jihad; Sabanegh, Edmund S.
The management of obstructive azoospermia resulting from intra-abdominal vasal obstruction poses a formidable surgical challenge. A number of surgical methods have been described to address this problem, including both open and laparoscopic approaches to mobilize and sometimes even re-route the abdominal vas deferens prior to performing a re-anastamosis. We present the first report, to our knowledge, of robotic intra-abdominal vasectomy reversal used to repair obstructive azoospermia resulting from prior laparoscopic vasectomy. In doing so, we summarize the techniques described previously in the literature and build upon this body of surgical experience by combining robotic-assisted laparoscopic mobilization of the vas with robotic vasovasostomy. We believe this novel approach for repairing intra-abdominal vasal defects minimizes morbidity, while at the same time obviating the need for the operating microscope, and thus represents a practical alternative to existing techniques. PMID:25024801
Marais, Hendrik J; Hendrickson, Dean A; Stetter, Mark; Zuba, Jeffery R; Penning, Mark; Siegal-Willott, Jess; Hardy, Christine
Several small, enclosed reserves in southern Africa are experiencing significant elephant population growth, which has resulted in associated environmental damage and changes in biodiversity. Although several techniques exist to control elephant populations, e.g., culling, relocation, and immunocontraception, the technique of laparoscopic vasectomy of free-ranging bull elephants was investigated. Bilateral vasectomies were performed in 45 elephants. Of these elephants, one died within 24 hr of recovery and two had complications during surgery but recovered uneventfully. Histologic examination confirmed the resected tissue as ductus deferens in all the bulls. Most animals recovered uneventfully and showed no abnormal behavior after surgery. Complications recorded included incisional dehiscence, 1 full-thickness and 2 partial-thickness lacerations of the large intestine, and initial sling-associated complications, for example, deep radial nerve paresis. One bull was found dead 6 weeks after surgery without showing any prior abnormal signs. Vasectomy in free-ranging African bull elephants may be effectively performed in their normal environment. The surgical procedure can be used as a realistic population management tool in free-ranging elephants without major anesthetic, surgical, or postoperative complications. PMID:24437080
Cilip, Christopher M; Allaf, Mohamad E; Fried, Nathaniel M
A noninvasive approach to vasectomy may eliminate male fear of complications related to surgery and increase its acceptance. Noninvasive laser thermal occlusion of the canine vas deferens has recently been reported. Optical coherence tomography (OCT) and high-frequency ultrasound (HFUS) are compared for monitoring laser thermal coagulation of the vas in an acute canine model. Bilateral noninvasive laser coagulation of the vas was performed in six dogs (n=12 vasa) using a Ytterbium fiber laser wavelength of 1075 nm, incident power of 9.0 W, pulse duration of 500 ms, pulse rate of 1 Hz, and 3-mm-diameter spot. Cryogen spray cooling was used to prevent skin burns during the procedure. An OCT system with endoscopic probe and a HFUS system with 20-MHz transducer were used to image the vas immediately before and after the procedure. Vasa were then excised and processed for gross and histologic analysis for comparison with OCT and HFUS images. OCT provided high-resolution, superficial imaging of the compressed vas within the vas ring clamp, while HFUS provided deeper imaging of the vas held manually in the scrotal fold. Both OCT and high HFUS are promising imaging modalities for real-time confirmation of vas occlusion during noninvasive laser vasectomy. PMID:22559684
Alpcan, Serhan; Ba?ar, Halil; Aydos, Tolga Re?at; Kul, O?uz; K?sa, Üçler; Ba?ar, Murad Mehmet
Objective: We aimed to investigate the changes in endothelial nitric oxide synthase (eNOS) and inducible nitric oxide synthase (iNOS) expression and apoptotic index in rat testicular tissue, as well as serum and seminal plasma sex hormone levels after vasectomy, and the effect of ozone therapy (OT). Material and methods: Adult male Wistar rats were used (n=6 per group). Control (G1), sham for 4 weeks (G2) or 6 weeks (G3), orchiectomy at the 4th (G4) or 6th (G5) week after left vasectomy, orchiectomy at the 4th (G6) or 6th (G7) week after bilateral vasectomy, orchiectomy after 6 weeks OT following left (G8) or bilateral (G9) vasectomy, orchiectomy after 6 weeks OT (G10). Results: In the left testes, while there were increases in eNOS and iNOS immunoreactivity and apoptotic indexes in G4 and G5, no changes were observed in contralateral testis. These values increased in G6 and G7, while OT inhibited these parameters in the left testis of G8 and both testes of G9. Sex hormone levels did not show any changes after vasectomy and ozone therapy. Conclusion: While OT was found to be protective against some parameters mentioned above under stress conditions, it seemed to cause some harmful effects when used in healthy conditions.
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... we're using bipolar forceps. This prevents inadvertent thermal injury to healthy issues. Since electrical current is ... the ability to move the anastomosis. during the performance of the anastomosis. and gains control. This measures ...
Bermejo-Alvarez, Pablo; Park, Ki-Eun; Telugu, Bhanu P
The transfer of preimplantation embryos to a surrogate female is a required step for the production of genetically modified mice or to study the effects of epigenetic alterations originated during preimplantation development on subsequent fetal development and adult health. The use of an effective and consistent embryo transfer technique is crucial to enhance the generation of genetically modified animals and to determine the effect of different treatments on implantation rates and survival to term. Embryos at the blastocyst stage are usually transferred by uterine transfer, performing a puncture in the uterine wall to introduce the embryo manipulation pipette. The orifice performed in the uterus does not close after the pipette has been withdrawn, and the embryos can outflow to the abdominal cavity due to the positive pressure of the uterus. The puncture can also produce a hemorrhage that impairs implantation, blocks the transfer pipette and may affect embryo development, especially when embryos without zona are transferred. Consequently, this technique often results in very variable and overall low embryo survival rates. Avoiding these negative effects, utero-tubal embryo transfer take advantage of the utero-tubal junction as a natural barrier that impedes embryo outflow and avoid the puncture of the uterine wall. Vasectomized males are required for obtaining pseudopregnant recipients. A technique to perform vasectomy is described as a complement to the utero-tubal embryo transfer. PMID:24637845
Minor, Agata; Chow, Victor; Ma, Sai
Male factor infertility has been associated with abnormal DNA methylation at imprinted genes. Little information is available on the status of imprinting in the sperm of men with azoospermia, including the association between aberrant imprinting and obstructive azoospermia (OA) or non-OA (NOA). Analysis of DNA methylation at imprinted genes in the sperm of men undergoing vasectomy reversal would aid determination of whether aberrant imprinting is associated with obstruction. Testicular sperm was retrieved from testicular biopsies obtained from men with azoospermia (N=18), including OA (N=10), NOA (N=5), and unknown pathology (N=3), and from men undergoing vasectomy reversal (N=17). Sperm was also obtained from proven fertile men (N=9). DNA methylation was investigated at multiple CpG sites within the differentially methylated regions (DMRs) of three imprinted genes, H19, IG-GTL2 and MEST, using bisulphite sequencing. Unique clones representative of single cells were analyzed. We found a significant decrease in DNA methylation at the H19 DMR in testicular sperm of azoospermic men compared with proven fertile men. The decrease was also significant between OA and proven fertile men, and between men undergoing vasectomy reversal and proven fertile men, suggesting that aberrant DNA methylation may be associated with obstruction. Changes in DNA methylation at IG-GTL2 and MEST DMRs among groups were not significant. Our data suggest that imprinting abnormalities may be associated with obstruction and may occur in response to changes in testicular environment and not only spermatogenesis failure, as previously reported. Methylation at the H19 DMR was particularly prone to modification in testicular sperm. PMID:21389080
Seppan, Prakash; Krishnaswamy, Kamakshi
This study was aimed to investigate the long-term effect of vasectomy using the bonnet monkey (Macaca radiata) as a primate animal model. Animals weighing around 6 to 8 kg were randomly chosen for bilateral, unilateral vasectomy and sham-control. The postoperative periods of six months and two years were considered as short and long-term, respectively. Sperm were collected and subjected to analysis before euthanasia. The testes and epididymides were excised from euthanized animals then embedded in paraffin. Normal histological changes were observed in sham-operated animals and short-term contralateral testes. In contrast, marked alterations were observed in the testes and epididymides of both short and long-term groups. Seminiferous epithelium was thinned out showing marked depletion of germ cells in long-term; only a thin layer of Sertoli cells, spermatogonia, and fewer spermatocytes were seen. Exfoliation of germ cells and the occurrence of multinucleated giant cells were common features in these tubules. The epididymal tubular lumens were greatly dilated with accumulated spermatozoa in short and long-term animals; significant defects were observed in the epithelium of the long-term animals. Microscopic spermatic granulomas were noticed in epididymides and the vas deferens. Large granulomas were seen in long-term vasectomized monkeys, frequently compressing the surrounding structures. These granulomas could be visualized in ultrasound, however, only at the late stage of its occurrence. Sperm collected from the unilateral vasectomized animals showed a poor motility score in the capillary mucus penetration test (CMPT). Results indicate that the changes observed after vasectomy might be due to pressure initially, whereas in the long-term the damage was supplemented by autoimmune attack. With immunoglobulin (IgG) deposition in contra-lateral unoperated testis of unilateral vasectomized animals it also showed degenerative changes and a concomitant drop in sperm quality. Although, granulomatous reactions were observed in the epididymis and vas deferens but testes were spared from such reactions even in the long-term. PMID:24593799
In the 1920s, research on the endocrine glands--especially the sex glands--was widely expected to lead to revolutionary new ways of improving human life. The medical marketplace was crowded with glandular techniques to revitalize the aged. 'Monkey glands' apart, the Austrian physiologist Eugen Steinach's simple, vasectomy-like operation was perhaps the most popular of these. Steinach was one of the leading endocrine researchers of the early 20th century and the Steinach Operation was based on rigorous laboratory research. It was much more than a simple scientific error, and its history shows us how early endocrine research was shaped by broader social and cultural forces. PMID:12965155
Leach, Matthew C.; Klaus, Kristel; Miller, Amy L.; Scotto di Perrotolo, Maud; Sotocinal, Susana G.; Flecknell, Paul A.
Background Current behaviour-based pain assessments for laboratory rodents have significant limitations. Assessment of facial expression changes, as a novel means of pain scoring, may overcome some of these limitations. The Mouse Grimace Scale appears to offer a means of assessing post-operative pain in mice that is as effective as manual behavioural-based scoring, without the limitations of such schemes. Effective assessment of post-operative pain is not only critical for animal welfare, but also the validity of science using animal models. Methodology/Principal Findings This study compared changes in behaviour assessed using both an automated system (“HomeCageScan”) and using manual analysis with changes in facial expressions assessed using the Mouse Grimace Scale (MGS). Mice (n?=?6/group) were assessed before and after surgery (scrotal approach vasectomy) and either received saline, meloxicam or bupivacaine. Both the MGS and manual scoring of pain behaviours identified clear differences between the pre and post surgery periods and between those animals receiving analgesia (20 mg/kg meloxicam or 5 mg/kg bupivacaine) or saline post-operatively. Both of these assessments were highly correlated with those showing high MGS scores also exhibiting high frequencies of pain behaviours. Automated behavioural analysis in contrast was only able to detect differences between the pre and post surgery periods. Conclusions In conclusion, both the Mouse Grimace Scale and manual scoring of pain behaviours are assessing the presence of post-surgical pain, whereas automated behavioural analysis could be detecting surgical stress and/or post-surgical pain. This study suggests that the Mouse Grimace Scale could prove to be a quick and easy means of assessing post-surgical pain, and the efficacy of analgesic treatment in mice that overcomes some of the limitations of behaviour-based assessment schemes. PMID:22558191
Freitag, B.; Sroka, R.; Koelle, S.; Becker, A. J.; Khoder, W.; Pongratz, T.; Stief, C. G.; Trottmann, M.
Introduction and objective: Vasectomy is a well-established method in family control. Even though it is a safe and low risk operation, this surgery is invasive and difficult to reverse. Therefore the aim of this study was to investigate new non-invasive methods for occlusion of the seminal duct. Material and Methods: Seminal duct tissue was obtained from patients (n=30) suffering from prostate cancer and therefore undergoing prostatectomy. In a first set of experiments, the seminal duct was occluded by intraluminal application of Histoacryl® (Braun Aesculap AG, Tuttlingen, Germany). In a 2nd set of experiments, endoluminal laser induced occlusion was performed. Four different laser wavelengths (1940nm, 1470nm, 1064nm, 940nm) and different sets of laser parameters (e.g. power, exposure duration, fibre diameter, energy applied) were compared. Effectiveness of occlusion of the seminal duct was proven by post-treatment irrigation flow measurement, as well as by morphological analyses. To evaluate a potential damage of the surrounding tissue, external temperature was measured using a thermometer during laser application. Results: Intraluminal application of Histoacryl® induced an immediate and complete occlusion of the seminal duct. The underlying connective tissue maintained its functional integrity after this treatment. By laser light application to a Histoacryl® block, a hole could be created into the block thus indicating the possibility of recanalization. Treatment with laser energy resulted in shrinkage of the ductal lumen. The laser application generally caused necrosis in the epithelium and induced formation of vacuoles in the underlying connective tissue. As described for endoluminal varicose treatment, this distinct local reaction might result in an intense inflammation leading to a functional occlusion of the vas deferens. Conclusions: Both laser-induced occlusion and application of Histoacryl® are fast and simple techniques which may be able to achieve a functional occlusion of the seminal duct. The application of Histoacryl® additionally may be easily reversible by laser treatment.
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Washington at Seattle, University of
said. UW Medicine writer Mary Guiden contributed to this report. To refer a patient or learn more this technology, patient's experience and outcomes will continue to advance with it. What the future holds procedure, but the robot, suspended above the patient, cannot transfer the movement of a patient
... NCHS Home Surveys and Data Collection Systems Key Statistics from the National Survey of Family Growth V ... Survey of Family Growth Staff Division of Vital Statistics National Center for Health Statistics 3311 Toledo Road ...
Schandiz, Hossein; Olav Hermansen, Nils; Jørgensen, Trond; Roald, Borghild
Staphylococcus lugdunensis is a coagulase-negative Staphylococcus (CoNS), and part of the normal skin flora. The bacterium is an emerging pathogen that, unlike other CoNS, resembles coagulase-positive Staphylococcus aureus infections in virulence, tissue destruction, and clinical course. We report a fatal case following minor surgery. The frequency of S. lugdunensis infections has probably been underestimated and under-reported in the past as few clinical laboratories routinely identify coagulase-negative Staphylococci. PMID:26058423
Population Council, New York, NY.
"Kerala's Pioneering Experiment in Massive Vasectomy Camps," the principal article in this monthly publication of the Population Council, is a detailed research report on the success of a massive vasectomy camp conducted at Cochin, the capital city of the Ernakulam District of Kerala State, India. The second article, "The Gujarat State Massive…
Chetkovich, Carol; Mauldon, Jane; Brindis, Claire; Guendelman, Sylvia
tubes tied) male sterilization (partner had vasectomy) IUD film (vaginal contraceptive film) other ways of making love (oral sex,tubes tied) male sterilization (partner had vasectomy) IUD film (vaginal contraceptive film) other ways of making love (oral sex,sex with men often I don=t think I can get pregnant (but I have not been sterilized/had my tubes
Foreit, K G; de Castro, M P; Franco, E F
The effect of magazine advertising on vasectomy acceptance was tested in São Paulo, Brazil. Four advertisements ran for ten weeks in eight magazines. Clinic performance doubled during the campaign and stabilized at 54 percent higher than baseline. The advertisements selectively attracted the target audience without bringing in large numbers of ineligible candidates, completely avoided negative reactions, and recruited men previously unexposed to vasectomy. The cost of the advertising campaign was offset by additional revenue generated by the increase in vasectomies performed. The results suggest that while interpersonal communications can maintain performance in voluntary sterilization programs, mass media promotion may be necessary for program growth. PMID:2497560
...Dental Care From Nonnaval Sources § 732.15 Unauthorized care. The following are not authorized by this part: (a) Chiropractic services. (b) Vasectomies. (c) Tubal ligations. (d) Breast augmentations or reductions. (e)...
Gartrell, Nanette K.; Bos, Henny M.W.; Goldberg, Naomi G.
birth control pills, condoms, vasectomy, Depo-Provera or injectables, Norplant implants, diaphragm, female condom, vaginalbirth? ’’ 17-year-old boys Sex with girls ‘‘Have you ever engaged in heterosexual vaginal,
...GENERAL PROVISIONS STANDARDS OF CARE FOR CHIMPANZEES HELD IN THE FEDERALLY SUPPORTED SANCTUARY SYSTEM § 9.7 Reproduction. Chimpanzee reproduction is prohibited...experienced in performing vasectomies in chimpanzees should perform the operation....
...GENERAL PROVISIONS STANDARDS OF CARE FOR CHIMPANZEES HELD IN THE FEDERALLY SUPPORTED SANCTUARY SYSTEM § 9.7 Reproduction. Chimpanzee reproduction is prohibited...experienced in performing vasectomies in chimpanzees should perform the operation....
New techniques are being developed for permanent male and female sterilization. The new methods are cheaper, easier to use, and effective. Vassoclude, a device under development by the Population Council, is used in the no-scalpel vasectomy technique. A pin hole created by the Vassoclude opens the way to apply a staple-like mechanism to place clips on the vas deferens. The method requires less manual dexterity than other tools, and there is no puncture hole. A new female method uses quinacrine hydrochloride pellets, which are inserted into the uterus with an IUD inserter. Permanent scarring of the fallopian tubes prevents pregnancy. The method is cheap, safe, and easy to use. The disadvantage is that multiple visits are required before the fallopian tubes are blocked. About 500,000 women currently use quinacrine worldwide. There have been few clinical trials. Most of the women live in Vietnam and Pakistan. Toxicological tests conducted by the US Food and Drug Administration and the World Health Organization have shown the product not to be safe. The Association for Voluntary Surgical Contraception reports that there are 140 million couples relying on female sterilization worldwide, while only 42 million men undergo vasectomies. In the US, reports are that 23% of American couples rely on tubal ligations, compared to 13% relying on vasectomy. 500,000 men underwent vasectomies in the US in 1991. Neither quinacrine nor the Vassoclude was available in the US in 1993. There is little interest in producing and marketing vasectomy tools, and studies continue to examine vasectomy's side effects or links with cancer, which discourages the choice of vasectomy as a contraceptive method. PMID:12288088
Hirschowitz, L; Rode, J; Guillebaud, J; Bounds, W; Moss, E
To establish the prevalence of vasitis nodosa in patients who had undergone vasectomy segments of vas deferens resected from 40 patients at the time of vasectomy reversal were examined histologically and immunohistochemically. The findings were correlated with clinical history and postoperative outcome. Controls comprised segments of normal vas deferens excised at vasectomy. Twenty of the 40 vasovasostomy specimens showed vasitis nodosa; in 13 this was associated with sperm granulomas and in two with spermatocoeles. The vasitis nodosa was characterised by multiple small ductules extending from the central lumen of the vas into the muscle layers and adventitia. In 14 cases there was mucinous metaplasia of the epithelium lining the ductules. The number of nerve fibres in the submucosa and muscle layers was reduced after vasectomy. In patients with vasitis, however, hyperplasia of nerve fibres in the adventitia (16 of 20 cases) and formation of neuromas were seen. Nerve fibre hyperplasia was seen in only one, and sperm granulomas and spermatocoeles in none of the 20 specimens without vasitis nodosa. The development of vasitis nodosa was independent of the patients' age or the interval between vasectomy and reversal. The restoration of fertility did not seem to be affected by previous vasitis nodosa. Images Fig 1 Figs 2a and b Fig 3 Fig 4 Fig 5 PMID:3366928
Michielsen, Dirk; Beerthuizen, Rob
A systematic Medline/PubMed and Cochrane Library review of the literature was carried out with regard to technique, effectiveness, safety and complications of male sterilisation. Vasectomy is an outpatient procedure which can be performed under local anaesthesia. The vas deferens is accessed by means of either a conventional incision with a scalpel or by using the 'no-scalpel technique'. A closed-ended vasectomy (by means of suture ligature, surgical clips or electrocautery) or the open-ended alternative is then carried out. Each of these techniques has both advantages and drawbacks. Fascial interposition has been shown to reduce the risk of failure. A promising alternative for occluding the vas consists of placing an intra-vas device. Haematoma and pain are the most common complications. Non-steroidal anti-inflammatory drugs, narcotic analgesics and neuroleptic drugs are effective for treatment of pain. The success of vasectomy reversal ranges from 30-60%. The data on record convincingly demonstrate that vasectomy is a safe and cost-effective intervention for permanent male contraception. The no-scalpel vasectomy under local anaesthesia is recommended. Occlusion of the vas is most successful when performed by means of an electrocautery; fascial interposition should complete the procedure. PMID:20230339
Rogers, Everett M.
A review of four quasi-experiments on family planning incentives in three Asian nations is presented, and a multi-national comparative field experiment on family planning incentives is proposed. Experiments include: (1) The Ernakulam vasectomy campaigns, (2) Indian Tea Estates retirement bond incentive program, (3) Taiwan educational bond…
DTP’s Biological Testing Branch oversees animal-production facilities that produce inbred, outbred, and hybrid strains of rats and mice. This program provides researchers nationwide with genetically defined, pathogen-free laboratory animals, as well as animal-related services such as jugular vein cannulations, vasectomies, ovariectomies, and castrations.
Renata Forste; Koray Tanfer; Lucky Tedrow
Data from the 1991 National Survey of Men indicate that about 12% of married men aged 20-39 have had a vasectomy and about 13% are married to a woman who is sterilized. Multivariate analyses indicate that the likelihood of sterilization rises with husband's age, wife's age, duration of marriage and number of children. Black couples are significantly less likely than
Davis, J E
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. PMID:337192
Silber, Sherman J; Barbey, Natalie; Lenahan, Kathy; Silber, David Z
Reversible contraception that does not alter natural behavior is a critical need for managing zoo populations. In addition to reversible contraception, other fertility techniques perfected in humans may be useful, such as in vitro fertilization (IVF) or oocyte and embryo banking for endangered species like amphibians and Mexican wolves (Canis lupus baileyi). Furthermore, the genetics of human fertility can give a better understanding of fertility in more exotic species. Collaborations were established to apply human fertility techniques to the captive population. Reversible vasectomy might be one solution for reversible contraception that does not alter behavior. Reversible approaches to vasectomy, avoiding secondary epididymal disruption, were attempted in South American bush dogs (Speothos venaticus), chimpanzees (Pan troglodytes), gorillas (Gorilla gorilla), Przewalski's horse (Equus przewalski poliakov), and Sika deer (Cervus nippon) in a variety of zoos around the world. These techniques were first perfected in > 4,000 humans before attempting them in zoo animals. In vitro fertilization with gestational surrogacy was used to attempt to break the vicious cycle of hand rearing of purebred orangutans, and egg and ovary vitrification in humans have led to successful gamete banking for Mexican wolves and disappearing amphibians. The study of the human Y chromosome has even explained a mechanism of extinction related to global climate change. The best results with vasectomy reversal (normal sperm counts, pregnancy, and live offspring) were obtained when the original vasectomy was performed "open-ended," so as to avoid pressure-induced epididymal disruption. The attempt at gestational surrogacy for orangutans failed because of severe male infertility and the lack of success with human ovarian hyperstimulation protocols. Vitrification of oocytes is already being employed for the Amphibian Ark Project and for Mexican wolves. Vasectomy can be a reversible contraception option in zoo animals, even in endangered species. Ongoing use of gamete and embryo freezing may salvage vanishing species. PMID:24437091
The defendant physician was charged with negligence and breach of contract in the performance of a tubal ligation on the plaintiff. After the plaintiff became pregnant and gave birth to twins, she and her husband sought damages for pecuniary losses resulting from the birth of twins, claiming that the defendant should have warned them of the risk of failure of the operation or mentioned the alternative of performance of a vasectomy on the husband. The Supreme Court of Victoria, Australia, held that the defendant had no duty to inform the plaintiffs of the risk of failure or the alternative of a vasectomy since his actions accorded with accepted practice within the profession. It also concluded that, even if he had warned the plaintiffs, they would not have withheld their consent to the operation. PMID:12289437
Addressing a conference of Parliament members on population and development in New Delhi, Prime Minister Indira Gandhi was reported to have informed the gathering that results of India's latest census "shocked us." The census counted a total national population of 683 million. It was 11 million more than officially anticipated. In her speech, Mrs. Gandhi was also reported to have reiterated that her government is totally committed to "voluntary family planning" and "firmly against compulsion." J.R.D. Tata, chairman of the Family Planning Foundation of India, proposed that the government raise monetary incentives for citizens voluntarily opting for vasectomy and tubectomy. He suggested that the present Rs. 200 for vasectomy and tubectomy be upped to Rs. 5000. He made the proposal in a call to the government to increase its outlay for the family planning program. PMID:12337557
Forste, R; Tanfer, K; Tedrow, L
Data from the 1991 National Survey of Men indicate that about 12% of married men aged 20-39 have had a vasectomy and about 13% are married to a woman who is sterilized. Multivariate analyses indicate that the likelihood of sterilization rises with husband's age, wife's age, duration of marriage and number of children. Black couples are significantly less likely than white couples to rely on sterilization, and interracial couples are less likely than same-race couples to be sterilized. The likelihood of reliance on vasectomy rather than tubal ligation also rises with husband's age, while black men are significantly less likely than white men to elect male over female sterilization. Use of male sterilization is strongly associated with having had a recent contraceptive failure while using a male method. PMID:7672099
Voluntary surgical contraception (VCS) includes all surgical procedures that produce permanent or nonpermanent contraceptive effects in both male and females. New developments in the marketing of VSC services and the methods of VSC are summarized. Resistance to VSC, especially vasectomy, has been high even when it is made convenient, safe and low-cost or free; traditional information, education and communication (IEC) activities have not been effective. The Population and Community Development Association (PDA) in Thailand has had much more success by marketing vasectomy as a consumer product, using business sector techniques such as professional advertising promotion, a Vasectomy Members Club with discount privileges in stores and social activities to help spread the word, multiple service outlets and client-oriented service. Improved methods of VSC include Ramathibodi uterine elevation, laprocator (laparoscope for single puncture tubal sterilization) and puncture technique for vasectomy. New products include Norplant and Norplant-2 implants, developed by the Population Council, New York, for female contraception. These subdermal implants contain the progestogen, levonorgestrel, in silastic-silicone tubing. The hormone is released into the bloodstream and provides effective protection for 5 years. Insertion and removal require training but are not difficult and the method is reversible at any time. Side effects have been bleeding irregularities and amenorrhea. Studies in Thailand and Indonesia have shown high acceptance and continuation rates for the implants. Lastly, chemical occlusion of the vas deferens by a percutaneous intravasal injection of a liquid drug (carbolic acid and butyl-cynoacrylate mixture) has been developed in China for permanent male sterilization. PMID:12342424
The first hospital to offer no-scalpel vasectomy services in La Paz, Bolivia, introduced its program in 1996. However, over the course of 2 years, only 1 vasectomy was performed. Vasectomy services in La Paz are underutilized due to inadequate counseling, outreach, and use of educational materials. While the national health and population policy mandates the provision of comprehensive reproductive health care for both men and women, Bolivian men rarely seek health care services of any kind because most services are designed mainly for women and children. The only services offered to men are urology related, which focus upon screening for STDs, and workplace-related services, such as for factory workers and miners. Nongovernmental organizations (NGO) are exploring how to increase men's involvement in health care and family planning services. Men need to be made aware of gender issues related to reproductive and sexual health. The Centro de Investigacion Social Tecnologia Apropriada y Capacitacion (CISTAC), a Bolivian NGO which focuses upon research and training in health and social issues, plans to use research, training, and information dissemination to broaden the male role and identity in Bolivia, which will also affect men's access to and receipt of health care services. Toward that end, CISTAC and AVSC co-sponsored a workshop to teach health care program managers about the relationship between gender issues and men's involvement in reproductive health care. PMID:12321882
Jacobsen, Kirsten R; Kalliokoski, Otto; Teilmann, Anne C; Hau, Jann; Abelson, Klas SP
Recognition of pain and stress is a common challenge when working with laboratory mice. The aim of the current study was to identify noninvasive parameters to assess the severity and duration of possible pain and stress after vasectomy in BALB/c mice. Mice underwent isoflurane anesthesia with or without vasectomy. Body weight, food and water intake, and fecal corticosterone metabolites (FCM) were measured 3 d before and 3 d after the procedure. Behavior was recorded 1, 2, 4, and 8 h after the procedure. Food and water consumption and defecation were reduced postoperatively in the vasectomized group compared with mice given anesthesia only. FCM were elevated the first day after anesthesia in the control mice but not in the vasectomized group. Vasectomy resulted in behavioral changes that were not seen in the group that was anesthetized only. In conclusion, food and water consumption and pain-related behaviors, but not FCM, may be useful as noninvasive parameters to assess postoperative pain and stress in vasectomized mice. PMID:22330871
Cilip, Christopher M.; Ross, Ashley E.; Jarow, Jonathan P.; Fried, Nathaniel M.
Development of a noninvasive vasectomy technique may eliminate male fear of complications and result in a more popular procedure. This study explores application of an optical clearing agent (OCA) to scrotal skin to reduce laser power necessary for successful noninvasive laser vasectomy and eliminate scrotal skin burns. A mixture of dimethyl sulfoxide and glycerol was noninvasively delivered into scrotal skin using a pneumatic jet device. Near-infrared laser radiation was delivered in conjunction with cryogen spray cooling to the skin surface in a canine model, ex vivo and in vivo. Burst pressure (BP) measurements were conducted to quantify strength of vas closure. A 30-min application of OCA improved skin transparency by 26+/-3%, reducing average power necessary for successful noninvasive laser vasectomy from 9.2 W without OCA (BP=291+/-31 mmHg) to 7.0 W with OCA (BP=292+/-19 mmHg). Control studies without OCA at 7.0 W failed to coagulate the vas with burst pressures (82+/-28 mmHg) significantly below typical ejaculation pressures (136+/-29 mmHg). Application of an OCA reduced the laser power necessary for successful noninvasive thermal coagulation of the vas by ~25%. This technique may result in use of a less expensive laser and eliminate the formation of scrotal skin burns during the procedure.
Diconsiglio, J M
In Bogota, Columbia, one of Profamilia's 8 male-only family planning (FP) clinics, which provide vasectomies and counsel men on topics such as how to avoid sexually transmitted diseases and how to cope with the needs of their families, can barely satisfy the demand for condoms. Providers explain this phenomenon in a country where the contraceptive prevalence rate for condoms is very low by suggesting that the men simply had to be asked to try condoms. Men not only have to be asked, however, they have to be asked in the right way. With resources for women still scarce, many FP personnel believe that it would be a waste of time to focus efforts on men. Others point out that FP clinics are female-centered are and suggest that men must be viewed as a very important part of any effort to prevent unwanted pregnancies. With the presence of AIDS in the heterosexual community, male contraception has moved from being desirable to being essential. Also, through the worldwide focus on women's status worldwide, many women are feeling empowered to demand an increased male role in contraception. The Chinese no-scalpel technique for vasectomy has spread throughout much of the world, and 42 million couples rely on vasectomy. However, in many developing countries, most men insist on achieving their desired family size and typically have more children than women. Despite this interest in producing babies, men rarely participate in child care activities. Through a variety of new male-targeted programs in the US and in developing countries, new techniques to involve men in FP responsibilities will be developed and disseminated. In the meantime, women will get center-stage at the 1994 International Conference on Population and Development in Cairo, and men will continue to receive condoms in Bogota. PMID:12345752
Labrecque, Michel; Hamel, Jean-Francois; Prévost, Jean-François; Warren, Louis
The rate of non-compliance with the post-vasectomy semen examination procedure at the Centre Hospitalier de l'Université Laval (CHUL) between October 1, 1985 and March 31, 1987 was 21%, one of the highest in the literature. The purpose of our study was to determine the causes of this situation. The socio-demographic profile obtained from the computerized files of 50 patients who did not comply with the procedure was comparable to that of the 183 patients who did comply. A telephone survey of 43 non-compliant patients was carried out. In 70% of the responses to an open question on the reasons for non-compliance, the subject cited on his own negligence. In response to the closed questions, the constraints involved in the semen examination procedure were cited most often (49%). In the responses to both open and closed questions, a lack of information was cited least often. There is not a distinctive profile among vasectomy patients at the CHUL that would make it possible to predict compliance. Despite the fact that it would be difficult to improve the factors associated with patient negligence, it might be possible to increase compliance by following up more closely and lessening the constraints. PMID:21249056
India adds each year the population of Sub-Saharan Africa to the earth. User based factors determining the type of contraceptive that is used most often in a country are sociocultural practices including religion, literacy, women's status and their role in decision making, men's status, misconceptions, and convenience of use. Service related factors include knowledge and skill of the provider, attitude of the provider, accessibility of family planning services, cost of the contraceptives, and quality of services. The government, nongovernmental organizations, and the pharmaceutical firms tend to be the contraceptive researchers and suppliers. The mass media are used to disseminate information on contraceptives. They often relay sensational reports about a contraceptive method that results in its reduced use. Temporary or spacing family planning methods include natural family planning methods, condoms, IUDs, oral contraceptives, implants, and injectables, spermicides and vaginal barriers. The natural family planning methods are sexual abstinence, especially in the postpartum period; rhythm or calendar method; and coitus interruptus. The most cost-effective method is also the most popular method--sexual sterilization. Even though female sterilization is more difficult to perform than vasectomy, it is more common than vasectomy. Contraception should become a people's movement rather than be forced upon the people. People should insist on good quality, affordable contraceptive services as their basic right. PMID:12345776
Kawachi, I; Colditz, G A; Hankinson, S
A risk-benefit analysis of five alternative approaches to fertility control among US women over the age of 30 was performed: tubal ligation, vasectomy, intrauterine device, barrier method (condom), and combined oral contraceptives. Taken into account were age-specific probabilities of contraceptive failure, fecundability, spontaneous abortion, reproductive mortality (ectopic pregnancy, delivery, or induced abortion), life table mortality, and mortality from specific cancer sites (ovarian, endometrial, breast, and prostate) and cardiovascular disease. Relative to women using no contraceptive precautions, the use of any method of contraception between the ages of 30 and 50 was associated with net benefit in terms of averted deaths. However, when duration of observation was extended up to age 80, we predicted an excess of about 880 deaths from prostate cancer per 100,000 users of vasectomy. Other methods continued to be associated with net benefit, ranging from 130 to 360 deaths averted per 100,000 users. It was concluded that the non-reproductive risks and benefits of contraceptive methods continue to be relevant long after the reproductive years. The balance of risks and benefits may differ in other countries with different cause-specific and life table mortality rates. PMID:7924318
Wang, Christina; Swerdloff, Ronald S.
Purpose of review Condoms and vasectomy are male controlled family planning methods but suffer from limitations in compliance (condoms) and limited reversibility (vasectomy); thus many couples desire other options. Hormonal male contraceptive methods have undergone extensive clinical trials in healthy men and shown to be efficacious, reversible and appear to be safe. Recent Findings The success rate of male hormonal contraception using injectable testosterone alone is high and comparable to methods for women. Addition of progestins to androgens improved the rate of suppression of spermatogenesis. Supported by government or non-government organizations, current studies aim to find the best combination of testosterone and progestins for effective spermatogenesis suppression and to explore other delivery methods for these hormones. Translation of these advances to widespread use in the developed world will need the manufacturing and marketing skills of the pharmaceutical industry. Availability of male contraceptives to the developing world may require commitments of governmental and non-governmental agencies. In a time when imbalance of basic resources and population needs are obvious, this may prove to be a very wise investment. Summary Male hormonal contraception is efficacious, reversible and safe for the target population of younger men in stable relationships. Suppression of spermatogenesis is achieved with a combination of an androgen and a progestin. Partnership with industry will accelerate the marketing of a male hormonal contraceptive. Research is ongoing on selective androgen and progesterone receptor modulators that suppress spermatogenesis, minimize potential adverse events while retaining the androgenic actions. PMID:20808223
Spence, C E; Kenyon, J E; Smith, D R; Hayes, R D; Baer, A M
The objective of the study was to determine whether surgical sterilization of both males and females in wolf pairs alters basic wolf social and territorial behaviors. Wolves were located from the air by snow-tracking methods and were tranquilizer-darted from a helicopter. Surgeries were performed either in a tent at the capture site or in a heated building in a nearby village. Six vasectomies and seven uterine horn ligations were performed in January and February of 1996 and 1997. Two females died: one likely related to the capture procedure, the other of a peritonitis unrelated to the surgery. One wolf had a litter. None of the wolves have shown changes in behavioral patterns. Surgical sterilization can be effective, but other, less invasive, fertility control techniques should be investigated. PMID:10065320
Family planning programmes initiated in the Islamic Republic of Iran from 1966 met with limited success. Following the 1986 census family planning was considered a priority and was supported by the country's leaders. Appropriate strategies based on the principles of health promotion led to an increase in the contraceptive prevalence rate among married women from 49.0% in 1989 to 73.8% in 2006. This paper reviews the family planning programmes in the Islamic Republic of Iran and their achievements during the last 4 decades and discusses the principles of health promotion and theories of behaviour change which may explain these achievements. Successful strategies included: creation of a supportive environment, reorientation of family planning services, expanding of coverage of family planning services, training skilled personnel, providing free contraceptives as well as vasectomy and tubectomy services, involvement of volunteers and nongovernmental organizations and promotion of male participation. PMID:22574484
To further implement China's family planning policy of "prevention first, birth control first," a study of the current family planning situation was conducted. A survey of the birth control methods employed by women of childbearing age and by men was based on a nationwide randomized sampling of 1/1000. In the different age groups, ranging from 15-49 years old, IUD users accounted for over 50%, tubal sterilization 25%, and vasectomy 10%. The main IUD users were women in the 20-24 age group. Tubal sterilization was more prevalent among the women in the 35-39 age group. The use of oral contraceptives (OCs) was more common among younger women but accounted for less than 10% of the total. The survey was based on the replies to questionnaires from 172,788 married women of childbearing age; 120,022 of them practiced contraceptive methods for a birth control rate of 69.46%. The breakdown was as follows: IUD, 34.84%; tubal sterilization, 17.63%; vasectomy, 6.94%; OCs, 5.86%; condom users, 1.39%; and other methods (including chemical suppositories, rhythm, or safe period method and withdrawal before ejaculation), 2.78%. There was a higher percentage of OC users in urban areas, and a marked preference for IUDs in the rural communities. The rural birth control rate was 68.58%; the urban rate was 74.17%. The use of the IUD has priority in all the areas; its percentage approaches the national average level. The use of vasectomy as a birth control method varies considerably according to area as does the use of OCs, condom, and tubal sterilization. Rural minority groups prefer the IUD and OCs; tubal sterilization, the condom, and vasectomy are preferred by the Han nationality. The birth control rate differed according to the different occoupation groups: 77.85%, workers; 76.01%, farmers; 85.15%, cadres; 59.52%, housewives; and 66.67%, others. The birth control rate was higher among those who received a college education than the illiterates, but statistics did not show a significant difference in the rate of those with a high school education and the illiterates. Mothers of 0-1 children generally preferred OCs; tubal sterilization was preferred by mothers with 2-3 children. The nonusers of contraception accounted for 30.54% among married women of childbearing age. A breakdown gives the following figures: menopause and infertility, 6.17%; divorced and widowed, 1.64%; planned parenthood, 10.51%; nonusers who should have practiced contraception, 12.22%. On a national level, the estimated number of nonusers of contraception among those who should be practicing contraception comes to about 20,000,000 women. PMID:12312960
Converse, Kathryn A.; Kennelly, James J.
We evaluated the vasectomy of 72 male Canada geese as a method to control growing populations of nuisance geese in Westchester County, New York. Thirty-three of the vasectomized males paired with a female and were located during ?1 breeding seasons; 7 treated males were not seen following surgery. The remaining 32 males were never observed paired with a female during the breeding season. Of 56 nesting attempts by the 33 pairs in ?1 breeding seasons, 84% of the nests were unsuccessful. Fidelity to nest sites during the second and third breeding seasons occurred for 17 of the 18 vasectomized males and their females that were observed for ?2 seasons. The results suggest that male sterilization may reduce productivity of nuisance Canada geese providing one carefully selects areas and flocks suitable for this type of control.
Hall, Mary Ann Kirkconnell; Stephenson, Rob B.; Juvekar, Sanjay
Women in a small coastal village in western India were asked to explain their preference for female sterili-zation over modern reversible contraceptive methods. Married women aged 19+ years were interviewed in six focus groups (n=60) and individually (n=15) regarding contraceptive methods and their use and side-effects. Women publicly denied contraceptive use but privately acknowledged limited use. They obtained contraceptive information from other village women and believed that modern reversible methods and vasectomy have high physical and social risks, and fertility goals could be achieved without their use. Women felt that reversible contraception is undesirable, socially unacceptable, and usually unnecessary, although the achievement of fertility goals is likely due to the use of female sterilization with abortion as a back-up method. Economic migration of village men may also play a role. Although women with high social capital can effectively disseminate correct knowledge, the impact on the uptake of reversible method is uncertain. PMID:18686557
Kinney, Matthew E; Wack, Raymund F; Grahn, Robert A; Lyons, Leslie
A 22-year-old captive Brazilian rainbow boa (Epicrates cenchria cenchria) gave birth to four offspring after being housed with a vasectomized male. Sexual reproduction as a result of failed prior vasectomy, recanalization of the vas deferens, or prolonged sperm storage was ruled out using the clinical history, histopathology, and gross necropsy. Short tandem repeat (STR) DNA markers were genotyped in the male, female, and four offspring. None of the offspring possessed a diagnostic STR allele present in the potential sire. In addition, all offspring were homozygous at each STR locus evaluated, supporting parthenogenetic reproduction. This is the first report of parthenogenesis in a Brazilian rainbow boa and has implications for the conservation of reptiles maintained in captive breeding programs. PMID:23086743
Since the early 1980s, Johns Hopkins University's Population communication Services has conducted evaluations of mass media campaigns in developing countries which communications personnel have designed to change health and sex behavior. The mass media campaigns involved relaying health and family planning information via radio, television, and pamphlets. The evaluations showed that these campaigns were an effective technique to promote behavior change, e.g. they have boosted demand for contraceptives, condom sales, clinic visits, and inquiries to hotlines. A 6-part television drama incorporating health and family planning into its storyline stimulated behavior change in Pakistan in 1991. 36% of people surveyed after the drama series said they would limit the number of children they would have. 44% planned to improve communication with their spouse. An amusing television promotion in Brazil which ran for 6 months in the late 1980s prompted 58% of new clinic patients in 1 town to seek a vasectomy. 1 clinic experienced an 81% increase in vasectomies. A 6-month campaign to promote condom use in Colombia in 1988-89 resulted in a 75% rise in condom sales. In the mid 1980, a 6-9 month mass media popular music campaign (2 songs and videos disseminated via television, radio, and print materials) in Mexico and Latin America strove to encourage youth to be responsible for their sexual behavior. During the campaign, an adult counseling center received an 800% increase in letters (50-450 letters/month). 4 radio and 5 television spots promoting health and family planning in Kwara State, Nigeria in 1984-87 increased family planning acceptors 500% from 258 to 1526 in the 7 existing clinics. Other successful campaigns took place in the Philippines, Zimbabwe, Indonesia, Turkey, Bolivia and Honduras. PMID:12285445
Any successful development program that combines family planning, nutrition, and parasite control such as the integrated project, must include effective information, education, and communication (IEC) components. The Population an Community Development Association (PDA), the largest nonprofit organization in Thailand provides a network of family planning service delivery composed of volunteer distributors including midwives, school techers and shopkeepers. Reliability and accessibility are the 2 important elements. A concerted media campaign which exposes people to condoms and other contraceptives helps desensitize an otherwise "too personal" issue. The problem which confronts family planning communication is how to counteract the sensuous messages form advetisers while focusing on mundane topics such as maternal and child health, responsible parenthood, and family budgets. The PDA has tried to use the same attractions to promote family planning. It distributes promotional items such as T-shirts, pens towels and cigarette lighters bearing family planning messages. In addition to the use of television and radio, PDA also utilizes every possible channel of communication. Approaches include: the Youth-to-Youth Program; informational exhibits; video-mobile vans which visit schools and factories; and the holding of PDA's vasectomy festivals. Informational exhibits on family planning and health care use a variety of audio-visual methods. Video is an effective communication medium. The PDA video material ordinarily consists of family dramas illustrating good and bad family planning practices. By holding vasectomy festivals, PDA provides a media-attracting forum to educate the public and promote vasectomey as the most effective birth control method. Mass media campaigns must be linked with fieldwork outreach. PMID:12314464
80% of the world's contraceptive users are women. This gender-based usage has occurred due to the emphasis of family planning programs and contraception research on female methods. Even if men desired to take responsibility for contraception, only the condom and vasectomy are available and have a reasonable assurance of protection. The Population Council has been researching male contraception through its Center for Biomedical Research. An oral contraceptive derived from gossypol, a cottonseed plant pigment, is being tested after successful clinical trials were performed in China during the 1970s. Also being investigated are male hormonal methods that regulate sperm production while protecting against loss of potency, loss of libido, and changes in secondary sex characteristics. A hormonal implant, effective for one year, has been in Phase I clinical trials since 1993. A small Phase I clinical trial is in process for a vaccine/implant for men that is effective for one year. Testing with injectables for men has suggested that different hormonal mixes could increase cardiovascular risk for men and exacerbate prostate cancer. Research has focused on new materials for condoms. Kraton-type materials are made from block copolymers and polyurethanes, and these condoms have shown some promise. The advantages of these products are that they are allergen-free, less susceptible to oxidation, and can be of thinner construction, which would increase sensitivity and acceptability. The percutaneous chemical method of no-scalpel vasectomy has been studied as a means of blocking passage of sperm in the vas deferens. In China and India, injections with liquid silicone, polyurethane, neem-oil, and n-butyl-cyanoacrylate mixed with phenol are being studied. Zinc injections that cause the epididymis to atrophy are being tested on animals in the US. Lasers and fiber cautery are other methods under investigation. Increased funding is essential for these and other research efforts. PMID:12288916
Williams, J R
Family planning (FP) and social marketing messages must utilize the rules concerning artfulness developed in the private sector for effective communication in the mass media around the world. They have to compete for the attention of television program viewers accustomed to receiving hundreds of 30-second messages. There are some rules essential to any effective communication program: 1) Command attention. In the US over 1350 different mass media messages vie for attention every single day. FP messages are sensitive, but dullness and passivity is not a requisite. 2) Clarify the message, and keep it simple and direct. Mixed messages equal less effective communication. 3) Communicate a benefit. Consumers do not only buy products, they buy expectations of benefits. 4) Consistency counts. The central message should remain consistent to allow the evaluation of its effectiveness, but execution should vary from time to time and medium to medium. 5) Cater to the heart and the head. Effective communication offers real emotional values. 6) Create trust. Words, graphics, sounds, and casting in the campaign should support 1 central key promise to a single prime prospect. 7) Call for action. Both commercial and social marketing campaigns can calculate results by quantifiable measurement of sales (of condoms) transactions (the number of IUD insertions), floor traffic (clinic visits), attitude shifts, and behavior change. The PRO-PATER Vasectomy Campaign of 1988 in Sao Paulo, Brazil successfully used the above rules for effective communication. During the 1st 2 months of the campaign, phone calls increased by over 300%, new clients by 97%, and actual vasectomies performed by 79%. PMID:12343901
Bangkok's fee-charging Integrated Family Planning and Parasite Control Program (FPPC) is implemented by the Population and Community Development Association (PDA) and has grown from serving 36 schools and raising about US$1500 in 1976 to serving 231 schools and 200 factories and raising over US$75,000 in 1984. In addition to promoting health, the program aims at instilling a lifetime commitment to sensible health and family practices in the community. This urban program has been implemented in conjunction with a rural FPPC program through the financial and technical support of JOICFP, since 1976. Prior to that, PDA provided only family planning services. PDA is currently Thailand's largest private, non-profit organization involved in health care, appropriate technology, refugee assistance, water supply, agricultural marketing, as well as family planning and parasite control. The FPPC program works to mobilize the community to offer its support. Community involvement begins with the management of the program. Another community involvement comes from medical professionals from the local medical university who participate in the program for a fraction of their fees. Community-based family planning volunteers distribute contraceptives throughout their areas. The community also actively supports the FPPC program financially by paying fees. To communicate the benefits that people can derive from the services it offers, Bangkok's Urban FPPC program utilizes sophisticated marketing techniques such as advertising, direct mail, and a variety of public relations efforts. Family planning is publicly promoted in vasectomy festivals held each year throughout Bangkok. Married men are offered vasectomies free of charge if they have had 2 or more children. Exhibitions on parasite control and other health-related topics are also featured together with the sale of promotional items. Many of the program's activities have become major media events. Much of the credit is due to the flexibility of the program to adopt to the changing health needs of the people. Through PDA's efforts in the urban areas, the people of Bangkok are recognizing the need for family planning and health services. PMID:12313885
Rice, D T
Medical colleges in India have been urged to increase the quality and quantity of teaching on population dynamics and family welfare planning since 1957. The recommendations of the Deans and Principals Conference of August 1967 and the directive of the Medical Council of India issued in August of 1968 outline a syllabus and present many suggestions about the ways in which a number of departments should contribute to the teaching of these subjects during the years of the undergraduate medical curriculum. The Preventive and Social Medicine (P and SM) department is involved in teaching these subjects. In order to determine to what extent the recommendations and directives were being implemented, a questionnaire was sent to the head of the department of P and SM in each of the 93 medical schools in India to ask what that department had done in the 1968-1969 academic year. It was determined that the departments of P and SM were devoting an average of 10.8 holrs of lecture or class discussion to teaching family welfare planning and population dynamics. Many departments said they needed more books in the field. About 40% were conducting research on 1 or more related topics. Questions on the subjects were included in examinations by 90% of the departments in their college exams and 75% said that questions on these topics appeared on the written University examinations. 73% of the departments used A-V aids in their teaching of family welfare planning and the same proportion utilized seminars. 1 department required students to insert an IUCD. However, in the internship, 17 departments required women to do so and 7 required men to do 1 or more insertions. 2 departments made it a requirement during the final year to assist tubectomy operations, and 9 departments did so during the internship. 1 department required final year students to do a vasectomy. During internship, 16 required men to do 1 or more vasectomies, and 7 required women to. Shortage of staff was the most frequent difficulty mentioned for implementing the suggested syllabus. The most frequent suggestion for improving teaching was the development of more adequate teaching family welfare planning clinics. It was concluded that compared with departments of P and SM in other countries, the ones in India were devoting a significant, and perhaps an adequate, amount of time to the teaching of family welfare planning and population dynamics. PMID:12254747
Tribe, Andrew; Hanger, Jon; McDonald, Ian J.; Loader, Jo; Nottidge, Ben J.; McKee, Jeff J.; Phillips, Clive J. C.
Simple Summary We designed a programme to control free-ranging kangaroos on a Queensland golf course, using contraceptive implants in females and vasectomisation or testicle removal in males. This reduced the numbers of pouch young to about one half of pre-intervention levels and controlled the population over a 2–4 year period. However, the necessary darting caused a mortality rate of 5–10% of captured animals, mainly due to complications before and after anaesthesia. It is concluded that population control is possible but careful management of kangaroos around the time of anaesthesia induction and recovery is important in such programmes to minimise losses. Abstract Traditionally, culling has been the expedient, most common, and in many cases, the only tool used to control free-ranging kangaroo populations. We applied a reproductive control program to a population of eastern grey kangaroos confined to a golf course in South East Queensland. The program aimed to reduce fecundity sufficiently for the population to decrease over time so that overgrazing of the fairways and the frequency of human–animal conflict situations were minimised. In 2003, 92% of the female kangaroos above 5 kg bodyweight were implanted with the GnRH agonist deslorelin after darting with a dissociative anaesthetic. In 2007, 86% of the females above 5 kg were implanted with deslorelin and also 87% of the males above 5 kg were sterilised by either orchidectomy or vasectomy. In 2005, 2008 and 2009, the population was censused to assess the effect of each treatment. The 2003 deslorelin program resulted in effective zero population growth for approximately 2.5 years. The combined deslorelin–surgery program in 2007 reduced the birth rate from 0.3 to 0.06%/year for 16 months, resulting in a 27% population reduction by November 2009. The results were consistent with implants conferring contraception to 100% of implanted females for at least 12 months. The iatrogenic mortality rates for each program were 10.5% and 4.9%, respectively, with 50% of all mortalities due to darting-related injuries, exertional myopathy/hyperthermia or recovery misadventure. The short term sexual and agonistic behaviour of the males was assessed for the 2007 program: no significant changes were seen in adult males given the vasectomy procedure, while sexual behaviours’ were decreased in adult males given the orchidectomy procedure. It is concluded that female reproduction was effectively controlled by implantation with deslorrelin and male reproductive behaviour was reduced by orchidectomy, which together achieved population control.
Bohring, C; Krause, W
The aim of this study was to isolate and characterize highly enriched membrane proteins by two-dimensional (2-D) electrophoresis and to identify surface antigens binding sperm autoantibodies (SpAb). The presence of SpAb may reduce fertility by affecting sperm motility and acrosome reaction. The presence of the SpAb was shown to prevent sperm penetration of cervical mucus, to inhibit sperm-zona pellucida interaction, and to interfere with the sperm-egg fusion. The swim-up method was used to separate mature and motile sperm. Sperm membranes were obtained by hypoosmotic swelling, homogenization and sonication. Membranes were further isolated by differential centrifugation steps. The highly purified human sperm membrane proteins were separated by two-dimensional gel electrophoresis and electrotransferred to polyvinylidene difluoride (PVDF) membrane. The antigens were identified by bound SpAb, the sources of which were seminal plasma samples of infertile patients or of patients following vasectomy. Fourteen surface antigens were detected. Their identification may be (i) important for understanding the mechanism by which SpAb impair sperm fertilization capacity, (ii) suitable as a basis of new methods of fertility regulation, and (iii) helpful in developing reproducible and reliable methods for determinations of SpAb. PMID:10344274
Bohring, C; Klepper, L; Krause, W
Antisperm antibodies (ASA) may affect sperm motility, acrosome reaction, sperm penetration of cervical mucus, binding to the zona pellucida, and sperm-egg fusion. We investigated the localization of ASA of infertile men or men after vasectomy bound on the sperm surface using an immunofluorescence method. Binding occurred in the acrosomal region, midpiece, and tail. Most of the ASA in both groups of patients bound to the midpiece alone or in combination with other regions of spermatozoa. Only few ASA samples showed binding to all the three sperm regions. A combination of binding to the acrosomal region and to the midpiece was never observed. In infertile patients with ASA, the binding site was compared with sperm parameters. ASA binding to the sperm head influenced the acrosome reaction. Binding of ASA on tail and/or midpiece was not associated with a significant alteration of viability and motility. Immunofluorescence appears to be a valuable tool in the diagnosis of immune infertility, in particular when impairment of the acrosome activity is suggested. PMID:15458547
Mazzitello, Karina I.; Candia, Julián; Dossetti, Víctor
In the context of an extension of Axelrod's model for social influence, we study the interplay and competition between the cultural drift, represented as random perturbations, and mass media, introduced by means of an external homogeneous field. Unlike previous studies [J. C. González-Avella et al., Phys. Rev. E 72, 065102(R) (2005)], the mass media coupling proposed here is capable of affecting the cultural traits of any individual in the society, including those who do not share any features with the external message. A noise-driven transition is found: for large noise rates, both the ordered (culturally polarized) phase and the disordered (culturally fragmented) phase are observed, while, for lower noise rates, the ordered phase prevails. In the former case, the external field is found to induce cultural ordering, a behavior opposite to that reported in previous studies using a different prescription for the mass media interaction. We compare the predictions of this model to statistical data measuring the impact of a mass media vasectomy promotion campaign in Brazil.
Edwards, J W
The Taoist belief in the duality of all existence relates to the traditional Chinese yin-yang scheme for sex and health. It is believed that the yin or female principle must be balanced with the yang or male principle if productivity and health are to be maintained. Coitus serves a prophylactic purpose in bringing the 2 principles in balance. Too frequent coitus, especially for males, depletes the body of energy. Coitus between 10 and 12 midnight is believed to be best. Even in postr evolutionary China, certain of these traditional beliefs are still accepted. A coital frequency of 1-2 times per week and avoidance of vasectomy as a contraceptive method derive from traditional beliefs. Traditional medicines are accepted in Chinese medical practice. It is not known how widespread these vestiges of traditional belief are. The government is trying to eliminate mystical beliefs associated with sex. The Chinese success in family planning can serve as an example to other countries. Certainly family planning programs must acknowledge indigeno us cultural variables. PMID:950780
Scott, Alison; Glasier, Anna
People who attend for contraceptive advice have usually formulated an idea of the type of contraceptive that will suit them best. They may wish to use a method that is long, short or medium acting. These are defined as follows: Long-acting method requires renewal no more frequently than every 3 months (e.g. injectable or intrauterine). Short-acting method used daily or with every act of intercourse (e.g. pills, condoms) Medium-acting method requires renewal weekly or monthly (e.g. ring, patch). For men the choice is limited to condoms or vasectomy. Some women do not wish to use hormonal preparations or have an intrauterine device (IUD) or implant inserted. There may also be cultural influences making certain methods of contraception unacceptable. Each of these factors influences the final decision of which method of contraception is decided upon. In addition to taking a full medical and sexual history to identify any risks to the individual's health, which might be increased by a particular contraceptive, time must be spent discussing the options available. It is important to ensure that there is a full understanding of the advantages and disadvantages of each method. The most successful contraceptive method is likely to be the one that the woman (or man) chooses, rather than the one the clinician chooses for them. Access for women to contraception can be improved by having convenient clinic times and service developments such as nurse prescribing and Patient Group Directions. PMID:16707277
McCracken, J S
This study analyzed contraceptive practices among the 1465 women 15-49 years of age in an urban UK general practice. At the time of the survey, 75% of these women were either married or cohabitating. 99% of contraceptive users 15-19 years of age compared with only 6% of those 35-39 years of age had selected oral contraceptives (OCs). The proportion of IUD users increased steadily with age. Use of Depo-Provera and the diaphragm was nonsignificant. Sterilization showed a steady increase with age, and vasectomy (of the male partner) represented 1/3 of all methods of contraception recorded among women aged 35 years and over. 4% of study subjects were pregnant at the time of the survey and 1% were infertile. The general fertility rate in this population was 56.6/1000. 9 (10%) of the 87 pregnancies occurring in the study period were terminated through induced abortion. Studies conducted in general practice settings as opposed to family planning clinics have the advantage of providing data on the contraceptive behavior of women in older age groups who do not attend the latter clinics. Family planning clinic surveys tend to overestimate the prevalence of OC use because they serve a younger population. Of note is the finding of this survey that surgical sterilization accounted for 83% of contraceptive use among women over 35 years of age; even among those 30-34 years of age, it accounted for 33% of contraceptive use. PMID:3701686
Cossack, Matthew; Ghaffary, Cameron; Watson, Patrice; Snyder, Carrie; Lynch, Henry
Previous studies have shown that male BRCA mutation carriers stand at increased risk of developing prostate cancer and have concerns about developing cancer. Genetic counseling practitioners often discuss strategies for reducing the risk of cancer for patients at high risk due to their genetic background. Addressing modifiable health habits is one such strategy. Unfortunately, modifiable risk factors for prostate cancer have only been documented in the general population and have not yet been studied in the BRCA carrier subpopulation. Therefore, this study aimed to identify modifiable risk factors for prostate cancer in BRCA carriers. We examined prostate cancer risk factors in 74 men who were part of families with a BRCA mutation. This study examined nine dichotomous variables including: exercise, history of vasectomy, smoking history, alcohol use, finasteride use, statin use, aspirin use, coffee use, and vitamin use. The survey was sent to all cases of prostate cancer in the Hereditary Cancer Center Database at Creighton University with a known BRCA status. This study confirmed the protective benefits of daily aspirin use, which have been observed in previous studies of the general population, and suggests its benefit in BRCA carriers. Protective benefits from regular vigorous exercise and daily coffee use trended towards significance, but neither factor withstood the Bonferroni Correction for multiple comparisons. PMID:23881471
Murdoch, Fern E; Goldberg, Erwin
The idea that men should participate in family planning by playing an active role in contraception has become more acceptable in recent years. Up to the present the condom and vasectomy have been the main methods of male contraception. There have been and continue to be efforts to develop an acceptable hormonal contraceptive involving testosterone (T) suppression. However the off target affects, delivery of the analogs and the need for T replacement have proven difficult obstacles to this technology. Research into the development of non-hormonal contraception for men is progressing in several laboratories and this will be the subject of the present review. A number of promising targets for the male pill are being investigated. These involve disruption of spermatogenesis by compromising the integrity of the germinal epithelium, interfering with sperm production at the level of meiosis, attacking specific sperm proteins to disrupt fertilizing ability, or interfering with the assembly of seminal fluid components required by ejaculated sperm for acquisition of motility. Blocking contractility of the vas deferens smooth muscle vasculature to prevent ejaculation is a unique approach that prevents sperm from reaching the egg. We shall note the lack of interest by big pharma with most of the support for male contraception provided by the NIH. PMID:24368213
Mech, L.D.; Fritts, S.H.; Nelson, M.E.
Human-population increase and land development portend increasing conflict with large predators. Concurrently, changes and diversification of human attitudes are bringing increased disagreement about wildlife management. Animal-rights advocacy resulting from urbanization of human populations conflicts with traditional wildlife management. These forces focus more on wolves than on other wildlife because of strong public and media interest in wolves. Thus wolf management in the future will come under even greater public scrutiny, involve more public input, and may have greater restrictions imposed on it. This will lead to increased complexity in wolf management including more zoning, more experimentation with lethal and non-lethal capture techniques and alternate methods of alleviating damage to pets, livestock, and large ungulate herds, and greater public and private subsidy of wolf damage. One form of non-lethal control of wolf populations that may hold some promise is direct sterilization of males to reduce the biotic potential of the wolf population. Experimental vasectomy of five wild male wolves from four packs in Minnesota indicates that sterile males will continue to hold mates and territories, which would be necessary if sterilization is to be a viable technique for assisting with population control. If sterile males held territories but failed to produce pups, such territories might contain only about a third the number of wolves as fertile pack territories. Because wolves are long-lived in unexploited populations and their territories are large, direct sterilization of relatively few animals each year might significantly reduce populations.
López-de la Peña, X A
This paper deals with informed consent in Mexican Health Legislation in the context of a contract regulated by the Mexican Civil Code, in which a patient capable of making a thoughtful decision agrees to a specific plan of medical management and has received sufficient information, in a clear and explicit manner so that he/she can make a decision and in consequence agrees, or does not agree, to a course of action and to its consequences, under the Nuremberg Code. In Mexico, informed consent has recently been incorporated into health care legislation, and is basically oriented toward the field of medical research, while in other medical procedures, a legal authorization, and not an informed consent form is required, as with surgical procedures such as definitive fertility control (e.g. vasectomy or fallopian tube ligation). We emphasize the necessity of the adding of informed consent to Mexican health legislation in general, substituting it for other terms to legalize medical action, such as authorization, permission, dispositioned compliance, acceptance or approval-all of which have an essentially different and limited connotation, and are not Patient's Rights legal protector mechanisms, from our point of view. PMID:9011521
Concern is expressed that the population should be effectively controlled in order to prevent communities from reaching their maximum size capable of survival. Growth should be stopped in order to maintain a high quality of life and an unspoiled environment. In addition to offering counsel to individuals concerning birth control doctors should actively influence public and government opinion for the development of a comprehensive birth control service within the National Health Service. The presently approved methods of abstention and contraception are inadequate methods of birth control. They are limited by the requirement of at least moderate levels of education, intelligence, foresight, and self-discipline. If this community continues to exclude male and female sterilization, the quality of its future population may be impaired by a selective underbreeding of individuals most able to use these exacting methods. Vasectomy and laparoscopy are procedures accepted by patients and essentially without medical complications. Publicity and facilities for their use need to be increased. Artificially induced abortion appears to be the 1 method of birth control which is completely without the disadvantages of selective application, and abortion law must be amended so that it allows the woman to determine for herself whether to continue or terminate her pregnancy. The provision of free facilities for contraception, abortion, and sterilization is necessary. There is no morality in allowing the birth of unwanted children. PMID:5040090
Withers, Mellissa; Dworkin, Shari L; Onono, Maricianah; Oyier, Beryl; Cohen, Craig R; Bukusi, Elizabeth A; Newmann, Sara J
Research has indicated that gender dynamics-and in particular men's disapproval of family planning-have had an influence on the low levels of contraceptive use in sub-Saharan Africa. Limited evidence exists, however, on effective strategies to increase male approval. We conducted 12 focus group discussions with married men aged 20-66 (N = 106) in Kenya to explore FP perceptions. Men's disapproval of FP was associated with anxieties regarding male identity and gender roles. Men often distrusted FP information provided by their wives because they suspected infidelity or feared being viewed as "herded." Men also feared that providers might pressure them into vasectomies or into disclosing extramarital sexual activity or HIV diagnoses to their wives. Suggested strategies include programs targeting couples jointly and FP education for men provided by male outreach workers. To encourage men's acceptance, community-based programs directly targeting men are needed to reduce stigma and misconceptions and to increase awareness of the benefits of FP. PMID:26059990
Most men, most of the time, want the best for their families. Surveys from around the world commonly show little difference in desired family size between men and women. The author notes that men in all societies are interested in their children and tend to naturally nurture, protect, and educate them. However, in almost every society, men are more likely than women to have extramarital affairs. When divorce occurs, the women almost always end up caring for the children. Women therefore have good reason to be more concerned and careful than men about the use of family planning. Pregnancy bears a greater personal burden for women relative to men. Men nonetheless want to have sex without incurring the long-term costs of rearing unplanned and unwanted children. Family planning services must be made accessible for both sexes and measures taken to respond to the differing perceptions of men and women. Male-oriented services, the acceptance of vasectomy, and the unmet need among men for contraception are discussed. PMID:12291935
Chen, Xiang-Feng; Wang, Hong-Xiang; Liu, Yi-Dong; Sun, Kai; Zhou, Li-Xin; Huang, Yi-Ran; Li, Zheng; Ping, Ping
Childhood inguinal herniorrhaphy is one common cause of seminal tract obstruction. Vasovasostomy (VV) can reconstruct seminal deferens and result in appearance of sperm and natural pregnancy in some patients. Secondary epididymal obstruction caused by a relatively long-term vasal obstruction is a common cause of lower patency compared with VV due to vasectomy in adults. From July 2007 to June 2012, a total of 62 patients, with history of childhood inguinal herniorrhaphy and diagnosed as obstructive azoospermia were treated in our center. The overall patency rate and natural pregnancy rate were 56.5% (35/62) and 25.8% (16/62), respectively. 48.4% (30/62) of the patients underwent bilateral VV in the inguinal region, with a patency rate of 76.7% (23/30) and a natural pregnancy rate of 36.7% (11/30), respectively. 30.6% (19/62) of the patients underwent bilateral VV and unilateral or bilateral vasoepididymostomies due to ipsilateral epididymal obstruction with the patency and natural pregnancy rate decreasing to 63.2% (12/19) and 26.3% (5/19). 21.0% (13/62) of the patients merely underwent vasal exploration without reconstruction due to failure to find distal vasal stump, etc. Our study indicate that microsurgical reanastomosis is an effective treatment for some patients with seminal tract obstruction caused by childhood inguinal herniorrhaphy. PMID:24994783
Autorino, Riccardo; Zargar, Homayoun; Kaouk, Jihad H
The aim of the present review is to summarize recent developments in the field of urologic robotic surgery. A nonsystematic literature review was performed to retrieve publications related to robotic surgery in urology and evidence-based critical analysis was conducted by focusing on the literature of the past 5 years. The use of the da Vinci Surgical System, a robotic surgical system, has been implemented for the entire spectrum of extirpative and reconstructive laparoscopic kidney procedures. The robotic approach can be applied for a range of adrenal indications as well as for ureteral diseases, including benign and malignant conditions affecting the proximal, mid, and distal ureter. Current evidence suggests that robotic prostatectomy is associated with less blood loss compared with the open surgery. Besides prostate cancer, robotics has been used for simple prostatectomy in patients with symptomatic benign prostatic hyperplasia. Recent studies suggest that minimally invasive radical cystectomy provides encouraging oncologic outcomes mirroring those reported for open surgery. In recent years, the evolution of robotic surgery has enabled urologic surgeons to perform urinary diversions intracorporeally. Robotic vasectomy reversal and several other robotic andrological applications are being explored. In summary, robotic-assisted surgery is an emerging and safe technology for most urologic operations. The acceptance of robotic prostatectomy during the past decade has paved the way for urologists to explore the entire spectrum of extirpative and reconstructive urologic procedures. Cost remains a significant issue that could be solved by wider dissemination of the technology. PMID:24993800
This is a case history of Anita, Mayan woman aged 38, who lives in the small village of Can Cun in the Yucatan, Mexico. She has had 10 pregnancies and 7 living children. She nearly died with her last birth. She has a good relationship with her children. She worked several jobs and sold illegal alcohol to put her son, Emiliano, through school. She is close with her married daughter, aged 17. She herself was married at 17. Because of previous bad pregnancies Anita would like to have no more children. Her husband, Demetrio was interested in a vasectomy but couldn't believe he would have the strength to work after the operation. He, like many Mayan men, practiced coitus interruptus and rhythm. When Anita finally went to the family planning clinic, under the auspices of the author, she chose oral contraceptives, but she never actually used them. Many Mayan women seldom get a period because they are always lactating. Some women would rather be pregnant then menstruating. The husband opposes schooling for his children because he needs them to help him work their crops of beans and corn. Sending children to school creates hardship because cash is needed for living expenses. PMID:538802
Trussell, J; Leveque, J A; Koenig, J D; London, R; Borden, S; Henneberry, J; LaGuardia, K D; Stewart, F; Wilson, T G; Wysocki, S
OBJECTIVES. The purpose of the study was to determine the clinical and economic impact of alternative contraceptive methods. METHODS. Direct medical costs (method use, side effects, and unintended pregnancies) associated with 15 contraceptive methods were modeled from the perspectives of a private payer and a publicly funded program. Cost data were drawn from a national claims database and MediCal. The main outcome measures included 1-year and 5-year costs and number of pregnancies avoided compared with use of no contraceptive method. RESULTS. All 15 contraceptives were more effective and less costly than no method. Over 5 years, the copper-T IUD, vasectomy, the contraceptive implant, and the injectable contraceptive were the most cost-effective, saving $14,122, $13,899, $13,813, and $13,373, respectively, and preventing approximately the same number of pregnancies (4.2) per person. Because of their high failure rates, barrier methods, spermicides, withdrawal, and periodic abstinence were costly but still saved from $8933 to $12,239 over 5 years. Oral contraceptives fell between these groups, costing $1784 over 5 years, saving $12,879, and preventing 4.1 pregnancies. CONCLUSIONS. Contraceptives save health care resources by preventing unintended pregnancies. Up-front acquisition costs are inaccurate predictors of the total economic costs of competing contraceptive methods. Images FIGURE 1 FIGURE 2 PMID:7702112
Parekattil, Sijo J; Gudeloglu, Ahmet
The introduction of the operative microscope for andrological surgery in the 1970s provided enhanced magnification and accuracy, unparalleled to any previous visual loop or magnification techniques. This technology revolutionized techniques for microsurgery in andrology. Today, we may be on the verge of a second such revolution by the incorporation of robotic assisted platforms for microsurgery in andrology. Robotic assisted microsurgery is being utilized to a greater degree in andrology and a number of other microsurgical fields, such as ophthalmology, hand surgery, plastics and reconstructive surgery. The potential advantages of robotic assisted platforms include elimination of tremor, improved stability, surgeon ergonomics, scalability of motion, multi-input visual interphases with up to three simultaneous visual views, enhanced magnification, and the ability to manipulate three surgical instruments and cameras simultaneously. This review paper begins with the historical development of robotic microsurgery. It then provides an in-depth presentation of the technique and outcomes of common robotic microsurgical andrological procedures, such as vasectomy reversal, subinguinal varicocelectomy, targeted spermatic cord denervation (for chronic orchialgia) and robotic assisted microsurgical testicular sperm extraction (microTESE). PMID:23241637
Chang, Chun-Hung; Wilson, Christopher R.; Fried, Nathaniel M.
Lasers have been used in combination with applied cooling methods to preserve superficial skin layers (100's ?m's) during cosmetic surgery. Preservation of a thicker tissue surface layer (millimeters) may also allow development of other noninvasive laser procedures. We are exploring noninvasive therapeutic laser applications in urology (e.g. laser vasectomy and laser treatment of female stress urinary incontinence), which require surface tissue preservation on the millimeter scale. In this preliminary study, four lasers were compared for noninvasive creation of deep subsurface thermal lesions. Laser energy from three diode lasers (650, 808, and 980 nm) and a Ytterbium fiber laser (1075 nm) was delivered through a custom built, side-firing, laser probe with integrated cooling. An alcohol-based solution at -5 °C was circulated through a flow cell, cooling a sapphire window, which in turn cooled the tissue surface. The probe was placed in contact with porcine liver tissue, ex vivo, kept hydrated in saline and maintained at ~ 35 °C. Incident laser power was 4.2 W, spot diameter was 5.3 mm, and treatment time was 60 s. The optimal laser wavelength tested for creation of deep subsurface thermal lesions during contact cooling of tissues was 1075 nm, which preserved a surface layer of ~ 2 mm. The Ytterbium fiber laser provides a compact, low maintenance, and high power alternative laser source to the Neodymium:YAG laser for noninvasive thermal therapy.
Birdsall, N; Sai, F T
By expanding use of family planning Sub-Saharan Africa, countries can limit the expected growth in population to below 1.8 billion by 2050: evidence for unmet needs, as well as feasible means of improving use of family planning are discussed. Government generally support family planning, but actually provide limited services, usually restricted to maternal-child health clinics. They need to expand services to adolescents, young married women and men, to offer more choices including sterilization, and to utilize other means of distribution. Evidence for unmet need for family planning, that is numbers of women who do not currently use, but who express desire for no more children, is suggested by the rising abortion rates. Educated women especially are increasingly resorting to clandestine abortions. A few areas and pilot studies indicate high contraceptive rates, when services are provided effectively. People fear contraceptives because they think they cause infertility. People fear contraceptives because they think they cause infertility, while unprotected women actually are at higher risk of infertility because of illegal abortions and problem pregnancies. Governments need to supply more choices of contraceptives, and especially female sterilization. Vasectomy is virtually unused. Community-based and non-governmental distribution are untapped resources. Clinics are known to be less effective in motivating people to come for preventive care. In contrast, community women can provide services at lower financial and psychological cost, while improving the community's sense of control over health. PMID:12316250
Zinner, Dietmar; Krebs, Ellen; Schrod, Annette; Kaumanns, Werner
We present data on sexual maturity in young hamadryas baboon males (Papio hamadryas hamadryas) and its reproductive consequences in a large captive baboon colony. Hamadryas baboons live in a multilevel social system, with one-male units (OMUs) as the smallest social entity. Male leaders of OMUs are believed to monopolize matings within their OMUs; hence mating is believed to be polygynous and monandrous. In a captive colony of hamadryas baboons, we found evidence that young males less than 4 years old fathered at least 2.5% of 121 offspring born subsequent to vasectomy of all adult males, and males aged 4-5 years fathered at least 16.5% of the offspring. Additional evidence that these young males are able to sire offspring came from a morphological comparison of sperm from hamadryas males of different ages. The sperm of a 48-month-old hamadryas baboon were morphologically indistinguishable from viable sperm from adult males, whereas sperm from a 45-month-old male showed some aberrations. If successful copulations by adolescent males constitute a regular pattern even in free-ranging hamadryas baboons, a hamadryas male's chances to reproduce would not be limited to his role as an OMU leader as previously assumed, and a male's reproductive career would consist of two phases: the adolescent phase, and the OMU leader male phase. PMID:16331661
Yong, Hwanyul; Lee, Eunsong
The reliability of a Korean black goat (Capra hircus coreanae) to detect estrus in Himalayan tahrs (Hemitragus jemlahicus) for an artificial breeding program was investigated. Estrus in six female Himalayan tahrs was synchronized using fluorogestone acetate (FGA) sponges. Thirteen days later, 200 IU of PMSG and 100 IU of hCG were injected before removing the sponges and simultaneously injecting 5 mg of PGF2? the next day. Penetration of the cervical canal and the thickness and location of red crayon marks were examined 40 ˜ 43 h later. Two females treated with sponges containing 60 or 45 mg of FGA had estrogen levels of 8.7 and 11.1 pg/mL, respectively. No red marks were found on the backs of these two tahrs. The remaining females had higher levels of estradiol, and the red crayon marks were clearly shown. The cervical folds of these tahrs were readily penetrated and the insemination gun was smoothly inserted into the uterine body. In conclusion, a Korean domestic goat with its chest crayon-harnessed was successfully used to detect estrus of Himalayan tahrs. This technique might be utilized as a part of breeding programs for wild goats and avoid the need for a vasectomy of conspecific males. PMID:24690603
Hendry, W. F.; Levison, D. A.; Parkinson, M. C.; Parslow, J. M.; Royle, M. G.
Genital tract reconstruction has been attempted in subfertile men with obstructive azoospermia (370 patients) or unilateral testicular obstruction (80 patients), and in vasectomised men undergoing reversal for the first (130 patients) or subsequent (32 patients) time. Histopathological changes in the obstructed testes and epididymes, and immunological responses to the sequestered spermatozoa have been studied to gain insight into possible causes of failure of surgical treatment. The results of surgery have been assessed by follow-up sperm counts and occurrence of pregnancies in the female partners. The best results were obtained with vasectomy reversal (patency 90%, pregnancy 45%), even after failed previous attempts (patency 87%, pregnancy 37%). Epididymovasostomy gave good results with postinfective caudal blocks (patency 52%, pregnancy 38%), while postinfective vasal blocks were better corrected by total anatomical reconstruction (patency 73%, pregnancy 27%) than by transvasovasostomy (patency 9%, no pregnancies). Poor results were obtained with capital blocks (patency 12%, pregnancy 3%), in which substantial lipid accumulation was demonstrated in the ductuli efferentes; three-quarters of these patients had sinusitis, bronchitis or bronchiectasis (Young's syndrome). There is circumstantial evidence to suggest that this syndrome may be a late complication of mercury intoxication in childhood. After successful reconstruction, fertility was relatively reduced in those men who had antibodies to spermatozoa, particularly amongst the postinfective cases. Similarly, impaired fertility was found in men with unilateral testicular obstruction and antibodies to spermatozoa. Mononuclear cell infiltration of seminiferous tubules and rete testis was noted occasionally, supporting a diagnosis of autoimmune orchitis; although rare, this was an important observation as the sperm output became normal with adjuvant prednisolone therapy. Images Figure 4 Figure 6 Figure 7 Figure 10 Figure 11 Figure 12 Figure 14 PMID:2241062
Family planning in People's Republic of China between 1956 to 1970 has been marked by rapid change and total interrelation with the political and social developments. Since 1949, the Communist government has taken several measures to protect the mother and child. The campaign for family planning was started in 1956 by public meetings, posters, lectures with films, and an extensive distribution of contraceptive means. However, in 1965 there were still 2 trends among women: 1, based on tradition, supported the idea that a large number of children was a source of honor, prosperity and security; the other taking hold among younger women was in favor of family planning. The rural population was the latest to start practicing family planning. In 1963 a movement of socialist education was launched together with the formation of mobile medical teams to inform and educate people all over the country and to make known the various forms available for family planning. The contraceptive methods used included: male and female sterilisation (vasectomy for men and tube ligation for women), IUD, and condom; abortion, legal for women who already had children or if it was necessary for the mother's health; and oral contraceptives, which were produced in China. Medical services were reorganized and teams of "bare-foot doctors" were sent all over China. They lectured on health measures and fertility regulation. Intellectuals were sent to live in villages and exchange their knowledge with that of the peasants and workers. The tendency has been to limit the number of children to 2 or 3. The young people are recommended to postpone their marriage, women till they are 25, men till later. Nationally produced contraceptive means are being experimented with such as herbs, or a new intrauterine plastic device called "flower". The regions with national minorities like Tibet, the Inner Mongolia and Sinkiang had been under underpopulated and therefore population growth has been encouraged mainly by trying to irradicate diseases. PMID:12306192
Nazarian, Hamid; Ghaffari Novin, Marefat; Jalili, Mohammad Reza; Mirfakhraie, Reza; Heidari, Mohammad Hassan; Hosseini, Seyed Jalil; Norouzian, Mohsen; Ehsani, Nahid
Background: The Wnt/?- The Wnt/?-catenin signaling pathway is involved in many developmental processes in both fetal and adult life; its abnormalities can lead to disorders including several types of cancers and malfunction of specific cells and tissues in both animals and humans. Its role in reproductive processes has been proven. Objective: This study was designed to evaluate the expression of the key regulator of this signaling pathway GSK3-? and its presumed role in azoospermia. Materials and Methods: WNT3a protein concentration and GSK3-? gene expression levels were measured and compared between two groups of infertile men. The test groups consisted of 10 patients with obstructive and 10 non-obstructive azoospermia. The control group was selected among healthy men after vasectomies that were willing to conceive a child using a testicular biopsy technique. Samples were obtained by testicular biopsy and screened for the most common mutations (84, 86 and 255) in the SRY region before analyzing. GSK3-? gene expression was assessed quantitatively by real time-PCR. Results: The WNT3a protein concentration had no significant difference between the two test groups and controls. Expression of GSK3-? was down-regulated in non-obstructive azoospermia (3.10±0.19) compared with normal (7.12±0.39) and obstructive azoospermia (6.32±0.42) groups (p=0.001). Conclusion: Down-regulation of GSK-3? may cause to non-obstructive azoospermia. Regulation and modification of GSK-3? gene expression by drugs could be used as a therapeutic solution. PMID:25031575
Cilip, Christopher M.; Ross, Ashley E.; Jarow, Jonathan P.; Fried, Nathaniel M.
Development of a noninvasive vasectomy technique may eliminate male fear of complications (incision, bleeding, infection, and scrotal pain) and result in a more popular procedure. This study builds upon previously reported ex vivo tissue studies by exploring acute and short-term chronic in vivo canine studies. Isolation of the canine vas was achieved using a conventional vas ring clamp method. No perforation of the scrotal skin was necessary to occlude the vas. Laser radiation with a wavelength of 1075 nm, average power of 11.2 W, 500-ms pulse duration, 0.5 Hz pulse rate, and 3-mm-diameter spot was synchronized with cryogen spray cooling of the scrotal skin surface in a total of 8 dogs (n = 16 vasa) for a treatment time of 60 s. Burst pressure measurements were conducted at Days 0 and 21 (n = 8 vasa each day) to quantify the strength of vas closure. The vas was successfully thermally occluded in 15/16 (94%) procedures with 14/15 (93%) vas recording burst pressures above ejaculation pressure. One vas was not present, and another vas recorded a bursting pressure below ejaculation pressure. The coagulated vas bursting pressure averaged 283 +/- 34 mm Hg at Day 0 and 260 +/- 77 mm Hg at Day 21, significantly higher than reported vas ejaculation pressures of 136 +/- 29 mm Hg. Minor scrotal skin burns were observed during the recovery period. Noninvasive thermal occlusion of the vas is feasible in an in vivo canine model. Elimination of minor skin burns and longer term chronic in vivo canine studies are needed to confirm azospermia after vas occlusion without recanalization.
Throughout the 3rd World, family planners have turned to television in order to spread their message. Combining education and entertainment in the form of advertisements and soap operas, television offers a way to provide clear and memorable information about an otherwise sensitive issue. In 1977, Mexico's Miguel Sabido developed the idea of using television as a means of social instruction. His initial soap opera dealt with adult literacy, and the success of that program led him to develop a show focusing on family planning called "Come Along with Me." Following the airing of this soap opera, attendance to family planning clinics increased by 32%. Since then, Mexico has produced a series of soap operas dealing with sex education, women's status, and the treatment of children. Soon, Mexican viewers will see a soap opera addressing the issue of AIDS. Family planners in other countries have also begun employing television. Conventional communication methods require trained counselors travelling villages, and most often, those most in need of family planning are the most difficult to reach. But over the last 10 years, the number of televisions in the Third World has doubled, and there is now approximately 1 television for every 12 people in the developing nations. In Turkey, advertisements have been used to promote modern methods of contraception. In Brazil, vasectomy has been one of the topics of ad campaigns. Mexico, the Philippines, and Nigeria have also experimented with the use of music videos. Nigeria has already had great success in integrating family planning themes to an already existing variety show. Family planning visits have increased by 47%. International agencies have recognized the value of television and have provided financial support. PMID:12343296
Rodriguez-Wallberg, K A
Cryopreservation techniques play today a central role in assisted reproduction, as they enhance the overall efficacy of in vitro fertilization (IVF) treatments by allowing the banking of supernumerary embryos obtained in these treatments, and their later use. The transfer of frozen/thawed embryos was established nearly 30 years ago, and although it has been clinical routine for a long time, the importance of freezing embryos has been newly emphasized. As recognized downsides of IVF treatment include the high prevalence of perinatal complications due to multiple births, the recommended practice of transferring fewer embryos in the fresh IVF treatment cycle, with the goal of performing single embryo transfer and the cryostorage of remaining embryos for their later use in frozen-thawed cycles, one at a time, is currently the trend. Also of great importance, cryopreservation techniques for spermatozoa and oocytes have additionally permitted gamete storage for long-term and the implementation of several new treatment modalities for assisted reproduction. Most of these methods are applied today in clinical programs of fertility preservation and third-part reproduction, such as sperm- and egg donor programs. Use of frozen thawed sperm has been in clinical use for over 50 years and banking sperm has been routinely offered to men, usually before gonadotoxic treatments, but also in many cases, practised as a "safety policy" previously to a vasectomy. Freezing methods for women's egg have required a much longer time to achieve a comparable effective clinical standard. Only recently, with the development of vitrification of oocytes, the clinical standard was recognized and since 2013 when the label "experimental" was removed, the freezing of oocytes could be regarded as an established method, and its use extended into clinical practice for fertility preservation but also performed after personal requirements, so called, "social freezing". PMID:25714875
Tomlinson, M; Meadows, J; Kohut, T; Haoula, Z; Naeem, A; Pooley, K; Deb, S
Are all patients undergoing chemotherapy for long-term sperm banking at risk of permanent sterility? Male fertility is generally lower in men with cancer and all patient groups are at risk of azoospermia. Careful management is required to ensure that samples are not stored for excessively long periods should they not be required. A retrospective analysis of 1688 patient records and prospective recall of patients for semen testing were performed. Pre-therapy fertility was compared with a group of pre-vasectomy patients as a comparator. Those who fail to bank spermatozoa, rates of disposal of samples and the utilization in assisted reproduction were also examined. Sperm quality was poorest in testicular cancer (TC) patients followed by those with Hodgkin's lymphoma (HL) prior to treatment. Post-therapy data were available in 376 patients (42%). Sperm number was lowest (and azoospermia highest at 77%) in patients with HL treated with regimens other than adriamycin, bleomycin, vinblastine and dacarbazine (ABVD). Non-HL NHL and leukaemic patients had similarly high rates of azoospermia at 46 and 55%. HL patients treated with ABVD (11%) and TC patients (9.7%) had the lowest rates of azoospermia. Azoospermia was seen in every treatment group except for TC patients receiving carboplatin. Only 45 patients used their samples in ART (4.5%) in 10 years. Little is known about the fertility status of the patients not coming forward for follow-up testing, those conceiving naturally, those with no intention of conceiving and some which may have psychological reasons for not attending. In conclusion, virtually all patients undergoing chemotherapy are potentially at risk of temporary or permanent infertility. However, as uptake and utilization of stored material remain low, sperm banks should be carefully managed to ensure that resources are targeted to the patients most in need. PMID:26084986
Andrade, A T
Hormonal contraceptives include oral pills with lower steroid concentrations such as the triphasic gestodene. A dose of less than 20 mcg of ethinyl estradiol in the combined pill is effective. The use of RU-486 or mifepristone to inhibit ovulation or as a postcoital method is still being investigated. The vaginal rings that release 20 mcg of levonorgestrel (LNG) have a 97% rate of efficacy. There are newer types that release 30 mcg of LNG or desogestrel. A progesterone-releasing ring used during lactation is being studied. Among implants Norplant has been approved in many countries, including by the US Food and Drug Administration, with excellent results. In Brazil it continues to be banned. Studies have been initiated about implants, such as Norplant 11 and UNIPLANT. The studies conducted by the World Health Organization on injectables such as Cyclofem (which contains 5 mg of estradiol cypionate and 25 mg of medroxyprogesterone acetate) as well as Mesigyna (5 mg of estradiol valerate and 50 mg of norethindrone enanthate) are awaited. These two monthly injectables have minor side effects, produce regular cycles, and are highly effective. The use of GnRH analogues for ovulation inhibition are held back because of cost, dosage, and routes of administration The hormonal IUD releasing 20 mcg of LNG holds promise for high efficacy, probable protection against inflammations, and pronounced reduction of menstrual bleeding, particularly in long-term use. The frameless IUD, called Flexigard, consists of 6 fixed copper cylinders placed in the myometrium, which causes less endometrial irritation and less incidence of inflammation, pain, and bleeding. It has been in an experimental testing phase for some years. The female condom helps prevent STDs and is under the woman's control. Among male contraceptives, a hormonal method awaits development, while gossypol with the ability to inhibit HIV proliferation and the Chinese method of scalpel-free vasectomy are effective methods. PMID:12345521
The State Family Planning Commission of the Planning and Statistical Department in China has published its 1988-90 population and family planning statistics. The table lists these statistics by year and percentage change between years. The data are reported as numbers and rates or proportions. The population of China increased from 1.096 to 1.143 billion between 1988-90. The largest increase occurred between 1989-90 (31.42% vs. 15.77% [1988-89]). The death rate declined slightly between 1988-89 (.08%), but increased somewhat between 1989-90 (.17%). The birth rate increase, but only slightly (.05% [1988-89] and .23% [1989-90]). The percentage of 1st parity births fell between 1988-89 (.3%), but rose between 1989-90 (.9%). The opposite occurred for 2nd parity births (0.2% and -2.1%, respectively). The total fertility rate fell consistently from 2.52 in 1988 to 2.35 in 1989 and to 2.31 in 1990. There was no change in the number of women of childbearing age between 1988-89, but between 1989-90, the number increased by 10 million. Yet the number of married women of childbearing age did not increase at all between 1988-90. The number of people adopting contraception increased 8.34% between 1988-89 and 10.32% between 1989-90. Likewise the contraceptive prevalence rate also rose (6% [1988-89] and 5% [1989-90]). Contraceptive prevalence was highest for IUDs (about 40%), female sterilization (around 37%), and vasectomy (1.5%). The number of people agreeing to have only 1 child increased during the time period (1.32% [1988-89] and 2.42% [1989-90]). Accordingly, so did the percentage of people agreeing to have only 1 child (o.6% [1988-89] and 1.5% [1989-90]). PMID:12285209
This article is a proflie of Khun Mechai, a leader in the Thai family planning field who was instrumental in creating the community-based contraceptive distribution program which began in 1973 with the 1st in a series of grants from the International Planned Parenthood Federation (IPPF). The community-based distribution program is active in some 16,000 villages and neighborhoods throughout Thailand. The Community-Based Family Planning Service (CBFPS) was established in 1974 with Khun Mechai as secretary general to coordinate the efforts of the nationwide network. The CBFPS has been linked with a massive, humorous, and creative campaign of "desensitization": Khun Mechai passes out condoms at official dinners, and honors the king's birthday with an annual free vasectomy marathon. As a result of his efforts, family planning is no longer a taboo topic and no longer the exclusive province of government bureaucrats and medical professionals. Khun Mechai's basic concern is in improving access to family planning services by overcoming physical and sociocultural distance and by providing an acceptable method of service delivery. All family planning activities of the Population and Community Development Association, the CBFPS parent organization, are voluntary. Links have been created between family planning and personal and community betterment to help motivate acceptance. Khun Mechai became acquainted with the country' development needs as a young economist with the National Economic and Social Development Board. His family planning activities grew out of his conviction that rapid, unplanned population growth is Thailand's and the world's single most serious problem. An incremental approcah with insistence on individual and local responsibility for development is essential to his philosphy and personality. PMID:12266279
Rizvi, S A; Naqvi, S A; Hussain, Z
The history of sterilization dates back to the time of Hippocrates, when female sterilization was recommended for preventing hereditary mental diseases. James Blundell introduced surgical sterilization in 1823 for the prevention of high risk pregnancies. Vasectomy was first performed in the US at the end of the 19th century, mainly to prevent hereditary disorders. Male sterilization was a means of genocide during Nazi rule in Germany. Religious beliefs have the most powerful impact on the practice or nonpractice of family planning. In the teachings of Islam, Christianity, and Judaism, only sporadic references explicitly prohibit contraception, yet various religious edicts have interpreted these references too broadly by advocating prohibition of most contraceptive methods. Recently, the world community endorsed the basic right of couples to decide the number of children they want and the right to family planning with free informed choice. An integral part of a successful family planning program is voluntarism. In Europe and North America sterilization is legal, except in Italy, France, and Turkey. In Latin America sterilization is illegal in a number of countries; in Burma and Vietnam restrictions are in place; and in Africa fertility regulation is illegal in one-third of the countries. Informed consent before sterilization during counseling by a skilled, unbiased counselor is indispensable. All family planning services should be part of the national health care system including the voluntary contraception services. Incentives may compromise voluntarism. Most programs require a minimum age and a minimum number of children, marital status, and spousal consent. For sterilization, a waiting period of 1-30 days has been recommended. The exclusion of childless and single individuals has been challenged as a violation of human rights. For mentally retarded people parents or guardians provide consent. Major ethical issues in the future could emerge concerning novel fertility techniques: cryopreservation of sperm and intracytoplasmic sperm injection. PMID:8535748
Ahsan, S B
More and more men are convincing their wives to use family planning in Bangladesh. In this conservative, Moslem country, women are not allowed to leave the homes so husbands must go to buy methods especially rural areas. 70% of women who use oral contraceptives (OCs), IUDs, or condoms report that their husbands obtain these method for them. many couples are poor peasants. Contraceptive prevalence is not 23.2%. Female sterilization and OCs are the 2 most popular methods (9% each) followed by condoms (2%), IUD (1.7%), and vasectomy (1.5%). The total fertility rate is 4.8 which is higher than the goal of 3.5 Bangladesh hoped to reach by 1995. In 1975, 30% of women believed fate determines family size but now only 8% think that. Attitude changes about family size have occurred despite illiteracy and poverty. Traditional religious beliefs are still prevalent in rural areas making it difficult for wives to speak to their husbands about family planning. Husband-wife communication is more open among urban, middle class couples. The long lasting hormonal implant, Norplant, holds promise as a means for Bangladesh to reach its goal. About 4500 women now have Norplant and government and nongovernment clinics plan to insert it into around 20,000 more women. A study of 2586 potential acceptors of Norplant at family clinics in Bangladesh 3 other developing countries shows that counseling diminishes the anxiety women and their husbands experience about Norplant and its side effects. A study in Bangladesh reveals higher continuation rates of Norplant for women whose husbands underwent counseling than for those whose husbands did not undergo counseling. Family planning advertisements on the radio, TV, and in newspapers have convinced couples to use family planning, but the advertisements tend to not explaining how to use family planning. Men are key to the changes in attitude about family planning in Bangladesh. PMID:12317723
Riedel, Julie Cross; Menz, Mary; Darney, Philip D.; Brindis, Claire D.
Abstract Background: This article presents the extent to which providers enrolled in California's Family Planning, Access, Care, and Treatment (Family PACT) program offer contraceptive methods onsite, thus eliminating one important access barrier. Family PACT has a diverse provider network, including public-sector providers receiving Title X funding, public-sector providers not receiving Title X funding, and private-sector providers. We explored whether Title X funding enhances providers' ability to offer contraceptive methods that require specialized skills onsite. Methods: Data were derived from 1,072 survey responses to a 2010 provider-capacity survey matched by unique identifier to administrative claims data. Results: A significantly greater proportion of Title X–funded providers compared to non–Title X public and private providers offered onsite services for the following studied methods: intrauterine contraceptives (90% Title X, 51% public non–Title X, 38% private); contraceptive implants (58% Title X, 19% public non–Title X, 7% private); vasectomy (8% Title X, 4% public non–Title X, 1% private); and fertility-awareness methods (69% Title X, 55% public non–Title X, 49% private) (all p<0.0001). The association between onsite provision and Title X funding remained after stratifying individually by clinic specialty, facility capacity to provide reproductive health services (based on staffing), and rural/urban location. Conclusions: Extra funding for publicly funded family-planning programs, through mechanisms such as Title X, appears to be associated with increased onsite access to a wide range of contraceptive services, including those that require special skills and training. PMID:24405313
Andrews, D J
The International Planned Parenthood Federation's Vision 2000 Strategic Plan has emphasized advocacy and the training of family planning associations (FPAs) in the Western Hemisphere region. During the summer of 1995 training programs in advocacy leadership management were sponsored for six FPAs in the Bahamas, Suriname, Belize, Colombia, Honduras, and Brazil. At the Western Hemisphere Regional Council Meeting in September 1995 awards were presented to FPAs for media outstanding projects. These FPAs used outreach to the community to promote the goals of Vision 2000. The Bahamas FPA won the Rosa Cisneros Award for articles published in a magazine that is distributed in primary and secondary schools and deals with the activities, achievements, and opinions of students. Issues include: love, relationships, responsibility, and teen pregnancy. A weekly television talk show also addresses the issues facing youth including education, music, community work, sexuality, pregnancy, and the relationship between teenagers and adults. The Family Planning Association of Honduras was also nominated for the award for a radio show on the health of mothers and children, the problems of adolescents, and FP. The newspaper Tiempo received the award for feature articles on social issues and FP. In 1994 the Association distributed thousands of booklets on contraceptives as well as fliers on vasectomy, female sterilization, oral contraceptives, IUDs, condoms, responsible parenthood, high-risk pregnancy, vaginal cytology, and cervical cancer. Similar posters were placed in hospitals and health centers, in 1997 FP posts, and 400 commercial outlets. The Family Planning Association of Suriname also carried out an impressive advocacy program during the period of 1968-93 with the goals of establishing a balance between population growth and the available resources to achieve well-being with regard to education, health care, nutrition, and housing. PMID:12291093
Blaney, C L
This article discusses the role of counseling men in the postpartum period in addition to individual counseling and services for postpartum women. About 30% of couples rely on contraceptive methods that require men's active participation, such as condoms, vasectomy, withdrawal, or periodic abstinence. Communication between spouses about fertility and contraception and involvement of men in contraceptive services is constrained by cultural barriers, providers' lack of training on how to counsel men, health systems that discourage men from using services, and men's attitudes toward reproductive health. Counselors also must understand what husbands need to know and what women would like husbands to know. Couples need to know when women's fertility resumes in the postpartum period. Fertility returns shortly after an abortion (within 3 weeks) and after 6 weeks in postpartum women who are not breast feeding. Full breast feeding can delay the return to menses for 6 months. All male methods are appropriate in the postpartum period for breast-feeding women. Condoms are important for AIDS and sexually transmitted disease prevention. Natural family planning is unreliable until menstrual cycles become regular and ovulation resumes. Men need to be informed about family planning methods and about their own reproductive health. Men could be encouraged to help with child care and to value a girl child. Messages must be culturally specific and address the needs of both partners. Post-abortion counseling for men might address the issues of wives' need for recuperation, warning signs of complications, the importance of iron for prevention of anemia, and fertility return. Research findings indicate that counseling mattered, particularly in Turkey where the failure of withdrawal was related to repeat abortions. Brochures were the best means of conveying information to men. PMID:12292684
Background Spousal communication can improve family planning use and continuation. Yet, in countries with high fertility rates and unmet need, men have often been regarded as unsupportive of their partner’s use of family planning methods. This study examines men and women’s perceptions regarding obstacles to men’s support and uptake of modern contraceptives. Methods A qualitative study using 18 focus group discussions (FGDs) with purposively selected men aged 15–54 and women aged 15–49 as well as eight key informant interviews (KIIs) with government and community leaders was conducted in 2012 in Bugiri and Mpigi Districts, Uganda. Open-ended question guides were used to explore men and women’s perceptions regarding barriers to men’s involvement in reproductive health. All FGDs and KIIs were recorded, translated, and transcribed verbatim. Transcripts were coded and analyzed thematically using ATLAS.ti. Results Five themes were identified as rationale for men’s limited involvement: (i) perceived side effects of female contraceptive methods which disrupt sexual activity, (ii) limited choices of available male contraceptives, including fear and concerns relating to vasectomy, (iii) perceptions that reproductive health was a woman’s domain due to gender norms and traditional family planning communication geared towards women, (iv) preference for large family sizes which are uninhibited by prolonged birth spacing; and (v) concerns that women’s use of contraceptives will lead to extramarital sexual relations. In general, knowledge of effective contraceptive methods was high. However, lack of time and overall limited awareness regarding the specific role of men in reproductive health was also thought to deter men’s meaningful involvement in issues related to fertility regulation. Conclusion Decision-making on contraceptive use is the shared responsibility of men and women. Effective development and implementation of male-involvement family planning initiatives should address barriers to men’s supportive participation in reproductive health, including addressing men's negative beliefs regarding contraceptive services. PMID:24597502
Page, Stephanie T; Amory, John K; Bremner, William J
Despite significant advances in contraceptive options for women over the last 50 yr, world population continues to grow rapidly. Scientists and activists alike point to the devastating environmental impacts that population pressures have caused, including global warming from the developed world and hunger and disease in less developed areas. Moreover, almost half of all pregnancies are still unwanted or unplanned. Clearly, there is a need for expanded, reversible, contraceptive options. Multicultural surveys demonstrate the willingness of men to participate in contraception and their female partners to trust them to do so. Notwithstanding their paucity of options, male methods including vasectomy and condoms account for almost one third of contraceptive use in the United States and other countries. Recent international clinical research efforts have demonstrated high efficacy rates (90-95%) for hormonally based male contraceptives. Current barriers to expanded use include limited delivery methods and perceived regulatory obstacles, which stymie introduction to the marketplace. However, advances in oral and injectable androgen delivery are cause for optimism that these hurdles may be overcome. Nonhormonal methods, such as compounds that target sperm motility, are attractive in their theoretical promise of specificity for the reproductive tract. Gene and protein array technologies continue to identify potential targets for this approach. Such nonhormonal agents will likely reach clinical trials in the near future. Great strides have been made in understanding male reproductive physiology; the combined efforts of scientists, clinicians, industry and governmental funding agencies could make an effective, reversible, male contraceptive an option for family planning over the next decade. PMID:18436704
Tulsiani, Daulat R P; Abou-Haila, Aïda
The world population, currently estimated to be over six billions, is expected to double in the next forty years. The projected growth will cause severe over crowding that will have an adverse effect on the ecological health of the planet. A recent survey by the United Nations found that a majority of men in many countries are willing to participate in family planning by taking full control of their fertility. However, the available contraceptives for men have either higher failure rates or they are irreversible. Thus, the contraceptive needs of tens of millions of men go unmet every day resulting in millions of unwanted pregnancies, and hundreds of thousands of abortions. Since the introduction of oral contraceptive (pill) for women over five decades ago, there have been numerous collaborative efforts by scientists and pharmaceutical companies to improve the effectiveness and delivery of contraceptives to women who wish to safely regulate their reproductive physiology. However, the contraceptive options available to men have not changed in several decades and are still limited to the use of condoms and timely withdrawal (coitus interruptus) or under going a minor surgical procedure (vasectomy) that prevents the release of spermatozoa during ejaculation. The first two methods have relatively higher typical-use failure rates, whereas the last approach is largely irreversible and not suitable for younger men. Despite non-stop efforts worldwide, we may still be several years away from providing safe, effective and affordable male contraceptives which will allow both men and women to participate fully in family planning. In this article, we will discuss various contraceptives currently available to regulate male fertility. In addition, we will summarize potentially new contraceptives for men that are at various stages of research and development. Finally, our intention is to discuss details of two safe, reversible and affordable male contraceptive approaches that are inching closure to being approved for use by the masses in India and China, the world's two most populous nations. PMID:20350290
Kamischke, Axel; Nieschlag, Eberhard
Although effective contraceptive methods are available, the incidence of teenage pregnancies and consecutive pregnancy interruptions remains high in industrial nations, including Germany. There are several reasons for this high incidence. Apart from earlier sexual maturation, the absence of contraceptive use or the use of inefficient methods contributes mainly towards this increase. Existing contraceptive methods for men either show unsatisfying efficacy (coitus interruptus, use of condoms) or problems of reversibility (vasectomy), which limits their broader use. Of the different experimental approaches towards male contraception, the hormonal approach is closest to practical implementation. Androgens are an essential part of all experimental approaches to hormonal contraception in males; they cause suppression of spermatogenesis through gonadotropin suppression. Previous clinical trials have validated the concept of hormonal contraception in men. However, the application modalities and the ineffectiveness of all self-administered androgen preparations have been unacceptable for practical use. Therefore recent developments focus either on androgen implants or on injectable, long-acting testosterone esters in combination with progestins, which also suppress gonadotropin secretion. Over the last decades various combinations of androgen preparations with different progestins or GnRH antagonists have been tested in clinical trials. Of these, testosterone with either depot medroxyprogesterone acetate, norethisterone, desogestrel or etonogestrel have shown promising efficacy in phase II clinical trials. However, whether hormonal contraception might be given to adolescent males remains to be elucidated. This will have to be assessed once a hormonal contraceptive for men has reached the market. Special attention will need to be given to bone maturation as androgens at the prescribed doses might induce premature closure of the epiphyseal joints. PMID:16205090
Page, Stephanie T.; Amory, John K.; Bremner, William J.
Despite significant advances in contraceptive options for women over the last 50 yr, world population continues to grow rapidly. Scientists and activists alike point to the devastating environmental impacts that population pressures have caused, including global warming from the developed world and hunger and disease in less developed areas. Moreover, almost half of all pregnancies are still unwanted or unplanned. Clearly, there is a need for expanded, reversible, contraceptive options. Multicultural surveys demonstrate the willingness of men to participate in contraception and their female partners to trust them to do so. Notwithstanding their paucity of options, male methods including vasectomy and condoms account for almost one third of contraceptive use in the United States and other countries. Recent international clinical research efforts have demonstrated high efficacy rates (90–95%) for hormonally based male contraceptives. Current barriers to expanded use include limited delivery methods and perceived regulatory obstacles, which stymie introduction to the marketplace. However, advances in oral and injectable androgen delivery are cause for optimism that these hurdles may be overcome. Nonhormonal methods, such as compounds that target sperm motility, are attractive in their theoretical promise of specificity for the reproductive tract. Gene and protein array technologies continue to identify potential targets for this approach. Such nonhormonal agents will likely reach clinical trials in the near future. Great strides have been made in understanding male reproductive physiology; the combined efforts of scientists, clinicians, industry and governmental funding agencies could make an effective, reversible, male contraceptive an option for family planning over the next decade. PMID:18436704
The 10th Annual Symposium on Latest Developments in Contraception, organized by the Biological Science Committee of the Australian Federation of Family Planning Associations, was held in February 1983 and provided an update on the current status of contraceptive technology. In a review of steroidal contraception, it was proposed that the Silastic vaginal ring is the most promising of the fertility control devices not requiring continual involvement of the couple. Product development costs, the length of time required for safety trials have hindered development of the perfect contraceptive device. In a discussion of IUD use, it was reported that there are fewer expulsions and a lower incidence of infection when the device is inserted between the 11th and 17th days of the menstrual cycle. Although it is current practice to reinsert copper IUDs every 2 years, no increase in failure rates has been observed after 5 years of continual use. It is recommended that IUD insertion be delayed until 8 weeks postpartum. Another participant asserted that there is no empirical evidence to justify the use of spermicides with diaphragms. Unknown factors of vaginal physiology and its interaction with sperm must be elucidated before a good barrier method can be introduced. Concern was expressed with the numbers of women seeking reanastomosis of the Fallopian tubes after tubal ligation. Success of reanastomosis depends on the type of initial procedure and the time elapsed. 7% of Australian men have had vasectomies, and the request rate for reversal is 2-3/1000/year. In a review of immunological contraception, it was noted that long-lasting, non-pharmacologically active agents are the most promising substances for future research, but their potential hazards are great. Dr. Evelyn Billings reported that the ovulation method of natural family planning is superior to the basal-body-temperature or rhythm methods since it takes stress-induced fluctuations in ovulation into account. The Symposium concluded that the effectiveness of the Billings method must be proven in follow-up research before it is offered as an alternative to other methods. A report that 40% of Australian teenagers surveyed did not use contraception at last intercourse underscores the need for medical personnel to educate younger patients about contraceptive techniques. PMID:6843444
Noor Laily Abu Bakar; Tan, B A; Tey, N P; Yusuf, Y
The aim of the present study is to evaluate the degree of exposure to to Information, Education, and Communication (I.E.C.) publications such as pamphlets and booklets on contraceptive methods among those who have attended the dialog sessions; and to investigate the effects of such exposure on contraceptive use as well as the ppropensity to talk about family planning. The survey, conducted by the National Family Planning Board and assisted by the Sciences University of Malaysia in 1978/79, covers 6 states. A total of 1190 respondents were selected from those who attended dialog sessions during that period. Of the total sample, 723 respondents (60.8%) were contacted and interviewed. The I.E.C. publications evaluated in this survey include booklets on methods of contraception; pamphlets on the pill, IUD, condom, rhythm method, tubal ligation, vasectomy; booklets on responsible parenthood, flip charts and posters. 61% of the respondents have been exposed to at least 1 form of the I.E.C. materials. About 17 to 18% of currently married respondents have been exposed to pamphlets on tubal ligation, rhythm methods, IUD and condom; 22% have been exposed to pamphlets on the pill and 43% to booklets on contraceptive methods. In gerneral, those who have been exposed to pamphlets on a particular method were more likely to use that method. Among those who have been exposed to pamphlets on the pill 26.4% were using the pill compared to 16.2% who have not been exposed. The proportion of condom users were 3 times more after exposure to pamphlets on the condom: 16% vs. 4.7%. About 50% of currently married respondents were using a contraceptive method at the time of the survey. Of those who have not been exposed to I.E.C. materials, only 34.4% were using a method, compared to 53-60% of those who had been exposed. Exposure to I.E.C. materials and its interaction with ethnicity act as the most important factor in accounting for the differntials in contraceptive use, both in the bivariate context and multivariate context. For all 3 ethnic groups studied -- Malays, Chinese, Indians--those who have been exposed to I.E.C. publications appear to be more vocal about family planning than those who have not. Tables and charts illustrate detailed results of the study. PMID:12313333
Le Quinquis, P; Chevrant-Breton, O
There has been no legislation in France explicitly authorizing voluntary sterilization, so that a practitioner carrying out a voluntary surgical sterilization runs a theoretical risk of lawsuit. Concern about the legal status of voluntary sterilization stems from 2 articles in the French penal code, article 16 which forbids the crime of castration, defined as the intentional complete and definitive amputation or removal of an organ necessary for procreation; and article 309 which forbids voluntary assault and battery resulting in death or inability to work for 8 days, or a lesser incapacity if the violence was premeditated. Vasectomy and tubal ligation differ from castration in that they do not involve removal or mutilation of the genital organs. Article 309 has been applied to a sterilization case only once. The criminal chamber of the Court of Cassation, France's highest appeals court, ruled in 1937 that the consent of the victim had no effect on penal responsibility, since individuals have no right to violate on their own persons the rules of public order by undergoing corporal injuries unjustified by medical need. There has been no penal judgment since 1937 in a voluntary sterilization case. In a 1983 judgment, the Court of Cassation upheld the responsibility of a surgeon for not informing a 28-year-old mother of 5 of the possibility of failure of the sterilization operation he performed on her. The patient found herself pregnant once again less than 1 month after the operation. Had she been informed of the possibility of pregnancy, she might have taken further precautions to avoid it. The court established a causal link between the problems created by the pregnancy and the fault of the physician in not providing adequate information. The court's decision was of interest because it included tubal ligation among surgical interventions condoned by the common law of medical responsibility, thereby implying acceptance of voluntary sterilization. The plaintiff brought the action in civil rather than criminal court, and the question of the legal status of the operation was not raised even though the operation was not performed to remedy any pathological condition. The Court of Cassation was careful to specify that the surgeon had an obligation to use appropriate techniques according to state of the art procedures to obtain sterilization. The surgeon's error was not failure of the operation but failure to warn the patient of the possibility of pregnancy. PMID:3961378
Background Pregnant women with prior venous thromboembolism (VTE) are at risk of recurrence. Low molecular weight heparin (LWMH) reduces the risk of pregnancy-related VTE. LMWH prophylaxis is, however, inconvenient, uncomfortable, costly, medicalizes pregnancy, and may be associated with increased risks of obstetrical bleeding. Further, there is uncertainty in the estimates of both the baseline risk of pregnancy-related recurrent VTE and the effects of antepartum LMWH prophylaxis. The values and treatment preferences of pregnant women, crucial when making recommendations for prophylaxis, are currently unknown. The objective of this study is to address this gap in knowledge. Methods We will perform a multi-center cross-sectional interview study in Canada, USA, Norway and Finland. The study population will consist of 100 women with a history of lower extremity deep vein thrombosis (DVT) or pulmonary embolism (PE), and who are either pregnant, planning pregnancy, or may in the future consider pregnancy (women between 18 and 45 years). We will exclude individuals who are on full dose anticoagulation or thromboprophylaxis, who have undergone surgical sterilization, or whose partners have undergone vasectomy. We will determine each participant's willingness to receive LMWH prophylaxis during pregnancy through direct choice exercises based on real life and hypothetical scenarios, preference-elicitation using a visual analog scale (“feeling thermometer”), and a probability trade-off exercise. The primary outcome will be the minimum reduction (threshold) in VTE risk at which women change from declining to accepting LMWH prophylaxis. We will explore possible determinants of this choice, including educational attainment, the characteristics of the women’s prior VTE, and prior experience with LMWH. We will determine the utilities that women place on the burden of LMWH prophylaxis, pregnancy-related DVT, pregnancy-related PE and pregnancy-related hemorrhage. We will generate a “personalized decision analysis” using participants’ utilities and their personalized risk of recurrent VTE as inputs to a decision analytic model. We will compare the personalized decision analysis to the participant’s stated choice. Discussion The preferences of pregnant women at risk of VTE with respect to the use of antithrombotic therapy remain unexplored. This research will provide explicit, quantitative expressions of women's valuations of health states related to recurrent VTE and its prevention with LMWH. This information will be crucial for both guideline developers and for clinicians. PMID:22646475
Current contraceptive methods are not well-suited to many Americans. More safe and effective methods would be desirable. A report, "Developing New Contraceptives: Obstacles and Opportunities" was released in January 1990. It summarized 2 years of data collection by the Committee on Contraceptive Development which includes pharmaceutical company executives, physicians, reproductive biologists, public health, legal, and public policy experts, demographers, and economists. Barrier facing the development of new methods in the US were analyzed and ways to speed up research suggested. Particularly ill served are teenagers, young mothers, and comparatively older couples. The health risks of pregnancy, delivery, and labor "may be underrated." The pill is now the most common form of contraception in the US, followed by female sterilization, condoms, and vasectomy. 95% of women, aged 15-44, who have ever had intercourse, have used 1 or more contraceptive methods. Contraceptive discontinuation and failure rates are high, too. No fundamentally new contraceptives have been approved for use since the IUD and the pill in the 60s. Modifications of existing methods are in clinical trials. Obstacles cited were attitudes of the public, federal regulations and product liability, and the organization of and resources available for research. Public attitudes are very conservative. There is no great demand for more products. Since the 1960s, only 1 large pharmaceutical company (Ortho Pharmaceutical Corp.) is still involved in contraceptive research. Activity by small firms, nonprofit organizations, and universities has increased. Federal research funding in reproductive biology has only increased modestly since the mid 1970s. Private foundation support has dramatically declined. The time involved in the great costs of data required for Food and Drug Administration (FDA) approval have reduced research incentives. The average time it takes to get FDA approval has increased in the past 20 years. Weighing the risks and benefits of contraceptives is different from doing that with other drugs, yet FDA procedures do not allow for this. Product liability laws are different in each of the 50 states. Contraceptive development was greatly damaged by the mid 1980s insurance crisis. The committee recommended that the FDA put more importance on the effectiveness and convenience of new contraceptives. A comprehensive postmarketing surveillance system should be set up, and congress should pass a federal products liability law. PMID:2379571
A survey was conducted in Jakarta to determine the knowledge and behavior of urban people toward health. The results of the survey will serve as the basis for developing appropriate health-related interventions. Areas included in the study were the following: nutrition, immunization, environmental health, family planning and health services. Information was also obtained on the availability of facilities in the homes. 4 sites in Jakarta were chosen for the project. 1000 family respondents were selected to give general information and another 400 family respondents were selected to give specific information. The sampling was done by a combination of the stratification, cluster and simple random methods. The strata were the middle-income and lower income groups. The data were collected in January 1975. Most of the household heads were 30 to 39 years old, had attended senior high school, and most worked in the private sector. Most of the families were Moslem. The study showed that there was inadequate knowledge of good nutrition, particularly for children under 5 years old. Few of the respondents knew of the importance of breastfeeding. Most of the families had adequate knowledge of immunization. About 80% knew about DPT and polio vaccines. The families were ignorant about diseases brought about by poor environmental conditions. They were also unaware of the consequences of improper garbage disposal. On average, each family had 3.36 living children, while the child death rate was 12%. Most of the families were familiar with oral and injectable contraceptives; 60% were familiar with condoms; and 10% with vasectomy. 68% of the families had been family planning acceptors. 62.3% of the families practiced self-medication: 11.3% went to a private doctor; 4.1% went to other health facilities and personnel; and 22.5% took their sick to the puskesmas (public health centers). The morbidity rate is high. The number of families with access to communication media is high. 7 out of 10 families have newspapers; 4 out of 10 have magazines. Electronic media is extensively available. 75 out of 100 families have wireless sets and 50 have televisions. It is concluded that family health can be improvement through a mass media communications program. PMID:12313889
Tulsiani, Daulat R P; Abou-Haila, Aida
The world population, currently estimated to be almost seven billion, is expected to double in less than four decades. The projected population growth will cause severe competition for existing resources, not to mention the issue of overcrowding of the planet and additional greenhouse gases that will have an adverse effect on the ecological health of the planet. A recent survey conducted by the United Nations Population Control Division shows that the majority of today's young men in many countries are willing to participate in family planning by taking full control of their fertility, an important global health issue. However, the contraceptive needs of tens of millions of men/couples go unmet every single day and results in millions of unwanted pregnancies. Ever since the approval of the birth control pill by the Food and Drug Administration (FDA) in 1960, scientists have been hoping for a male equivalent. It has, however, been a difficult road, in part because of the complicated science of the male reproductive system. It is easier to control a monthly event of ovulation in women than to regulate the production of millions of fertile spermatozoa every day in men. Thus, the contraceptive options for men have not changed in decades and are still limited to the use of condoms, a timely withdrawal/pulling out (coitus interruptus) or vasectomy, a minor surgical procedure in which the vas deferens is occluded to prevent the release of spermatozoa during ejaculation. The first two approaches have a relatively higher failure rate, whereas the last approach is largely irreversible and not suitable for younger men. In this article, we will discuss various approaches currently available for men to take control of their fertility. Our intention is to discuss the details of three similar approaches that will provide safe, affordable and reversible contraception for men and are close to being approved for use by millions of men around the globe. The availability of safe, reversible and reliable male contraceptives will allow men and women to take full control of their fertility in family planning. PMID:24654689
This articles focuses on John Paul II's 1993 Veritatis Splendor, an 1798 page encyclical letter to the Church's bishops on the crisis in the Catholic Church of family limitation and the implications for the laity and society. The communication states that a flexible interpretation of theology must be abandoned. Paul VI's 19963 Humanae Vitae is reportedly affirmed. John XXIII's spiritualism and concern with conscience is ignored. This encyclical is identified as not spoken "ex cathedra" or from the throne, which would have made the pronouncement true, unarguable forever, and subject to excommunication for those disobeying. Pope John Paul II is said to be preparing another encyclical on life issues and sexuality. Reference is made in this encyclical to devices that are acceptable to use to gauge a safe period for copulation without impregnation. The devices include the rectal thermometer and the calculator for determining the infertile days in the natural cycle. Veritatis Splendor's position on fertility is viewed as an issue of loyalty to the Church and not as an honest evaluation of the moral implications of artificial birth control. This encyclical comes closer to "ex cathedra" than the Humanae Vitae, which banned the birth control pill, IUD, spermicides, hormonal implants, vasectomies, and tubal ligation. Liberal Catholic theologians are reported to have interpreted Paul VI's statement that "God illuminates from within the hearts of the faithful and invites their assent," as a validation of dissent. Pope John Paul II closes the door to dissent in this proclamation. The Church also closes the door to free will for people to decide for themselves. The Jesuits, with different notions of divine will, are described as potentially concluding that the denial of free will and individual reason for the sake of Papal supremacy must be the work of the devil himself. For good Catholics this encyclical is interpreted as potentially forcing even stronger opposition to the Vatican's teachings and continued adherence to the dictates of their own conscience. A God who gave men and women the power of his reason would not allow the Pope, however infallible, to take this away. Among nonreligious thinkers the Catholic posture is viewed as very wrong on birth control. Divisions within the Church are expected to increase. PMID:12345270
The village of Bhorletar, in the middle hills of Nepal, is run by an elected Village Development Committee (VDC). It consists of 9 wards with a total of 3000 people. The village center is growing fast, with 35 new houses built in the last year. Bhorletar is 1 of 8 villages selected by the National Planning Commission and the World Conservation Union (IUCN) to develop and test a system of local environmental planning. The effort is a central part of the National conservation Strategy, which began in 1983. The task of drawing up environmental plans for Bhorletar and 7 other villages was begun in 1990 with the help of 2 nongovernmental organizations and the IUCN planning team. This included drawing up land use maps on forest patches, trees species, landslides, cropping patterns, and hazard-prone areas. Finally, an environmental plan based on this profile was defined by the villagers themselves and approved in meetings. Each village selected its own activities and was granted project funds to supplement the work of men and women from the village. These activities included community forest conservation; improved fuel-wood stoves; new latrines; protective dams and afforestation; improved roads; vegetable gardens and marketing; and a new health post. There is no health post in Bhorletar, and the nearest hospital is a 7 hours' walk away. Contaminated water, poor diet, and a polluted environment are the main causes of a child death rate of around 100 per 1000. Most of the women and girls were too busy with household and farming chores to attend the planning meetings or school. According to the profile, 99 men and only 5 women were practicing family planning. The only family planning commonly available has been an annual vasectomy camp. Women find sterilization services almost impossible to obtain, though they are increasingly using Depo-Provera injections at a health center in the adjoining village. Bhorletar's experience, and that of the 7 other villages, has proved that local communities can plan and carry out their own development programs. PMID:12287332