Weiske, W H
Vasectomy is regarded as the safest method now available for male fertility control. Almost 100 million men worldwide have relied on vasectomy for family planning. This review discusses all currently relevant operative techniques, including no-scalpel vasectomy, complications, possible long-term effects on the testis and epididymis, and diseases for which associations with vasectomy have been suggested, such as arteriosclerosis, autoimmune diseases and cancer of the prostate and testis. Other topics of discussion include the timing of post-operative semen analysis, patient noncompliance concerning post-operative controls, persistent cryptozoospermia and transient reappearance of spermatozoa after vasectomy, vasectomy failure and legal aspects.
Belker, A M
Techniques, results, complications, and medicolegal aspects of vasectomy are discussed in this article. Emphasis is placed on techniques that prevent spontaneous recanalization of the ends of the vas deferens after vasectomy. Factors that affect the reversibility of vasectomy are discussed. New microsurgical techniques of vasectomy reversal are described, and results of these new techniques are compared with results of nonmicrosurgical techniques of vasectomy reversal. Indications for bypass vasoepididymostomy during vasectomy reversal procedures, as well as techniques for performing vasoepididymostomy, are discussed.
Belker, A M
A vasovasostomy may be performed on an outpatient basis with local anesthesia, but also may be performed on an outpatient basis with epidural or general anesthesia. Local anesthesia is preferred by most of my patients, the majority of whom choose this technique. With proper preoperative and intraoperative sedation, patients sleep lightly through most of the procedure. Because of the length of time often required for bilateral microsurgical vasoepididymostomy, epidural or general anesthesia and overnight hospitalization are usually necessary. Factors influencing the preoperative choice for vasovasostomy or vasoepididymostomy in patients undergoing vasectomy reversal are considered. The preoperative planned choice of vasovasostomy or vasoepididymostomy for patients having vasectomy reversal described herein does not have the support of all urologists who regularly perform these procedures. My present approach has evolved as the data reported in Tables 1 and 2 have become available, but it may change as new information is evaluated. However, it offers a logical method for planning choices of anesthesia and inpatient or outpatient status for patients undergoing vasectomy reversal procedures.
Ramasamy, Ranjith; Schlegel, Peter N.
Vasectomy is an elective surgical sterilization procedure for men that is intended to obstruct or remove a portion of both vas deferens, thereby preventing sperm from moving from the testes to the ejaculatory ducts. Although intended for permanent sterilization, vasectomy can be reversed in most men seeking to restore their fertility due to a change in marital status or reproductive goals. The purpose of this document is to provided a synopsis of the latest techniques used in vasectomy and reversal. PMID:21716894
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.
Finger, W R
There is far less information available for men about vasectomy than there is available for women about comparable contraceptive services. Also, men do not have medical check-ups on a regular basis, and therefore have less contact with medical practitioners during which vasectomy could otherwise be discussed. Vasectomy needs to be promoted in order for men to learn about and accept it as their contraceptive method of choice. To that end, Marie Stopes International (MSI) launches a vasectomy promotion campaign annually which includes advertising in local newspapers and upon billboards at football stadiums. The campaigns use light-hearted and bold ideas, with some shock value. This approach helps to relax men who otherwise tend to be wary of both the surgical procedure and subsequent consequences of vasectomy. Prevailing social norms should, however, guide the content of promotional campaigns. The UK is one of only a few countries in the world where about the same proportions of men and women use sterilization; 16% of men and 15% of women have been sterilized. A MSI campaign in the UK which began during fall 1997 prompted an increase in the number of inquiries about vasectomy at the Marie Stopes Vasectomy Clinic. Promotional campaigns in developing countries have also been successful. It is also important that campaigns be put in the larger context of promoting all contraceptive methods.
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.
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.
Chantarasak, N D; Basu, P K
Routine vasectomy was performed on a 29-year old man for whom rheumatoid arthritis had been diagnosed 4 years previously and treated with nonsteroidal anti-inflammatory drugs. The man experienced a flare-up of arthralgia in the wrists 2 weeks prior to the vasectomy. He was treated with a single course of parenteral methyl prednisolone and was in remission at the time of the surgery. On the day following the vasectomy, the patient noticed some erythema around the wound and felt unwell but did not seek medical advice until 4 days later. He was clinically toxic when he presented and experiencing painful gangrene of the scrotum. Treatment was begun immediately with parenteral benzyl penicillin, tobramycin and metronidazole plus aggressive debridement; 30 ml of pus drained and beta hemolytic streptococci Group A, sensitive to penicillin, were cultured. Within a few hours, further spread of gangrene along the penile shaft was noted. He was given hyperbaric oxygen treatment for 3 days followed by secondary debridement. No further spread of the gangrene occurred. 1 week later there was a good tranulating bed over the anterior scrotum. Meshed split skin graft was applied with tie-over dressings. An almost 100% take was achieved 4 weeks later. If hyperbaric oxygen had been employed immediately after surgery, spread of the gangrene might have been avoided. The use of hyperbaric oxygen should be considered as a firstline treatment.
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.
Barnes, Marian N.; Blandy, J. P.; England, H. R.; Gunn, George; Howard, Geraldine; Law, Barbara; Mason, Bridgett; Medawar, Jean; Reynolds, C.; Shearer, R. J.; Singh, M.; Stanley-Roose, Dorothy G.
In a prospective study of 1,000 people treated by vasectomy at the Margaret Pyke Centre under local anaesthesia as outpatients minor sepsis occurred in 12 cases, an abscess in one, and haematoma needing drainage in seven. Spontaneous recanalization of the vasa occurred in six patients and an unsuspected third vas was found in one. Except in patients with recanalization or a third vas the semen was always free from motile spermatozoa within three months, but non-motile spermatozoa have so far persisted for up to 17 months in a few cases. PMID:4758395
Mott, Frank E.; Farooqi, Bilal; Moore, Harry
Venous thromboembolic events have several known major risk factors such as prolonged immobilization or major surgery. Pulmonary embolism has rarely been reported after an outpatient vasectomy was completed. We present the rare case of a healthy 32-year-old Caucasian male with no known risk factors who presented with pleuritic chest pain 26 days after his outpatient vasectomy was performed. Subsequently, he was found to have a pulmonary embolism as per radiological imaging. We explore the association between outpatient vasectomies and venous thromboembolic events. A review of the literature is also included. PMID:26989373
Patel, Abhishek P; Smith, Ryan P
Vasectomy is a safe and effective method of contraception used by 42–60 million men worldwide. Approximately 3%–6% of men opt for a vasectomy reversal due to the death of a child or divorce and remarriage, change in financial situation, desire for more children within the same marriage, or to alleviate the dreaded postvasectomy pain syndrome. Unlike vasectomy, vasectomy reversal is a much more technically challenging procedure that is performed only by a minority of urologists and places a larger financial strain on the patient since it is usually not covered by insurance. Interest in this procedure has increased since the operating microscope became available in the 1970s, which consequently led to improved patency and pregnancy rates following the procedure. In this clinical update, we discuss patient evaluation, variables that may influence reversal success rates, factors to consider in choosing to perform vasovasostomy versus vasoepididymostomy, and the usefulness of vasectomy reversal to alleviate postvasectomy pain syndrome. We also review the use of robotics for vasectomy reversal and other novel techniques and instrumentation that have emerged in recent years to aid in the success of this surgery. PMID:26975488
Rival, Claudia; Wheeler, Karen; Jeffrey, Sarah; Qiao, Hui; Luu, Brian; Tewalt, Eric F; Engelhard, Victor H; Tardif, Stephen; Hardy, Daniel; del Rio, Roxana; Teuscher, Cory; Tung, Kenneth
CD4+ CD25+ regulatory T cells (Tregs) strongly influence the early and late autoimmune responses to meiotic germ cell antigens (MGCA) and the gonadal immunopathology in vasectomized mice. This is supported by the published and recently acquired information presented here. Within 24h of unilateral vasectomy (uni-vx) the ipsilateral epididymis undergoes epithelial cell apoptosis followed by necrosis, severe inflammation, and granuloma formation. Unexpectedly, vasectomy alone induced MGCA-specific tolerance. In contrast, uni-vx plus simultaneous Treg depletion resulted in MGCA-specific autoimmune response and bilateral autoimmune orchitis. Both tolerance and autoimmunity were strictly linked to the early epididymal injury. We now discovered that testicular autoimmunity in uni-vx mice did not occur when Treg depletion was delayed by one week. Remarkably, this delayed Treg depletion also prevented tolerance induction. Therefore, tolerance depends on a rapid de novo Treg response to MGCA exposed after vasectomy. Moreover, tolerance was blunted in mice genetically deficient in PD-1 ligand, suggesting the involvement of induced Treg. We conclude that pre-existing natural Treg prevents post-vasectomy autoimmunity, whereas vasectomy-induced Treg maintains post-vasectomy tolerance. We further discovered that vasectomized mice were still resistant to autoimmune orchitis induction for at least 12-16 months; thus, tolerance is long-lasting. Although significant sperm autoantibodies of low titers became detectable in uni-vx mice at 7 months, the antibody titers fluctuated over time, suggesting a dynamic "balance" between the autoimmune and tolerance states. Finally, we observed severe epididymal fibrosis and hypo-spermatogenesis at 12 months after uni-vx: findings of highly critical clinical significance.
Jean-François, E; Jean-Pierre, T; Régis, B; Guy, D; Parviz, G
Vasectomy is recognized as an efficient method of contraception. However, some recent findings have suggested that vasectomy may raise a potential health risk, notably related to prostate cancer. The goal of the present study is to evaluate the spatial and temporal evolution of this surgical practice in Québec (Canada). Using the registry of the Régie de l'assurance-maladie du Québec, we describe the course of vasectomy practice during the past 21 years. We also estimate the frequency of vasectomy procedures on the regional scale. Observed and expected rates of vasectomy and a synthetic index of vasectomy allow us to evaluate its spatial and temporal evolution. The results show a similar annual growth rate of this practice during the last 10 years. The mean age at the time of vasectomy of the study subjects (N = 332,000) is 35 years old. However recently, this mean age seems to be more representative because of the lower proportions of younger (< 25 years old) and older (> 50 years old) patients at the time of vasectomy. In addition, we observe some clear differences concerning the vasectomy rates between specific geographical sectors; the rates being significantly lower (p < 0.01) in urban and some rural areas. The highest rates are found in the suburbs of Montréal and Québec City. There are also some local variations of the practice, which are difficult to interpret. In this article, we compare our results to those for the rest of Canada and the United States. We note that the rates are generally similar to those for the Province of Québec. Besides, we discuss about the reasons for strong spatial variations of the surgery.
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... for Primary Care . 3rd ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 126. Read More Birth control and family planning Scrotum Testes Review Date 3/28/2016 Updated by: Scott Miller, MD, urologist in private practice in Atlanta, ...
... to cause permanent sterility in a man by preventing the transport of sperm out of the testes. ... vas deferens is tied off and cut apart preventing sperm from being released within the ejaculate. The ...
Clarkson, T B; Alexander, N J
The work that stimulated a series of experiments, conducted to determine the relationship between vasectomy and atherosclerosis in nonhuman primates, is summarized along with results in 2 nonhuman primate species. Attention is directed to the following: immunologic injury and atherosclerosis; immunologic responses to vasectomy; effects of atherogenic diet and vasectomy; and the effects of vasectomy alone. Using rabbits as the animal model, early workers found that inducing both immunologic serum sickness and hyperlipoproteinemia caused more extensive atherosclerosis than did hyperlipoproteinemia alone and that the resulting lesions more closely resembled those of human beings in both morphologic characteristics and anatomic location. The mechanism by which immunologic injury exacerbates atherosclerosis still remains unclear, but studies focusing on injury to the vascular endothelium as an important mechanism in atherogenesis are currently of considerable interest. Sperm agglutination, sperm immobilization, and immunofluorescence have all been used to demonstrate circulating free antisperm antibodies after vasectomy. Such antibodies occur in about 50% of vasectomized men and in vasectomized males of several animal species. It is unclear why circulating free antisperm antibodies have not been found in all vasectomized men and male animals. The development of an antibody response to sperm antigen in vasectomized rhesus monkeys has been shown to correlate with high sperm counts before vasectomy and similar observations have been made in studies of men. Results in nonhuman primate species showed that vasectomized monkeys developed more extensive and severe atherosclerosis than did nonvasectomized monkeys of the same age and dietary history. In 2 species of monkeys, the effect of vasectomy on atherogenesis seemed to be present whether the animals were hyperlipoproteinemic or had plasma lipid concentrations in the normal range. The presumed mechanism of atherosclerosis
Goldsmith, A; Goldberg, R J
Social constraints, the structure of the Latin American family, and the "machismo" cult are some of the reasons for the scarcity of vasectomy programs in Latin America. If processes of screening and counseling, and selfselection are employed, vasectomy programs can be just as successful in Latin America as in other countries. Some psychological factors will always have to be considered. One theory by Desmond Morris holds that the primitive behavior patterns of man, which evolved to protect the young, still persists today although they are no longer necessary. One study showed that men who had received vasectomies were socially more aggressive and assertive as compensatory behavior. The Spanish tradition of patriachy combined with the Roman Catholic tradition of male dominance determines the culture in which machismo is a natural outgrowth. The woman is regarded as property. For the woman, bearing children is the reason for existence. It is possible that all men view vasectomy as castration on the subconscious level. In most Latin American countries the laws are against voluntary contraceptive sterilization, but the laws are not enforced.
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.
Piotrow, P T; Kincaid, D L
In the article "Evaluation of a Communications Program to Increase Adoption of Vasectomy in Guatemala" by J.T. Bertrand et al (Stud Fam Plann 1987 Nov/Dec), the authors conclude that the use of a male promoter alone was 4 times more cost-effective in increasing the number of vasectomies than the use of radio alone because the costs of the radio program were 4 times higher. This conclusion is questionable for several reasons. 1) The district where the promoter was used alone was twice as large as the radio-only district. 2) In one of the promoter-only districts the same promoter worked throughout the program, but in the other, 3 different promoters had to be recruited and trained, due to high personnel turnover. 3) The initial costs of a radio program may be higher, but 1 program can be broadcast in all districts with little or no extra cost, whereas the costs of a promoter would have to be multiplied by the number of districts. 4) Although the promoter and the radio program produced approximately equal numbers of vasectomies, the radio messages reached over 70% of the people surveyed. Thus, on a national basis, radio broadcasts would be far more cost-effective than the use of salaried promoters in each district.
Despite its simplicity and freedom from complications, vasectomy in France faces significant legal, bureaucratic, political, ideologic, psychological, and medical obstacles. Legal obstacles are the most important inasmuch as a principal of French law holds that the individual does not have free disposition of his body. The sole existing French jurisprudence on the question equated male sterilization with premeditated assault and battery. Although no physician has been prosecuted for performing vasectomy since this 1936 Court of Appeals decision, physicians performing vasectomies remain somewhat at the mercy of the caprices of the magistrate. Social security refuses to pay for sterilization performed for contraceptive reasons, which may discourage low income candidates. The Council of the Order of Physicians opposes vasectomy because of its legal status and because article 22 of the Medical Code states that sterilization can only be performed for very serious medical indications. In 1983 the Council changed its recommendation to "very serious indications", dropping the word "medical", but it does not vigorously support vasectomy because of the legal question. Malpractice insurance coverage of vasectomy practitioners is based on whether the results of criminal trials indicate that the operator violated the penal code; the hazy legal status of vasectomy therefore makes insurance coverage unlikely. Political obstacles to vasectomy are far from resolved. No party has openly supported voluntary sterilization, less because of ideological or demagogic considerations than because of the fertility decline in France. Public opinion might question a law authorizing definitive contraception at a time when the replacement of generations is not even assured. Religious objections to contraception in general and sterilization in particular remain strong. A 1978 survey of 1273 French doctors showed that 35% of practicing Catholics but 61% of nonbelievers among them had favorable
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
Clarkson, T B; Lombardi, D M; Alexander, N J; Lewis, J C
We report here the effect of a moderately atherogenic diet on the progression of atherosclerosis among cynomolgus macaques that were either vasectomized or sham vasectomized. Both groups were compared to sham vasectomized monkeys fed a control Monkey Chow diet. As expected, slight hyperlipoproteinemia induced by the moderately atherogenic diet increased endothelial cell replication rates and resulted in the development of intimal lesions among sham vasectomized monkeys. Unexpectedly, vasectomy resulted in reduced leukocyte adherence to arterial surfaces, reduced endothelial cell replication rates in response to the moderately atherogenic diet, and at most arterial sites, smaller intimal lesions were produced. These data suggest that with slight hyperlipoproteinemia vasectomy may result in a small protective effect against atherosclerosis, while other studies have shown that marked hyperlipoproteinemia in cynomolgus macaques along with vasectomy results in exacerbation of atherogenesis.
Alderman, Philip M.
Vasectomies have not been as widely favoured as have techniques of sterilization in Canada for some years, in spite of having a better morbidity and mortality record than tubal sterilizations. Physicians or others who themselves have had the procedure seem to be in an especially favourable position to describe accurately the advantages and risks of this surgery, as well as its alternatives. Questionnaires inquiring about reasons for choosing vasectomy were sent to 42 medical doctors who had undergone the procedure. Counsellors can usefully proffer to inquiring patients the same advantages that reportedly motivated the medical doctors: convenience, economy, and safety. PMID:21253074
Kısa, Sezer; Savaş, Esen; Zeyneloğlu, Simge; Dönmez, Sevgül
This study was conducted as a descriptive study, designed to determine the opinions and attitudes of married couples living in Turkey about vasectomy. The sample consisted of 350 women. Researchers used a questionnaire to collect data. Descriptive statistics and chi-square analysis were used. The results showed that 14% of women and 43.0% of men were of the opinion that undergoing a vasectomy procedure was a sin. Chi-square analysis determined statistically significant differences between the male and female groups (p < .05). More than 88.0% of the men were not willing to have vasectomy and 35.4% thought that vasectomy had a negative effect on marriage and sexual health. In addition, 58.9% thought that vasectomy had a negative effect on men's health. Women were more likely than men to see vasectomy as merely a cultural taboo instead of a sin. Sociocultural factors, such as ideas that contraception is the woman's responsibility, that sterilized men lose status in society, or that sterilized men lose authority in the family, as well as misconceptions about vasectomy such as concerns about sexual functioning, psychological effects, and effects on physical strength, were determined to be the main barriers for vasectomy use in Turkish culture. The study recommends determining strategies for overcoming sociocultural barriers by raising awareness and increasing the utilization of vasectomy. Couple-specific family planning programs can make an important contribution toward improving awareness of the benefits of vasectomy.
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
Altok, Muammer; Şahin, Ali Feyzullah; Divrik, Rauf Taner; Yildirim, Ümit; Zorlu, Ferruh
ABSTRACT Objectives: There is no trial comparing bipolar cautery and ligation for occlusion of vas in non-scalpel vasectomy. This study aimed to compare the effectiveness of these vasectomy occlusion techniques. Materials and Methods: Between January 2002-June 2009, patients were allocated in alternate order. We recruited 100 cases in cautery group and 100 cases in ligation group. Non-scalpel approach was performed during vasectomy and fascial interposition was performed in all cases. First semen analysis was done 3 months after vasectomy. Vasectomy success was defined as azoospermia or non-motile sperm lower than 100.000/mL. Results: Four patients from the cautery group were switched to the ligation group due to technical problem of cautery device. Thus, data of 96 patients as cautery group and 104 patients as ligation group were evaluated. After vasectomy, semen analyses were obtained from 59 of 96 (61.5%) patients in cautery group and to 66 of 104 (63.5%) patients in ligation group. There was no statistical significant difference between the two groups in terms of the success of vasectomy (p=0.863). Conclusion: Although bipolar cautery technique is safe, effective and feasible in non-scalpel vasectomy, it has no superiority to ligation. There was no statistically significant difference in terms of the success and complications between the two groups. PMID:26742977
Nutt, Max; Reed, Zachary; Köhler, Tobias S
The potential influence of vasectomy being a risk factor for the development of prostate cancer is not a new concept, with more than 30 publications addressing the topic. Given the global frequency of vasectomy and the prevalence of prostate cancer, this subject justifiably deserves scrutiny. Several articles have claimed that vasectomy puts men at risk for future development of prostate cancer. We explore articles that have shown the contrary (no link), explore the studies’ strengths and weaknesses, describe possible prostate cancer pathophysiologic mechanisms, and apply Bradford Hill criteria to help discern correlation with causation. The risk and interest of association of prostate cancer with vasectomy has waxed and waned over the last three decades. Based on our review, vasectomy remains a safe form of sterilization and does not increase prostate cancer risk. PMID:27486569
Castillo Jimeno, J M; Santiago González, A; Rodríguez Pérez, M J; Quel Alzueta, N; Ruiz Rubio, J L; Antón López, M J; Martínez Morillas, M
We reviewed 1,800 vasectomy procedures using the double lateral scrotal incision and single incision of the raphe that had been performed at the Family Planning Center. The number of complications were minimal for both techniques: 6.5% for the patients submitted to the double incision and 5.5% for those submitted to the single incision procedure. The advantages of the single incision procedure are: it is easy to perform, less anesthesia is required, there are less complications, and the operating time is reduced.
Rosenberg, L; Palmer, J R; Zauber, A G; Warshauer, M E; Strom, B L; Harlap, S; Shapiro, S
We previously reported a strong positive association between vasectomy and the risk of prostatic cancer that arose in multiple comparisons made within data collected from 1976 to 1988 in an ongoing hospital-based surveillance study of many exposures and diseases. We have reassessed this association with data collected in the surveillance study during 1988-1992 from a new set of patients (355 cases of prostatic cancer and 2,048 controls with nonmalignant conditions). Because some studies have reported increased relative risks of lung cancer and testicular cancer in vasectomized men, we also used the surveillance database (4,126 men with various cancers, 7,027 men with nonmalignant conditions) to assess the relation of vasectomy to the risk of these and other cancers. In the newly collected data, the multivariate relative risk estimate for prostatic cancer in vasectomized men was 1.2 (95% confidence interval (CI) 0.6-2.7). For lung cancer and testicular cancer, the relative risk estimates were 1.3 (95% CI 0.8-2.1) and 0.8 (95% CI 0.4-1.9), respectively; for lung cancer occurring > or = 15 years after vasectomy, the relative risk estimate was 1.9 but it was not statistically significant (95% CI 0.7-5.0). For pancreatic cancer, the relative risk estimate was 1.8 (95% CI 1.0-3.1). For each of the other cancers considered--malignant melanoma, large bowel cancer, bladder cancer, kidney cancer, lymphoma, leukemia, and other cancers--the relative risk estimate was 1.3 or less and compatible with a value of 1.0. The present data provide little support for an association of vasectomy with the risk of prostatic cancer or other cancers. In addition, the data from two sets of cases of prostatic cancer and controls interviewed consecutively illustrate that increased relative risks detected in screening for statistically significant associations may tend to have an upward bias and to be lower in subsequent data.
Despite the growing popularity of vasectomy in recent years, historians have largely ignored the history of the procedure. The current article provides a preliminary examination of voluntary male sterilization in Canada and, in so doing, challenges the gendered paradigm scholars have often applied to the history of contraception. State-sponsored Medicare and late decriminalization of contraception are discussed as factors that slowed widespread adoption of vasectomy in Canada while evolving surgical techniques are highlighted for their role in increasing acceptability of the procedure. The article explores how evolving definitions of hegemonic masculinity have both hindered and encouraged acceptance of vasectomy over time.
Santiso, R; Bertrand, J T; Pineda, M A; Guerra, S
In this study of 1,600 men aged 25-50 from semi-rural Guatemala, three-fourths had heard of vasectomy. Among these, 54 per cent approved of it. However, the survey reveals a widespread lack of knowledge regarding the procedure, as well as negative perceptions or doubts about its effect on sexual performance, ability to do hard work, health, and manhood. One-fourth of the respondents who knew of vasectomy and who desired no more children expressed interest in having the operation, a finding which raises questions as to the potential (unrecognized) demand for vasectomy in other developing countries. PMID:3966604
Tan, Wei Phin; Levine, Laurence A
Post-vasectomy pain syndrome remains one of the more challenging urological problems to manage. This can be a frustrating process for both the patient and clinician as there is no well-recognized diagnostic regimen or reliable effective treatment. Many of these patients will end up seeing physicians across many disciplines, further frustrating them. The etiology of post-vasectomy pain syndrome is not clearly delineated. Postulations include damage to the scrotal and spermatic cord nerve structures via inflammatory effects of the immune system, back pressure effects in the obstructed vas and epididymis, vascular stasis, nerve impingement, or perineural fibrosis. Post-vasectomy pain syndrome is defined as at least 3 months of chronic or intermittent scrotal content pain. This article reviews the current understanding of post-vasectomy pain syndrome, theories behind its pathophysiology, evaluation pathways, and treatment options.
Tan, Wei Phin; Levine, Laurence A
Post-vasectomy pain syndrome remains one of the more challenging urological problems to manage. This can be a frustrating process for both the patient and clinician as there is no well-recognized diagnostic regimen or reliable effective treatment. Many of these patients will end up seeing physicians across many disciplines, further frustrating them. The etiology of post-vasectomy pain syndrome is not clearly delineated. Postulations include damage to the scrotal and spermatic cord nerve structures via inflammatory effects of the immune system, back pressure effects in the obstructed vas and epididymis, vascular stasis, nerve impingement, or perineural fibrosis. Post-vasectomy pain syndrome is defined as at least 3 months of chronic or intermittent scrotal content pain. This article reviews the current understanding of post-vasectomy pain syndrome, theories behind its pathophysiology, evaluation pathways, and treatment options. PMID:26952956
Shattuck, Dominick; Perry, Brian; Packer, Catherine; Chin Quee, Dawn
ABSTRACT Vasectomy is a highly effective and safe contraceptive method for couples who want to stop childbearing, but only 2.4% of men around the world use this method. We conducted an extensive review of the vasectomy research literature and programmatic reports, published between April 2005 and April 2015, to synthesize barriers and facilitators to vasectomy adoption. Of the more than 230 documents initially retrieved in our search, we ultimately included 75 documents in our review and synthesized the findings according to the Supply–Enabling Environment–Demand (SEED) Programming Model. Regarding promoting demand for vasectomy services, we found there was a general lack of awareness about the method among both men and women, which often fueled erroneous assumptions about how vasectomy affects men. Several types of programmatic activities directly addressed knowledge gaps and negative misperceptions, including community-based and mass media communications, employer-based promotion, and group counseling. For supply of services, the lack of or inaccurate knowledge about vasectomy was also prevalent among providers, particularly among community-based health workers. Programmatic activities to improve service delivery included the use of evidence-based vasectomy techniques such as no-scalpel vasectomy, whole-site trainings, task shifting, cascade training, and mobile outreach. Finally, programmatic approaches to building a more enabling environment included engagement of governments and other community and religious leaders as well as campaigns with gender transformative messaging that countered common myths and encouraged men's positive engagement in family planning and reproductive health. In summary, a successful vasectomy program is comprised of the mutually reinforcing components of continual demand for services and access to and supply of well-trained providers. In addition, there is an underlying need for enabling policies within the cultural and gender
Shattuck, Dominick; Perry, Brian; Packer, Catherine; Chin Quee, Dawn
Vasectomy is a highly effective and safe contraceptive method for couples who want to stop childbearing, but only 2.4% of men around the world use this method. We conducted an extensive review of the vasectomy research literature and programmatic reports, published between April 2005 and April 2015, to synthesize barriers and facilitators to vasectomy adoption. Of the more than 230 documents initially retrieved in our search, we ultimately included 75 documents in our review and synthesized the findings according to the Supply-Enabling Environment-Demand (SEED) Programming Model. Regarding promoting demand for vasectomy services, we found there was a general lack of awareness about the method among both men and women, which often fueled erroneous assumptions about how vasectomy affects men. Several types of programmatic activities directly addressed knowledge gaps and negative misperceptions, including community-based and mass media communications, employer-based promotion, and group counseling. For supply of services, the lack of or inaccurate knowledge about vasectomy was also prevalent among providers, particularly among community-based health workers. Programmatic activities to improve service delivery included the use of evidence-based vasectomy techniques such as no-scalpel vasectomy, whole-site trainings, task shifting, cascade training, and mobile outreach. Finally, programmatic approaches to building a more enabling environment included engagement of governments and other community and religious leaders as well as campaigns with gender transformative messaging that countered common myths and encouraged men's positive engagement in family planning and reproductive health. In summary, a successful vasectomy program is comprised of the mutually reinforcing components of continual demand for services and access to and supply of well-trained providers. In addition, there is an underlying need for enabling policies within the cultural and gender environments
Hamilton, Robert J; Macdonald, Erin M; Li, Qing; Mamdani, Muhammad M; Earle, Craig C; Kulkarni, Girish S; Jarvi, Keith A; Juurlink, David N
Objective To determine the association between vasectomy and prostate cancer, adjusting for measures of health seeking behaviour. Design Population based matched cohort study. Setting Multiple validated healthcare databases in Ontario, Canada, 1994-2012. Participants 326 607 men aged 20 to 65 who had undergone vasectomy were identified through physician billing codes and matched 1:1 on age (within two years), year of cohort entry, comorbidity score, and geographical region to men who did not undergo a vasectomy. Main outcomes measures The primary outcome was incident prostate cancer. Secondary outcomes were prostate cancer related grade, stage, and mortality. Results 3462 incident cases of prostate cancer were identified after a median follow-up of 10.9 years: 1843 (53.2%) in the vasectomy group and 1619 (46.8%) in the non-vasectomy group. In unadjusted analysis, vasectomy was associated with a slightly increased risk of incident prostate cancer (hazard ratio 1.13, 95% confidence interval 1.05 to 1.20). After adjustment for measures of health seeking behaviour, however, no association remained (adjusted hazard ratio 1.02, 95% confidence interval 0.95 to 1.09). Moreover, no association was found between vasectomy and high grade prostate cancer (adjusted odds ratio 1.05, 95% confidence interval 0.67 to 1.66), advanced stage prostate cancer (adjusted odds ratio 1.04, 0.81 to 1.34), or mortality (adjusted hazard ratio 1.06, 0.60 to 1.85). Conclusion The findings do not support an independent association between vasectomy and prostate cancer. PMID:27811008
The acceptability of vasectomy in 4 Latin American countries is repo rted. The unenthusiastic reception of vasectomy in Latin America is apparently due to a paucity of male sterilization programs and not to machismo. The 1st vasectomy program in Latin America was established in Bogota, Colombia, in 1970. This was followed by programs in Costa Rica (1971), El Salvador (1972), and Guatemala (1973). Upon expansion of the Colombian program from 1 city to 9 cities, the number of voluntary vasectomies increased from 100 to 560. 235 vasectomies were performed in the 1st 6 months of the Costa Rican program, and 278 were performed in the 1st 9 months of the Guatemalan program. During the 1st 2 years of the program in El Salvador, the monthly average of operations performed rose from 3 to 19. In El Salvador at least, vasectomy was acceptable to men aged 22-69 years, with 2-20 living children, and from all types of occupations.
Doiron, Karine; Légaré, Christine; Saez, Fabrice; Sullivan, Robert
Vasectomy has been shown to affect the pattern of mRNA expression of P34H, a human sperm protein added to the acrosomal cap during epididymal transit. It has been reported that vasectomy alters the histology of the reproductive tract in various species as a result of the increased pressure in the epididymis. The aim of this study was to evaluate if other epididymis-specific mRNAs, which are expressed in different patterns along the duct, are altered by vasectomy as well. We analyzed the expression of P31m (a monkey homologue of human P34H) and three different HE-like (HE-l) mRNAs along the epididymis in the cynomolgus monkey (Macaca fascicularis). Sexually mature cynomolgus monkeys were vasectomized unilaterally; then the epididymides were surgically removed at different time points. The ipsilateral normal epididymis was used as a control. Histomorphometric measurements showed that the height of the epididymal epithelial cells started to be affected only at 14 wk postsurgery. However, Northern blot and in situ hybridization analysis showed that the expression pattern of P31m, HE1, and HE5-like mRNA along the epididymis was not affected by vasectomy. Only the HE2-like mRNA predominantly expressed in the normal corpus epididymidis was significantly lowered 14 wk after vasectomy. Thus, ductal obstruction differentially alters mRNA expression along the epididymis of the cynomolgus monkey.
Hubert, Celia; White, Kari; Hopkins, Kristine; Grossman, Daniel; Potter, Joseph E.
The low prevalence of vasectomy among Latino men in the United States is often attributed to cultural characteristics despite limited evidence supporting this hypothesis. We assessed male partners’ perceived willingness to undergo vasectomy through surveys with 470 Mexican-origin women who did not want more children in El Paso, Texas. We conducted two focus groups on men's knowledge and attitudes about vasectomy with partners of a subsample of these women. Overall, 32% of women reported that their partner would be interested in getting a vasectomy. In multivariable analysis, completing high school (OR=2.03 [1.05, 3.95]), having some college education (OR=2.97 [1.36, 6.48]) or receiving US government assistance (OR=1.95 [1.1, 3.45]) was associated with partners’ perceived interest. Despite some misperceptions, male partners were willing to get a vasectomy, but were concerned about cost and taking time off work to recover. Health education and affordable vasectomy services could increase vasectomy use among Mexican-origin men. PMID:27180707
Vasectomy provides a long-term effective sterilization for men and is performed on nearly 500,000 men annually in the United States. Improvements in technique have led to a decreased failure rate and fewer complications, although significant variations in technique exist. Use of cautery occlusion with or without fascial interposition appears to have the least failures. A no-scalpel approach lowers risk of hematoma formation, infection and bleeding post-operatively. A patient can be considered sterile when azoospermia is achieved or the semen analysis shows less than 100,000 non-motile sperm per milliliter. Incorporating these principles may allow the physician to optimize outcomes in vasectomy. PMID:27141443
Hancock, P; McLaughlin, E
The British Andrology Society guidelines for the assessment of post vasectomy semen samples recommend that initial assessment is undertaken 16 weeks post vasectomy and after the patient has produced at least 24 ejaculates. The laboratory should examine a freshly produced seminal fluid specimen by direct microscopy and if no sperm are seen the centrifugate should be examined for the presence of motile and non-motile spermatozoa. It is recommended that the clinician should give clearance after the production of two consecutive sperm free ejaculates. In cases of persistent identification of non-motile spermatozoa the referring clinician should advise the patient regarding the cessation of other contraceptive precautions. Surgeons are responsible both preoperatively and postoperatively for the counselling of couples regarding complications and the possibility of late recanalisation after clearance. PMID:12401817
Gutmann, Matthew C
This paper discusses research on men's reproductive health and sexuality in Oaxaca, Mexico, and specifically why some men there choose to be sterilized. Men who opt for vasectomies do so after considering numerous cultural, historical, physiological, commercial, and other concerns. Men and women in Oaxaca negotiate certain cultural folk beliefs about supposed male sexual desires and practices before arriving at the decision to get the operation. Vasectomy as a method of birth control is chosen despite folk beliefs that take the form of a totemic illusion which treats male sexuality as naturalized, something fixed, and as entirely distinct from female sexuality. Among its many consequences, this totemic illusion serves to conceal inequalities in the sphere of reproductive health and sexuality in relation to contraception.
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.
Miller, Amy L; Kitson, Gemma L; Skalkoyannis, Benjamin; Flecknell, Paul A; Leach, Matthew C
Mice used in biomedical research should have pain reduced to an absolute minimum through refinement of procedures or by the provision of appropriate analgesia. Vasectomy is a common and potentially painful surgical procedure carried out on male mice to facilitate the production of genetically modified mice. The aim of our study was to determine if 0.05 mg/kg buprenorphine would ameliorate pain associated changes following abdominal vasectomy and to determine if the mouse grimace scale is an appropriate tool for the assessment of pain in this model. Eight male CBA mice underwent abdominal vasectomy as part of a genetically modified mouse-breeding programme. Here we assessed pain using a previously validated behaviour-based method and the mouse grimace scale. All mice received buprenorphine (0.05 mg/kg s.c.) pre-surgery. Behaviour and grimace scores were compared between baseline (pre-surgery), 30 min, 5 h, 24 h and 25 h post surgery. Following 24 h post-op, all mice were administered 5 mg/kg meloxicam (s.c.) as additional analgesia. Significant increases in specific pain behaviours and mouse grimace scale score were found 30 min post surgery. At 5 h post surgery, scores were returning to baseline levels. Frequency of rearing was significantly decreased at both 30 min and 5 h post surgery compared to baseline, demonstrating a longer lasting change in normal exploratory behaviour. Buprenorphine (0.05 mg/kg) was ineffective at ameliorating these pain-associated changes in CBA mice and should be considered inadequate at this dose. By 24 h post surgery, pain associated behaviours, grimace scale and rearing had all returned to baseline levels. There was no change in pain behaviours or MGS following administration of meloxicam indicating that an additional dose of meloxicam does not appear to offer benefit at this point. Using the mouse grimace scale to assess pain in mice, appeared to be effective in the immediate post vasectomy period in CBA mice
Bhuyan, K; Ali, I; Sarma, G; Das, U
No scalpel vasectomy (NSV) has proved to be a safe and simple procedure for permanent sterilization for men. Ligation and excision of the vas deferens followed by fascial interposition is the procedure of choice. It is believed that vas excision without fascial interposition has a risk of failure. The objective of this study was to evaluate the technique of NSV with ligation and excision only. No scalpel vasectomy performed in an urban centre was taken for this prospective study. Only ligation and excision procedure was applied in its execution. It was demonstrated and performed under the supervision of an expert. Information regarding early and late complications including failure was gathered. A total number of 3,392 NSVs were performed in an urban training centre between Apr' 2009 to Mar' 2013. The procedure applied was only excision and ligation of the vas deferens. The fascial interposition was not included in the procedure. Haematoma (1), bleeding (3), foreign body granuloma (1), scrotal pain (3), epididymitis (1) and sinus formations (1) were encountered. There was only one failure in the whole group of acceptors. NSV with ligation and excision is a simple and easy procedure to learn and perform. Complications and failures are negligible. The additional fascial interposition needs more surgical skill and is time-consuming, hence can be avoided where a large number of acceptors need to undergo NSV in a rural camp.
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.
Ghirelli-Filho, Milton; de Marchi, Patricia Leme; Mafra, Fernanda Abani; Cavalcanti, Viviane; Christofolini, Denise Maria; Barbosa, Caio Parente; Bianco, Bianca; Glina, Sidney
ABSTRACT Objective To evaluate the incidence of Y-chromosome microdeletions in individuals born from vasectomized fathers who underwent vasectomy reversal or in vitro fertilization with sperm retrieval by epididymal aspiration (percutaneous epididymal sperm aspiration). Methods A case-control study comprising male children of couples in which the man had been previously vasectomized and chose vasectomy reversal (n=31) or in vitro fertilization with sperm retrieval by percutaneous epididymal sperm aspiration (n=30) to conceive new children, and a Control Group of male children of fertile men who had programmed vasectomies (n=60). Y-chromosome microdeletions research was performed by polymerase chain reaction on fathers and children, evaluating 20 regions of the chromosome. Results The results showed no Y-chromosome microdeletions in any of the studied subjects. The incidence of Y-chromosome microdeletions in individuals born from vasectomized fathers who underwent vasectomy reversal or in vitro fertilization with spermatozoa recovered by percutaneous epididymal sperm aspiration did not differ between the groups, and there was no difference between control subjects born from natural pregnancies or population incidence in fertile men. Conclusion We found no association considering microdeletions in the azoospermia factor region of the Y chromosome and assisted reproduction. We also found no correlation between these Y-chromosome microdeletions and vasectomies, which suggests that the assisted reproduction techniques do not increase the incidence of Y-chromosome microdeletions. PMID:28076602
Alpcan, Serhan; Başar, Halil; Aydos, Tolga Reşat; Kul, Oğuz; Kısa, Üçler; Başar, 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. PMID:26328178
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.
Clarkson, T B; Alexander, N J
made in this study, we suggest that the antisperm antibodies that form after vasectomy may result in circulating immune complexes that exacerbate atherosclerosis. Images PMID:6765957
Viveros; Gomez; Otero
Vasectomy service providers at the Clínica del Hombre (Men's Clinic) in Bogotá, Colombia, construct their representations concerning male sterilization on the basis of biomedical discourse, their interaction with clinic users, and their own life experiences. During provision of such services, the counselors are the health professionals who have the closest contact with these clients of the clinic. Counselors are in charge of exploring their motivations in requesting the service, in addition to providing information allowing them to take a calm, sound decision. They also directly filter demand based on their experience, knowledge, and skills, in permanent negotiation between institutional criteria (number of children and gap between them, client's age, steadiness of couple's relationship, and conviction concerning the decision), and their perception and assessment of the client. An analysis of the counselors' representations of decision-making as pertaining to vasectomy indicates that it is a relatively simple and harmless procedure as well as a liberating option in terms of family planning.
Qu, Ning; Terayama, Hayato; Naito, Munekazu; Ogawa, Yuki; Hirai, Shuichi; Kitaoka, Miyuki; Yi, Shuang-Qin; Itoh, Masahiro
Immunization of mice with viable syngeneic testicular germ cells (TGC) alone can induce autoimmune responses against autoantigens of both round and elongating spermatids, resulting in the development of experimental autoimmune orchitis (EAO). Histological lesions in this EAO model without an adjuvant are characterized by lymphocytic infiltration into the testes, spermatogenic disturbance, and a complete lack of epididymitis. In this study, we investigated the effects of vasectomy (Vx) on TGC-induced EAO expecting that Vx augments the severity of testicular inflammation in A/J mice. The results showed that mice receiving Vx alone exhibited no significant inflammatory cell response in either the testes or epididymides, and mice receiving shamVx+TGC immunization had EAO with no epididymitis. In sharp contrast, no EAO was found in the testes of any mice receiving Vx+TGC immunization. Instead, caput epididymitis involving CD4+T cells, CD8+T cells, B cells, and macrophages were induced in them with striking elevation of the tissue levels of both IL6 and IL10 mRNA. Furthermore, serum autoantibodies induced by shamVx+TGC immunization were reactive with both round (immature) and elongating (mature) spermatids; however, those induced by Vx+TGC immunization were specific to acrosomes of mature spermatids and spermatozoa. These unexpected results indicate that Vx may induce the mode by which autoreactive lymphocytes gain access to TGC autoantigens in the epididymides, leading to autoimmune responses against the autoantigens of mature rather than immature spermatids.
... Promoting Men’s Health New Research on Male Contraceptive Methods All related news Home Contact Accessibility Web Policies and Notices FOIA Facebook Twitter Pinterest YouTube RSS NIH...Turning Discovery Into Health ® Printed from the NICHD Web Site
... Promoting Men’s Health New Research on Male Contraceptive Methods All related news Home Contact Accessibility Web Policies and Notices FOIA Facebook Twitter Pinterest YouTube RSS NIH...Turning Discovery Into Health ® Printed from the NICHD Web Site
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Shih, Grace; Zhang, Ying; Bukowski, Kyle; Chen, Angela
Sterilization, male and female combined, is the most common use of contraception in the United States. Despite the lower risk, higher cost-efficacy, and high efficacy of vasectomy compared with female sterilization, more US women rely on female sterilization than male sterilization. Reasons for low use of vasectomy include lack of knowledge and misconceptions about the procedure, lack of access, provider bias, and patient preferences. This article will provide a basic overview of male and female sterilization, an exploration of vasectomy barriers, and ways obstetrician-gynecologists can increase vasectomy uptake including regular recommendation of vasectomy to patients in long-term committed relationships considering sterilization.
Masterson, J.; Avalos, E.; Santomauro, M.; Walters, R.; Marguet, C.; L'Esperance, J.; Drain, D.
Background Men seeking a vasectomy should receive counseling prior to the procedure that includes discussion of later seeking a reversal. We sought to determine demographic factors that may predispose patients to possibly later seek a vasectomy reversal. Methods All U.S. Military electronic health records were searched between 2000 and 2009 for either a vasectomy or vasovasostomy procedure code. Aggregate demographic information was collected and statistical analysis performed. Result A total of 82,945 patients had a vasectomy of which 4,485 had a vasovasostomy resulting in a vasovasostomy-to-vasectomy rate of 5.04%. The average age at vasovasostomy was 34.9±5.0, with an average interval of 4.1±2.2 years. Men undergoing a vasectomy at a younger age were more likely to have a vasovasostomy. Various religions did have statistically significant differences. Within ethnic groups, only Native Americans [OR=1.39 (95% CI 1.198-1.614)] and Asians [OR=0.501 (95% CI 0.364-0.690)] had statistically significant differences when compared to Caucasians. Men with more children at the time of vasectomy were more likely to have a vasovasostomy. Conclusion Younger men, Native Americans, and men with more children at vasectomy were more likely to undergo a vasovasostomy. The reason for these differences is unknown, but this information may assist during pre-vasectomy counseling. PMID:24917734
32202112Tubal ligation or vasectomy ( Essure or hysterectomy) 7 39 47 Men 9 38 54 Women Officer 19 56 51 Men 16Withdrawal What method(s) of birth control do you or...control patch 61Other 53Spermicide 01IUD 41Diaphragm 01Female condom 82Rhythm 50Tubal ligation or vasectomy ( Essure or hysterectomy) 6 19 59 Officer
8% Diaphragm .7% 2.8% NO Vasectomy or tubal ligation (tubes tied) 11.1% 10.7% I am (or my partner is) sterile 1.8% 1.3% I am not sexually active...35.90, p < .001). Service members who had opted for surgical sterilization (vasectomy or tubal ligation ) were older (mean = 34.7 years old) than...to be sterilized (X2 (N = 806) = 153.16, p < .001), with 41.3 % of chiefs (E7-E9) reporting that they or their partner had had a vasectomy or tubal
... Campbell-Walsh Urology . 11th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 141. Read More Infertility Klinefelter syndrome Vasectomy Review Date 3/28/2016 Updated by: Scott Miller, MD, urologist in private practice in Atlanta, ...
Shetty, Jagathpala; Bronson, Richard A; Herr, John C
Anti-sperm antibodies (ASA) are an important cause of immunological infertility. The objective of this study was to identify immunodominant sperm antigens recognized by anti-sperm antibodies (ASA) in serum samples of infertile men, women and vasectomized men. High-resolution two-dimensional gel electrophoresis was employed to separate human sperm proteins using isoelectric focusing (IEF) or nonequilibrium pH gradient electrophoresis (NEPHGE), followed by PAGE and Western blotting. Serum samples from five infertile male and five infertile female subjects that contained ASA as assayed by the immunobead binding test (IBT), were analyzed by Western blotting using NEPHGE gels followed by enhanced chemiluminescence (ECL) to identify the basic sperm antigens reactive to the sera. Serum samples from five fertile male and five fertile female subjects that were ASA-negative by IBT were used as controls. Serum samples from six vasectomized men collected before vasectomy and at different time intervals until 6 months after vasectomy were analyzed by Western blotting using IEF gels. The ECL blots were analyzed to compare immunoreactivity between serum samples from fertile and infertile subjects and identify antigens unique to sera of the infertile subjects. Similarly, immunoreactivity between serum samples from pre- and post-vasectomy was compared to identify antigens unique to sera collected following vasectomy. Five allo-antigenic basic protein spots were recognized by sera from infertile males but not from fertile subjects. Five sperm iso-antigenic basic spots were recognized by infertile female subjects. Two among six of the vasectomized men's sera showed a difference in the Western blot profile 6 months after vasectomy, recognizing at least one new protein spot in each case when compared to pre-vasectomy sera. The acrosomal protein SP-10 was identified as an alloantigen recognized by a post-vasectomy serum. Molecular identities of the known allo- and iso
Ahn K-c; Kim O-k
In order to assess the acceptability of existing and potential male fertility regulating methods in Korea, a total of 353 male respondents were interviewed from 3 sampling areas: 99 cases from urban middle socioeconomic status, 104 cases from urban low socioeconomic status, and 150 cases from the rural area. Respondents from each area differed in terms of educational attainment and socioeconomic status. Respondents from each area have about the same level of knowledge of contraceptive methods, but their behaviors differ considerably. The rate of currently practicing contraception was highest among rural samples and lowest among urban low socioeconomic groups. The relative acceptability of 2 existing (condom and vasectomy) and 2 potential (daily pill and monthly injection) male fertility regulating methods was assessed using several measures of acceptability. Whatever measure used, the most consistent finding among sampling groups was that vasectomy is the least acceptable method. Vasectomy is least preferred among potential users, and this finding suggests that the current target system on vasectomy in the national family planning program should be reconsidered. For all measures of acceptability potential methods were more preferred than either condom or vasectomy for the rural and urban low socioeconomic status samples. With regard to the potential male methods, methods with longer duration of action are preferred to methods with a shorter duration. Urban-rural residence was found to be significantly related to the acceptability of condom and vasectomy; urban residents liked condom and vasectomy more than rural residents. Age of respondents was not significantly related to the attitudes toward using each male method but significantly related to the behavioral intention to use each male method. The education level is not significantly related to the acceptability of condom but related to the acceptability of other male fertility regulating methods. More than 1/2 of
Vasectomy is done by a family physician at the family planning clinic of le Centre Hospitalier de l'Université Laval. The technique used combines an occlusion with metal clips and an excision of one to two centimetres of the vas deferens. The post-operative complications encountered with 304 vasectomies were hematomas (4%), infections of the scotal skin (1%), orchi-epididymitis (1%) and granulomas (1%). All these problems were treated on an out-patient basis, and no consultation with specialists was required. Of 151 patients who came back for a post-vasectomy semen examination, one had a test result showing motile spermatozoa. These figures are comparable to other results published. The family physician can easily incorporate this simple and safe procedure into his practice. ImagesFigure 1Figure 2Figure 3Figure 4Figure 5Figure 6 PMID:21263976
Mihevc, Nancy T.; And Others
The concept of reality held by individuals and societies can be explored by examining reactions to the censorship of the two-part television show in the "Maude" series that dealt with abortion and vasectomy. The station managements of WMBD in Peoria, Illinois, and of WCIA in Champaign-Urbana, Illinois, chose not to broadcast the two…
Herrel, Lindsey; Hsiao, Wayland
Up to 6% of men who have undergone vasectomy will ultimately elect for reversal in the form of vasovasostomy or vasoepididymostomy for various reasons. Vasovasostomy performed to regain fertility is a technique that has undergone numerous advances during the last century, including the use of microsurgical equipment and principles to construct a meticulous anastomosis. It is important during vasovasostomy to ensure good blood supply to the anastomosis as well as to build as a tension-free anastomosis. Visual inspection to ensure healthy mucosa and inner muscularis as well as atraumatic handling of tissues is helpful. With vasovasostomy, it is essential to create a watertight anastomosis to prevent secondary scar formation. The microdot technique of vasovasostomy allows for markedly discrepant lumens to be brought together more precisely. Thereby, the planning is separated from suture placement, which prevents dog-ears and avoids subsequent leaks. In the age of in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI), it becomes even more important to clarify outcomes after vasectomy reversals, as patients now have a choice between surgical sperm retrieval coupled with IVF/ICSI versus vasectomy reversal. Little data on long-term outcomes for vasectomy reversals exist. Therefore, further research in this field needs to evaluate the rate of late failures and the predictors of late failures. PMID:23147468
Peterson, Herbert B
Worldwide, sterilization (tubal sterilization and vasectomy) is used by more people than any other method of contraception. All techniques of tubal sterilization in widespread use in the United States have low risks of surgical complications. Although tubal sterilization is highly effective, the risk of pregnancy varies by age and method of occlusion. Pregnancies can occur many years after the procedure, and when they do, the risk of ectopic gestation is high. There is now strong evidence against the existence of a post-tubal ligation syndrome of menstrual abnormalities. Although women who have undergone tubal sterilization are more likely than other women to undergo hysterectomy subsequently, there is no known biologic basis for this relationship. Although sterilization is intended to be permanent, expressions of regret and requests for reversal are not uncommon and are much more likely to occur among women sterilized at young ages. Tubal sterilization has little or no effect on sexual function for most women. Vasectomy is less likely than tubal sterilization to result in serious complications. Minor complications, however, are not uncommon. Vasectomy does not increase the risk of heart disease, and available evidence argues against an increase in the risk of prostate cancer, testicular cancer, or overall mortality. Whether a postvasectomy pain syndrome exists remains controversial. Although the long-term effectiveness of vasectomy is less well-studied than that for tubal sterilization, it seems likely to be at least as effective. Intrauterine devices and progestin implants are long-acting, highly effective alternatives to sterilization.
... 32 National Defense 5 2013-07-01 2013-07-01 false Unauthorized care. 732.15 Section 732.15... DENTAL CARE Medical and 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....
... 32 National Defense 5 2012-07-01 2012-07-01 false Unauthorized care. 732.15 Section 732.15... DENTAL CARE Medical and 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....
... 32 National Defense 5 2010-07-01 2010-07-01 false Unauthorized care. 732.15 Section 732.15... DENTAL CARE Medical and 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....
... 32 National Defense 5 2011-07-01 2011-07-01 false Unauthorized care. 732.15 Section 732.15... DENTAL CARE Medical and 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....
... 32 National Defense 5 2014-07-01 2014-07-01 false Unauthorized care. 732.15 Section 732.15... DENTAL CARE Medical and 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....
All men undergoing reversal after vasectomy between 1984 and 1986 at the Steglitz clinic at the Free University of Berlin were given a deep psychological examination consisting of a history and interview and administration of the Giessen self image and partner image tests and the Giessen worry questionnaire. In 30 of the 40 cases 1 or more of the following factors was present at the time of vasectomy: status as a student, no relationship or a bad one, current or planned psychotherapy of one partner, a generalized rejection of children on ideological grounds or subjection to vasectomy in order to deliberately alienate parents. Of the 40 men treated, 25 had been married and living with their wives at the time of vasectomy, of which 22 had natural children, 2 adopted children and 1 with neither natural nor adopted children. 7 of the men were in a fixed relationship, all without either natural or adopted children. 8 of the men were not partners in a relationship; of these, 5 had natural children and 3 had neither natural nor adopted children. At the time of reversal the 29 new relationships averaged 13 months old, of which 15 were 24 months and 4 6 years. Of the 10 men living in an unchanged relationship, 3 were reacting to the death of a natural child, 3 experienced a wish for more children when their youngest child entered school and with 4 couples, previously childless, which resulted from psychotherapy of either the man or the wife.
Haddad Kashani, Hamed; Moshkdanian, Ghazale; Atlasi, Mohammad Ali; Taherian, Ali Akbar; Naderian, Homayoun; Nikzad, Hossein
Objective: Vasectomy, though in some cases are being confronted with irreversibility, has been accepted as an effective contraceptive method. It is estimated that near 2-6% of vasectomised men ultimately show a tendency to restore their fertility. In some cases, vasectomy has been considered as an irreversible procedure due to many post-vasectomy complications causing this debate. The aim of present study was to investigate the pattern of expression of galectin-3, an inflammatory factor secreted by macrophages and immune cells, following the vasectomy in mice testis tissue. Materials and Methods: In this experimental study, twenty mature male Balb/c mice, aged two months, were divided into two equal groups: sham and vasectomised groups (n=10). They were sacrificed four months after vasectomy, while the pattern of galectin-3 expression was investigated using a standard immunohistochemistry technique on testicular tissues. Stereological analyses of testes parameters in vasectomised and shamoperated groups were compared by mixed model analysis. Results: Based on observations, although galectin-3 was not expressed in sham-operated group, it was expressed in 40% of testicular tissues of vasectomised mice, like: seminiferous tubules, interstitial tissues and tunica albugina. Also, our result showed a significant alteration in number of germ and sertoli cells of testicular tissue in vasectomised group in comparison to sham-operated group. In addition, the result of mixed model method confirmed a significant reduction in germ and sertoli cells of vasectomised group. Conclusion: The expression of galectin-3 at different parts of testicular tissue in vasectomised group is higher than sham group. This express illustrates the increase of degenerative changes and inflammation reactions in testicular tissue, leading to chronic complications and infertility, after the vasovasostomy PMID:23700556
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
Schroeder-Printzen, I; Schroeder-Printzen, J; Gleissner, J; Weidner, W
In recent years there have been several Supreme Court adjudications concerning andrological issues. Among other things it was reconfirmed that drug therapy for erectile dysfunction does not have to be paid by compulsory health insurance providers. In contrast one Supreme Court decided that cryoconservation of ejaculates has to be paid by compulsory health insurance providers under certain circumstances.Vasectomy in men under guardianship is performed approximately 100 times per year in Germany. Before vasectomy is performed judicial authorisation has to be obtained in an extensive court proceeding.The Tissue Act regulates the implementation of the EG guideline 2004/23/EG into German law. This is only important for urologists who perform MESA/TESE procedures. Current case law does not allow use of the title Männerarzt as patients can confuse it with the official title andrologist.
Schurr, Efrat; Cytter-Kuint, Ruth; Ehrlichman, Matityahu; Weiser, Giora
Vasitis represents an inflammation of the vas deferens. This is a rare entity seen mostly in adult males following local surgery (e.g., vasectomy, hernia repair). Children with groin masses have a wide differential diagnosis. We describe a child with a groin mass following epididymitis diagnosed with vasitis and review the known literature regarding diagnostic tools and treatment. Vasitis in children, although rare, can be seen as a complication of epididymitis. PMID:25024800
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
Wibowo, Erik; Johnson, Thomas W; Wassersug, Richard J
From a Darwinian perspective we live to reproduce, but in various situations genetic males elect not to reproduce by choosing medical treatments leading to infertility, impotence, and, in the extreme, emasculation. For many men, infertility can be psychologically distressing. However, for certain genetic males, being infertile may improve their quality of life. Examples include (1) men who seek vasectomy, (2) individuals with Gender Dysphoria (e.g., transwomen, and modern day voluntary eunuchs), (3) most gay men, and (4) men treated for testicular and prostate cancer. Men who desire vasectomy typically have a Darwinian fitness W >1 at the time of their vasectomies; i.e., after they have their desired number of offspring or consider themselves past an age for parenting newborns. In contrast, prostate and testicular cancer patients, along with individuals with extreme Gender Dysphoria, do not necessarily seek to be sterile, but accept it as an unavoidable consequence of the treatment for their condition undertaken for survival (in case of cancer patients) or to achieve a better quality of life (for those with Gender Dysphoria). Most gay men do not father children, but they may play an avuncular role, providing for their siblings’ offspring's welfare, thus improving their inclusive fitness through kin selection. In a strictly Darwinian model, the primary motivation for all individuals is to reproduce, but there are many situations for men to remove themselves from the breeding populations because they have achieved a fitness W ≥1, or have stronger medical or psychological needs that preclude remaining fertile. PMID:26924280
Wibowo, Erik; Johnson, Thomas W; Wassersug, Richard J
From a Darwinian perspective we live to reproduce, but in various situations genetic males elect not to reproduce by choosing medical treatments leading to infertility, impotence, and, in the extreme, emasculation. For many men, infertility can be psychologically distressing. However, for certain genetic males, being infertile may improve their quality of life. Examples include (1) men who seek vasectomy, (2) individuals with Gender Dysphoria (e.g., transwomen, and modern day voluntary eunuchs), (3) most gay men, and (4) men treated for testicular and prostate cancer. Men who desire vasectomy typically have a Darwinian fitness W >1 at the time of their vasectomies; i.e., after they have their desired number of offspring or consider themselves past an age for parenting newborns. In contrast, prostate and testicular cancer patients, along with individuals with extreme Gender Dysphoria, do not necessarily seek to be sterile, but accept it as an unavoidable consequence of the treatment for their condition undertaken for survival (in case of cancer patients) or to achieve a better quality of life (for those with Gender Dysphoria). Most gay men do not father children, but they may play an avuncular role, providing for their siblings' offspring's welfare, thus improving their inclusive fitness through kin selection. In a strictly Darwinian model, the primary motivation for all individuals is to reproduce, but there are many situations for men to remove themselves from the breeding populations because they have achieved a fitness W ≥1, or have stronger medical or psychological needs that preclude remaining fertile.
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 the scrotal skin to reduce both the laser power necessary for successful noninvasive laser vasectomy and the probability of scrotal skin burns. A mixture of DMSO/glycerol was noninvasively delivered into the scrotal skin using a Madajet. Near-infrared laser radiation with a range of average powers (7.0-11.7 W) was delivered in conjunction with a range of cryogen spray cooling rates (0.20-0.33 Hz) to the skin surface in a canine model, ex vivo and in vivo. Burst pressure (BP) measurements were conducted to quantify the strength of vas closure. A 30-min application of the OCA improved skin transparency by 26 +/- 5 %, reducing the 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 optical clearing agent reduced the laser power necessary for successful noninvasive thermal coagulation of the vas by approximately 25%. This technique may result in the use of a less expensive laser system and eliminate the formation of scrotal skin burns during the procedure.
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.
Schill, W B
The various aspects of male fertility control are elaborated. A discussion of spermatogenesis and fertilization mechanisms lays the groundwork for determining how these processes can be inhibited. Mechanical male contraceptive methods are coitus interruptus and coitus condomatus. Coitus interruptus can cause neurotic disturbances in both partners and has a failure rate of 10-20/100 use-years. The condom has a failure rate of about 7/100 use-years. Vasectomy is the most practicable operative male contraceptive method. Scrotal hematoma, scrotal abcesses, and congestive epididymitis are possible post-operative complications. 2/3 of the men who have vasectomies develop sperm autoantibodies, and some develop sperm granulomas. Spontaneous recanalization occurs in .8% of the cases. The incipience of azoospermia after vasectomy is dependent on the number of ejaculations but is difficult to predict. Castration and increasing the temperature of the gonads are other operative methods of male contraception. Medicamentive methods of male contraception must be safe, effective, fast, and reversible; they must cause no genetic changes, disturbances in libido or potency, or changes in secondary sex characteristics. Medicamental agents can affect spermatogenesis; the maturation of the spermatozoa; transport, motility, or metabolism of the spermatozoa; capacitation of the spermatozoa; or the penetration enzymes. Heavy metal compounds, cytostatic, or antibiotic compounds are unsuitable as spermatogenic inhibitors due to side effects. 5-Thio-D-Glucose may show promise as an antispermatogenic agent.
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.
Lu, Wen-Hong; Liang, Xiao-Wei; Gu, Yi-Qun; Wu, Wei-Xiong; Bo, Li-Wei; Zheng, Tian-Gui; Chen, Zhen-Wen
Because of unavoidable complications of vasectomy, this study was undertaken to assess the efficacy and safety of male sterilization with a nonobstructive intravas device (IVD) implanted into the vas lumen by a mini-surgical method compared with no-scalpel vasectomy (NSV). IVDs were categorized into two types: IVD-B has a tail used for fixing to the vas deferens (fixed wing) whereas IVD-A does not. A multicenter prospective randomized controlled clinical trial was conducted in China. The study was comprised of 1459 male volunteers seeking vasectomy who were randomly assigned to the IVD-A (n = 487), IVD-B (n = 485) or NSV (n = 487) groups and underwent operation. Follow-up included visits at the 3rd–6th and 12th postoperative months. The assessments of the subjects involved regular physical examinations (including general and andrological examinations) and semen analysis. The subjects’ partners also underwent monitoring for pregnancy by monthly interviews regarding menstruation and if necessary, urine tests. There were no significant differences in pregnancy rates (0.65% for IVD-A, 0 for IVD-B and 0.21% for NSV) among the three groups (P > 0.05). The cumulative rates of complications at the 12th postoperative month were zero, 0.9% and 1.7% in the three groups, respectively. In conclusion, IVD male sterilization exhibits a low risk of long-term adverse events and was found to be effective as a male sterilization method, similar to the NSV technique. IVD male sterilization is expected to be a novel contraceptive method. PMID:24589454
Kogan, Paul; Wald, Moshe
Although the twentieth century has seen great strides in the development of female contraception, not a single new agent has been introduced as an approved method for common use for male contraception. Condoms (considered uncomfortable by some) and vasectomy (a permanent invasive procedure) are the only options provided to men, leaving an undue burden on women to bear contraceptive responsibility. Significant developments have, however, been made with regard to hormonal and nonhormonal contraception, and minor, reversible, procedural contraception. This article reviews the currently available, soon to be available, and theoretically possible methods of male contraception.
Pienkos, Edward Joseph
The purpose of this article is to describe a simple, intellectually reasonable, initial treatment for all subacute and chronic postvasectomy scrotal pains. The use of intramuscular testosterone cypionate in a dose of 400 mg monthly for 3 months is described for patients suffering from painful sperm granuloma at the vasectomy site or in the epididymis, circumventing the need for other medical or surgical approaches. Excellent results have been achieved in patients and a representative case is illustrated. The rationale for this approach based on endocrinological and immunological mechanisms is described.
Guzman, David Sanchez-Migallon
Basic surgical instrumentation for avian soft tissue surgery includes soft tissue retractors, microsurgical instrumentation, surgical loupes, and head-mounted lights. Hemostasis is fundamental during the surgical procedures. The indications, approach, and complications associated with soft tissue surgeries of the integumentary (digit constriction repair, feather cyst excision, cranial wound repair, sternal wound repair, uropygial gland excision), gastrointestinal (ingluviotomy, crop biopsy, crop burn repair, celiotomy, coelomic hernia and pseudohernia repair, proventriculotomy, ventriculotomy, enterotomy, intestinal resection and anastomosis, cloacoplasty, cloacopexy), respiratory (rhinolith removal, sinusotomy, tracheotomy, tracheal resection and anastomosis, tracheostomy, pneumonectomy) and reproductive (ovocentesis, ovariectomy, salpingohysterectomy, cesarean section, orchidectomy, vasectomy, phallectomy) systems are reviewed.
Maclean, Courtney C; Thompson, Ivana S
Postpartum obese women have an increased risk of breastfeeding difficulties and depression. Retaining the pregnancy weight at 6 months postpartum predicts long-term obesity. Risks for weight retention include excessive gestational weight gain, ethnicity, socioeconomic status, diet, exercise, depression, and duration of breastfeeding. Exercise and reducing total caloric intake promote postpartum weight loss. Intrauterine devices and contraceptive implants are the most effective contraceptives for obese women. Contraceptive pills, patches, and vaginal rings are effective options; however, obese women should be made aware of a potential increased risk of venous thromboembolism. Vasectomy and hysteroscopic sterilization carry the least surgical risk for obese women.
Methods of male contraception are discussed. Estrogens, although effective, are not acceptable because of the side effects (gynecomastia and libido changes). Androgens are effective for varying periods but require constant monitoring of effectiveness. Antiandrogens inhibit not only spermatogenesis but also libido and are thus unsuitable for use as contraceptives. Immunization against sperm protein components can be carried out in men or women; this promising technique is still experimental. Enzymatic techniques are still in the research stages. Vasectomy, a simple and practical alternative, requires thorough information and counseling of both husband and wife before it can be judged appropriate.
Parekattil, Sijo J.; Cohen, Marc S.; Vieweg, Johannes W.
Our goal was to develop a robotic approach for vasoepididymostomy (RAVE) and vasovasostomy (RAVV) using a 4 arm High Definition Platform (Intuitive Surgical, CA) and present our human in-vivo results. All 3 RAVV procedures were successful and one patient had 102 million motile sperm/ml of ejaculate at 1 month post-op. The RAVE procedure patient only had a few non-motile sperm at 6 month follow up in his ejaculate. The use of robotics seems to offer advantages in terms of ergonomics and suture control. Further evaluation is needed to assess the clinical potential of robotics in vasectomy reversal.
Boward, Emily S; Wilson, Stacey L
The screening and confirmatory tests available to a forensic laboratory allow evidence to be examined for the presence of bodily fluids. With the majority of evidence being submitted involving sexual assaults, it is important to have confirmatory tests for the identification of semen that are straightforward, quick, and reliable. The purpose of this study was to compare two commonly used semen identification kits utilized by forensic laboratories: ABAcard(®) p30 and Rapid Stain Identification of Human Semen (RSID™-Semen). These kits were assessed with aged semen stains, fresh and frozen post-vasectomy semen, post-coital samples collected on different substrates, post-vasectomy semen mixed with blood, saliva, and urine, a series of swabs collected at increasing time intervals after sexual intercourse, and multiple non-semen samples. The test kits were compared on the basis of sensitivity, specificity, and the cost and time effectiveness of each protocol. Overall, both semen identification tests performed well in the studies. Both kits proved specificity for identifying semen, however the ABAcard(®) p30 test surpassed the RSID™-Semen test in sensitivity, cost per test, and simplified test protocol.
Ferrís-i-Tortajada, J; Berbel-Tornero, O; Garcia-i-Castell, J; López-Andreu, J.A.; Sobrino-Najul, E; Ortega-García, J.A.
Introduction The aim is to update and disclose the main environmental risk factors, excluding dietary factors, involved in the etiopathology of prostate cancer. Materials and methods Bibliographic review of the last 25 years of non-dietary environmental risk factors associated with prostate cancer between 1985 and 2010, obtained from MedLine, CancerLit, Science Citation Index and Embase. The search profiles were Environmental Risk Factors/Tobacco/Infectious-Inflammatory Factors/Pesticides/Vasectomy/Occupational Exposures/ Chemoprevention Agents/Radiation and Prostate Cancer. Results While some non-dietary environmental risk factors increase the risk of acquiring the disease, others decrease it. Of the former, it is worth mentioning exposal to tobacco smoke, chronic infectious-inflammatory prostatic processes and occupational exposure to cadmium, herbicides and pesticides. The first factors that reduce the risk are the use of chemopreventive drugs (Finasterida, Dutasteride) and exposure to ultraviolet solar radiation. With the current data, a vasectomy does not influence the risk of developing the disease. Conclusions The slow process of prostate carcinogenesis is the final result of the interaction of constitutional risk and environmental factors. Non-dietary environmental factors play an important role in the etiopathology of this disease. To appropriately assess the risk factors, extensive case studies that include all the possible variables must be analyzed. PMID:21439685
Methods of contraception for use by men include condoms, withdrawal and vasectomy. Prevalence of use of a method and continuation rates are indirect measures of acceptability. Worldwide, none of these "male methods" accounts for more than 7% of contraceptive use although uptake varies considerably between countries. Acceptability can be assessed directly by asking about intended (hypothetical) use and assessing satisfaction during/after use. Since they have been around for a very long time, there are very few data of this nature on condoms (as contraceptives rather than for prevention of infection), withdrawal or vasectomy. There are direct data on the acceptability of hormonal methods for men but from relatively small clinical trials which undoubtedly do not represent the real world. Surveys undertaken among the male general public demonstrate that, whatever the setting, at least 25% of men - and in most countries substantially more - would consider using hormonal contraception. Although probably an overestimate of the number of potential users when such a method becomes available, it would appear that hormonal contraceptives for men may have an important place on the contraceptive menu. Despite commonly expressed views to the contrary, most women would trust their male partner to use a hormonal method.
The Senate Human Resources Subcommittee under the chairmanship of Senator Alan Cranston has completed its work on the Family Planning Services and Population Research Amendments of 1973 (S. 1708) and has referred the bill to the Senate Labor and Public Welfare Committee. Right-to-Life activists are zeroing in on committee members in hopes of amending the bill to prohibit federal funds for sterilization and continued research on abortifacient drugs. If such provisions were to be approved, it would prohibit men from obtaining vasectomies with federal assistance and eliminate what has become a most popular birth control method for couples who have reached their desired family size. Such a prohibition would be especially discriminatory of low income males who cannot afford to finance a vasectomy through the private health care system. Banning use of IUDs by federal family planning agencies could also interfere with valuable cancer research and the treatment of such ailments as asthma and duodenal ulcers. The Senate Labor Committee needs to be fully advised as to the dangerous implications of these provisions and of the public opposition to their enactment. Vocalize your opposition today by urging the committee to exclude such amendments from the legislation they send to the Senate. The committee members are: Chairman: Williams, New Jersy; Randolph, West Virginia; Pell, Rhode Island; Kennedy, Massachusetts; Nelson, Vermont; Mondale, Minnesota; Eagleton, Missouri; Cranston, California; Hughes, Iowa; Hathaway, Maine; Javits, New York; Dominick, Colorado; Schweiker, Pennsylvania; Taft, Ohio; Beall, Maryland; and Stafford, Vermont.
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. In this study, 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 6 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.
Younis, I.; Bhutiani, R. P.
AIMS: To compare the effect of buffered commercial 1% xylocaine (with 1:200,000 adrenaline) and the unbuffered commercial 1% xylocaine (with 1:200,000 adrenaline) preparation on pain during infiltration and procedure. PATIENTS AND METHODS: A randomised, double blind controlled trial involving 85 patients who underwent bilateral vasectomy under local infiltration anaesthesia. RESULTS: Each patient served as his own control by receiving the buffered commercial preparation on one side and unbuffered commercial preparation on the other. Linear analogue pain scores during infiltration and procedure were recorded and analysed. The study demonstrated that pain perceived by the patient both during infiltration and the procedure was significantly lower when buffered commercial xylocaine was used as compared to the pain perceived with the use of unbuffered commercial xylocaine. CONCLUSIONS: Use of buffered xylocaine is a simple, inexpensive and significantly effective way of reducing pain during infiltration and in surgical procedures performed under local anaesthesia. PMID:15140310
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.
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.
7. Fetal Death Rate 0 10 0 .8 1.1 0 8 Autopsy Rate 7 49 70 42.2 47 62 9. Number of Tubal Ligations 10 126 10. Number of Therapeutic Abortions 0 1 11...0 0 0 0 0 6. Anesthetic Death Rate (1 in 5000) 0 0 0 0 0 0 7. Fetal Death Rate 0 0 0 0 .8 8. Autopsy Rate 3 3 37.5 o 37.5 42.2 47 9. Number of Tubal ... Ligations 19 19 10. Number of Therdpeutic Abortions 0 0 11. Number of Vasectomies 12 12 12. Normal Tissue Removed Rate (10%) 5 5 1.9 1.9 .7 1 13
Vargas-Blasco, César; Gómez-Durán, Esperanza L; Arimany-Manso, Josep; Pera-Bajo, Francisco
Clinical safety and medical professional liability are international major concerns, especially in surgical specialties such as urology. This article analyzes the claims filed at the Council of Medical Colleges of Catalonia between 1990 and 2012, exploring urology procedures. The review of the 173 cases identified in the database highlighted the importance of surgical procedures (74%). Higher frequencies related to scrotal-testicular pathology (34%), especially testicular torsion (7.5%) and vasectomy (19.6%), and prostate pathology (26 %), more specifically the surgical treatment of benign prostatic hyperplasia (17.9%). Although urology is not among the specialties with the higher frequency of claims, there are special areas of litigation in which it is advisable to implement improvements in clinical safety.
Parekattil, Sijo J.; Moran, Michael E.
This article presents a review of the history and evolution of robotic instrumentation and its applications in urology. A timeline for the evolution of robotic instrumentation is presented to better facilitate an understanding of our current-day applications. Some new directions including robotic microsurgical applications (robotic assisted denervation of the spermatic cord for chronic orchialgia and robotic assisted vasectomy reversal) are presented. There is a paucity of prospective comparative effectiveness studies for a number of robotic applications. However, right or wrong, human nature has always led to our infatuation with the concept of using tools to meet our needs. This chapter is a brief tribute to where we have come from and where we may be potentially heading in the field of robotic assisted urologic surgery. PMID:21116362
Yen, Ching-Heng; Lee, Chun-Te; Su, Chung-Jen; Lo, Hua-Cheng
A 53-year-old Taiwanese male had several episodes of left epididymitis with hydrocele refractory to antibiotic treatment. Partial epididymectomy plus preventive vasectomy were planned, and, incidentally, an ill-defined nodule was found lying on the tunica vaginalis near the epididymal head. The pathological diagnosis was malignant mesothelioma of the tunica vaginalis testis. Radical orchiectomy with wide excision of the hemi-scrotal wall was performed. So far, there is no evidence of recurrence after more than 3 years of follow-up. Malignant tumor should be considered in the case of recurrent epididymitis refractory to empirically effective antibiotic treatment. Although the nature of this tumor is highly fatal, the malignancy can possibly be cured by early and aggressive surgical treatment.
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.
80% of women using contraception in Zambia use oral contraceptives (OCs), yet they often complain about side effects. 66% of people polled at family planning (FP) clinics prefer OCs and 30% chose condoms. Nevertheless only 10% of the 60% of married couples familiar with FP use contraception. This contributes to Zambia having 1 of the highest annual population growth rates in the world (3.4%). The Planned Parenthood Association of Zambia (PPAZ) thinks that if males become more knowledgeable about FP, the population growth would slow down. At least 60% of men in Zambia approve of their wives using FP, yet they are slow to use male contraception. They say condoms reduce sensation and wives often consider condoms a nuisance. The AIDS epidemic forces men to rethink their views toward condom use, however. Those 30% of men who do use condoms are more likely to use them with their girlfriends or women with whom they are unfamiliar. So they are not using them for FP purposes. Men fear vasectomy because they perceive it to cause impotence. Considerable education to counter this myth is needed to increase the number of vasectomies. Besides some men prefer their wives be sterilized rather than themselves because if the men lose all their children they can have other children with other wives. PPAZ aims programs at men in order to expand their participation and nurture their influence in FP matters. It has a male counseling program serving rural villages along the railroad lines which begin in the northern copper belt and end in urban areas in the south to promote birth spacing. It is working with companies to include FP services in their clinics so men can learn more about FP. FP specialists in Zambia foresee an increase in male support of FP as they realize the difficulty of supporting large families during the economic crises.
Hüssy, Daniela; Janett, Fredi; Albini, Sarah; Stäuber, Norbert; Thun, Rico; Ackermann, Mathias
Ovine herpesvirus 2 (OvHV-2), a member of the viral subfamily Gammaherpesvirinae, shares numerous similarities with human herpesvirus 8 (HHV-8). Both viruses are apathogenic in their healthy original host, may cause lymphoprolipherative diseases, cannot routinely be propagated in cell culture, and may be sexually transmitted. However, the pathways of sexual transmission of these viruses, as well as the underlying pathogenetic dynamics, are not well understood. Organs from naturally OvHV-2-infected, as well as OvHV-2-free, sheep were quantitatively analyzed for OvHV-2 by the DNA amplification techniques. The dynamics of OvHV-2 multiplication and excretion were monitored after experimental infections and, most importantly, subsequent to vasectomy. The OvHV-2 DNA load in various tissues and internal organs was not merely reflecting the viral DNA load in the bloodstream, which suggested compartmentalization of OvHV-2. Moreover, OvHV-2 DNA was detected at several portals for virus shedding, i.e., the respiratory, alimentary, and urogenital tracts. Transient OvHV-2 excretion was detected in ejaculates of experimentally infected rams. Upon vasectomy, OvHV-2 DNA reappeared in the ejaculatory plasma, but the titers did not decline after reaching a peak. Spiking and fractionation experiments revealed an inhibitory activity, associated with the spermatozoa, which was able to suppress detection of viral DNA but which was no longer present in samples from vasectomized animals. Therefore, epidemiological studies on viruses that may be transmitted by the ejaculatory pathway and for whose tracing nucleic acid amplification methods are used, i.e., OvHV-2, HHV-8, and the human immunodeficiency virus, should include vasectomized males.
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.
Ball, R A; Steinberg, J; Wilson, L A; Loughlin, K R
An evaluation of vas reanastomoses in rats comparing suture only, carbon dioxide (CO2) laser-assisted, and fibrin-based tissue adhesive was performed in our laboratory. A cohort of 60 known fertile male Sprague Dawley rats initially underwent lower midline abdominal exploration and transection of their vas deferens bilaterally, followed by immediate microsurgical vasovasostomy by one of the three experimental methods. All groups initially had the severed vasa ends coapted by two or three transmural (mucosa through serosa) sutures of 10-0 nylon under an operating microscope. The conventionally sutured group had an additional four to six nylon 10-0 sutures placed externally in the serosa only to complete the anastomosis. The CO2 laser-assisted group underwent laser welding with denaturation of the serosa to seal the anastomosis. A fibrin-based tissue adhesive, produced by combining human cryoprecipitate and thrombin, was placed topically over the coapted vas ends to seal the anastomosis in the third group. Postoperative evaluation revealed similarities among the three surgical groups with the fibrin-based tissue adhesive group resulting in the highest patency rate (89%) and pregnancy rate (85%) as well as the lowest granulation rate (18%) and shortest operative time (27 minutes). The laser-assisted group resulted in the lowest pregnancy rate (68%), while the sewn anastomosis group had the lowest patency rate (76%). Both laser-assisted and conventionally sewn vasectomy reversals required significantly longer operative time (39 and 46 minutes, respectively) compared with the fibrin-based tissue adhesive-assisted procedures (p < 0.01). This study provides evidence that alternative microsurgical techniques may be utilized to perform uncomplicated, expeditious, and successful vasectomy reversals.
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%.
In 1985 the Colombian Family Planning Association PROFAMILIA realized that men did not want to come to its family planning centers simply because they felt intimidated by the feminine atmosphere there. Nor did they dare disclose their problems and sexual questions even to a female professional. The solution was to establish a family planning center, La Clinica del Hombre (Men's Clinic), providing services exclusively for men and staffed with men to provide the necessary privacy. Latin American men's attitudes are changing. In 1985 in Bogota, the majority of men were convinced that a vasectomy was equivalent to castration. In 1993, 300 vasectomies were performed in the clinic each month. The Colombian Family Planning Association is not only providing contraception, but also information on sexual and reproductive education to avoid misunderstanding of the available methods. PROFAMILIA has incorporated a sexuality consultation into its services, so they can deal with husbands and wives separately, without spoiling the couple's relationship. PROFAMILIA now has 7 family planning clinics for men and 48 for women, thanks to the contribution of international donors. The Challenge Grant for Men's Programs, given by an anonymous donor from the United States, helped with the fund-raising to open 3 clinics in the Atlantic Coast Region where needs were vital. The Clinica del Hombre will incorporate a program to treat infertility, in addition to the department of urology, general medicine, ambulatory surgery, and treatment of sexually transmitted diseases. In January, 1994, they will begin offering dental and plastic surgery services because, owing to the violence that exists in the country, there are many men whose faces are disfigured and who need to have corrective plastic surgery.
The "filarial dance" is not characteristic of filariasis: observations of "dancing megasperm" on high-resolution sonography in patients from nonendemic areas mimicking the filarial dance and a proposed mechanism for this phenomenon.
Adejolu, Margaret; Sidhu, Paul S
The objective of this series was to show that the sonographic appearance described as the "filarial dance" is not characteristic of filariasis but occurs in nonendemic areas as a manifestation of epididymal obstruction. An experienced observer documented cases after initial observation of the filarial dance in routine clinical practice using high-frequency linear array transducers. The filarial dance was described as excessive to-and-fro movement of echogenic particles within a prominent epididymis and graded 1 to 4 according to the extent and distribution of the abnormality. The country of birth, exposure to filarial infection or travel to a filarial-endemic area, previous scrotal surgery including vasectomy, any previous or current scrotal inflammatory disease, and any congenital testicular abnormalities were recorded. Over a 10-year period, sonographic appearances consistent with the filarial dance were observed in 18 patients (bilateral in 6). The mean patient age was 47.7 (range, 28-91) years. The abnormality was graded in the 24 affected testes as follows: grade 1, n = 3; grade 2, n = 8; grade 3, n = 8; and grade 4, n = 5. No patient had a history of filariasis or travel to an endemic area. Six of 18 patients (33.3%) had bilateral vasectomies; 5 (27.8%) had a history of epididymo-orchitis in the ipsilateral testis; 3 (16.7%) had previous scrotal surgery; and 4 (22.2%) had no relevant urologic history. We have described a sonographic appearance identical to the filarial dance in men with no history of filarial infection. Most had previous scrotal surgery or infection, suggesting that the filarial dance may not always be due to movement of filarial worms. The unifying condition in patients with filariasis and our patients is lymphatic obstruction, likely the underlying cause of the appearance in both groups.
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.
Mahasarakham province in Thailand has adopted family planning as its primary development policy. Although not a new issue, family planning until now has been largely ignored by most government sectors. Most consider family planning to be the sole responsibility of the Ministry of Public Ealth (MOPH), and this is why family planning has not been as successful as it should be. Discussion covers the general problem (rapid population increase, limited arable land, productivity, social and economic development, and deforestation), problems of family planning in the past (trained personnel and accessibility and government sectors ignoring or hindering family planning programs), integrated rural development (motivation, mobilizing teamwork, the integrated approach, mobile medical team, family planning for both the rich and the poor, and emphasis on vasectomy and IUD), objectives of the family planning program, and implementation. Mahasarakham uses an integrated rural development approach that emphasizes 9 development components: family planning, fisheries development, vegetable growing, water purification, rice banks, soy beans, using anchovies for natural fish sauce, insect extermination by electricity, and fuel from rice banks. All of these components contribute to the development of a better quality of rural life. The major problem is population growth, which at 1.8% remains high. Mahasarakham will promote the family planning program as the top priority, and this service will be brought to the people. The objectives of the family planning program are: to reduce the population growth rate Mahasarakham to zero growth within 2-3 years: to provide access to family planning services to all people in Mahasarakham; to educate people about family planning to increase its acceptance: to initiate a proper rural development program in Mahasarakham; and to promote intergovernmental cooperation by means of the integrated approach, which will have good results in later rural
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
have not been demonstrated. Among irreversible methods, many workers have sought an active or passive mehtod of immunizing against paregnancy, but no usable results have yet been obtained. Vasectomy is a simple and easy surgical procedure which is well accepted in some countries, although in most countries the responsibility for contraception is assumed by the women. Vasectomy has 1 advantage over female sterilization: sperm may be preserved in a bank for several years.
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
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 PGF2α 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
de Vries, M; Ramos, L; de Boer, P
Homologous recombination is the key to meiotic functioning. The basis of this process is provided by numerous SPO11-induced DNA double-strand breaks. Repair of these breaks occurs via the crossover (CO) and non-crossover (NCO) pathways. By means of immunofluorescence staining of Replication protein A (RPA) and MutL homolog 1 (MLH1) in combination with the DNA damage marker γH2AX, we studied transitional (CO and NCO) and late (CO) recombination nodules, respectively. Testicular samples were from non-obstructive azoospermic probands (testicular spermatozoa were found) and probands that had a history of normal fertility prior to a vasectomy. All probands were ICSI candidates. γH2AX foci mostly colocalized with delayed transitional nodules (RPA) for which variation was found among probands. Highest incidences of colocalization were found in patients. The level of MLH1 signal intensity was lower in probands who showed more frequent γH2AX RPA colocalization in late pachytene, suggesting communication between the CO and NCO pathways. Our results suggest the presence of a genetic risk pathway for children conceived from non-obstructive azoospermic probands and urge for follow-up studies investigating the level of recombination involved de novo mutations in these children.
Ross, R.K.; Paganini-Hill, A.; Henderson, B.E.
The two most important demographic characteristics of prostate cancer in Los Angeles are the high rates among blacks, which are two times those among whites and four times those among Asians, and the rapid increase in rates with age after age 40. Despite the high rates among blacks, a birth cohort analysis indicates that mortality rates among black men born after 1900 have decreased. In this report, epidemiologic and experimental evidence supporting each of three etiologic hypotheses--industrial exposure to cadmium, sexual transmission by an infectious agent, and endocrine factors--are reviewed. Evidence from descriptive data in Los Angeles suggests that only a small portion of cases might be attributable to industrial exposures. In a cohort study of Catholic priests, we found no deficit of prostate cancer mortality, strong evidence against sexual transmission of the disease. Experimental evidence and a limited amount of human data support an endocrine hypothesis. Preliminary results of a case-control study of prostate cancer are presented, but these results are unable to distinguish among these hypotheses further. This study finds a substantial protective effect of vasectomy, an event that is accompanied by reduced prostatic function and size, but this result is thus far statistically insignificant.
A belief in the heritability of degeneracy and the extreme fecundity of degenerate persons emerged in the late 19th and early 20th centuries. Concern that an ever-greater proportion of the population would be burdened with defective germ plasm and an ever-rising portion of the nation's wealth would be diverted to covering the costs of the behavior and institutional care of these persons led to the formulation of 4 alternative solutions: marriage restriction laws, indefinite segregation in institutions, castration, and sterilization. This paper examines the role played by physicians in the development of a eugenical sterilization policy. In the 1907-13 period, 12 states (Indiana, Washington, California, Connecticut, Nevada, Iowa, New Jersey, New York, North Dakota, Michigan, Kansas, and Wisconsin) enacted sterilization laws. A review of the medical journals from this period suggests that a handful of activist physicians were outspoken lobbyists for involuntary sterilization. They educated their profession about the need for social control measures to stop the spread of defective germ plasm and frequently exaggerated the curative powers of vasectomy in this regard. Despite physicians' efforts, only 1422 sterilizations of institutionalized persons were performed pursuant to state law in 1907-17, and all eugenic sterilization laws were declared invalid in 1918.
Eschen, A; Castano, F
A study, which was conducted in Colombia's five largest cities, determined men's, women's, and health care provider's knowledge, attitudes, and needs regarding sexual and reproductive health services for men. Data were collected through 60 focus groups, 720 surveys of service users and nonusers, 45 interviews with health care staff, and 5 couple's life histories. The study found that, due to the inadequate service facilities offered to men, it was difficult for men to achieve the goal of being responsible about their own and their partner's sexual and reproductive health. Only 9 of the 14 health care facilities surveyed rendered services such as vasectomy, health care promotion or prevention, and educational programs aimed at men. According to providers, one reason for lack of services is the low utilization rate even if such services are available. In addition, existing services focus on disease management rather than preventive protocols. The AVSC will work with health care facilities, the Ministry of Health, and health insurance companies in establishing sexual and reproductive health services for men in Bogota, Cali, and Medellin.
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.
Profamilia, the Association for the Welfare of the Colombian Family, was begun in 1965. It includes the largest Planned Parenthood clinic in the world. Profamilia's acceptors have increased from 83 in 1965 to 73,000 in 1972. In addition to the Profamilia service center, Pilot Center, there were 43 clinics in 29 Colombian cities in 1972. In that same year, Profamilia's Education Department carried out 15,265 talks for 208,159 prospective family planning users and gave 6116 film presentations to 163,709 people in urban areas. In rural areas some 6893 conferences and 2542 film presentations were given to over a quarter million people. In 1971 Profamilia began a nonclinical contraceptive distribution project in Risaralda. There is also a voluntary sterilization program. 2000 vasectomies have been performed and they are now averaging 100 per month. 398 family planning information centers were attended by 20,000 individuals in 1972. Profamilia has been a member of the International Planned Parenthood Federation since 1968.
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.
Li, Dun-Gao; Zhu, Yan; Li, He-Ping; Chen, Xue-Jin; Jiang, Man-Xi
The maintenance and preservation of strains of mice used in biomedical research presents a unique challenge to individual investigators and research institutions. The goal of this study was to assess a comprehensive system for mouse strain conservation through a combination of natural mating, sperm cryopreservation and assisted reproductive technology. Our strategy was based on the collection and cryopreservation of fresh epididymal sperm from male mice by semi-vasectomy; these mice were then naturally mated for breeding purposes. If no satisfactory results were obtained from natural breeding, then the cryopreserved sperm were used for in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI); resultant embryos were then transferred into pseudopregnant-recipient female mice. Our results show that some semi-vasectomized mouse strains can be conserved by natural breeding, and that sterile males can be compensated for through the use of IVF and ICSI technology. As such, we believe this system is suitable for the purpose of strain conservation, allowing the continuation of natural breeding with the safeguard of assisted reproduction available.
Notwithstanding the fact that family planning counseling and services are absolutely free in Basse-Terre, Guadeloupe, requests for induced abortion are increasing. A survey was conducted among 500 women to discover the areas of resistance to contraception. Most women were between 18-32; 38% had at least 1 abortion, and of these 28% had at least 2. 67% of women with parity 6 or over would have liked a smaller family; no woman wanted more than 5 children and ideal family size was considered to be 3. 1 out of 4 women did not disucss contraception with their partner; 3 out of 4 had tried the pill, but 1 out of 4 thought it to be dangerous; only 13% of women who had taken or were taking the pill were satisfied; only 1 out of 2 women took the pill duringly breast feeding. 1 out of 3 women interviewed had tried the IUD. 23% relied on coitus interruptus and 18% on the condom for protection. Sterilization was not very popular and it was requested mainly by women aged 30-44 with parity 3 and over. Only 1 out of 4 knew about vasectomy. All women stated to prefer contraception to induced abortion, and only 68% knew that abortion was legal. The results indicate poor information and comprehension of contraceptive methods. The role of physicians, nurses, and midwives remains paramount in informing couples about their responsibilities in contraception.
Sigg, C; Brüngger, A; Rakosi, T
Seminal plasma transferrin concentrations were measured in semen samples from 424 men attending a fertility unit. There was a clear positive correlation between seminal plasma transferrin concentration and sperm density: transferrin concentrations decrease with decreasing sperm density and are lowest in patients with azoospermia and those who have undergone vasectomy. The differences between the various groups in sperm density are highly significant, but individual data counts also vary widely. Furthermore, it was demonstrated that in polyzoospermia the seminal plasma transferrin concentration is increased, suggesting primary tubular hyperactivity. No correlations with other seminal parameters or hormonal values were found. Seminal plasma transferrin concentrations in normozoospermia and in varicocele testis or in cases with increased numbers of immature germ cells in the ejaculate were not significantly different. This may be interpreted as indicative of intact secretory activity of Sertoli cells in both varicocele and increased desquamation of immature germ cells. The absence of correlation with any of several important spermatological parameters and our inability to differentiate between azoospermia caused by obstruction and by tubular impairment indicate that seminal plasma transferrin is not a useful marker for Sertoli cell function or for seminiferous tubular dysfunction.
Tung, Kenneth S K; Harakal, Jessica; Qiao, Hui; Rival, Claudia; Li, Jonathan C H; Paul, Alberta G A; Wheeler, Karen; Pramoonjago, Patcharin; Grafer, Constance M; Sun, Wei; Sampson, Robert D; Wong, Elissa W P; Reddi, Prabhakara P; Deshmukh, Umesh S; Hardy, Daniel M; Tang, Huanghui; Cheng, C Yan; Goldberg, Erwin
Autoimmune responses to meiotic germ cell antigens (MGCA) that are expressed on sperm and testis occur in human infertility and after vasectomy. Many MGCA are also expressed as cancer/testis antigens (CTA) in human cancers, but the tolerance status of MGCA has not been investigated. MGCA are considered to be uniformly immunogenic and nontolerogenic, and the prevailing view posits that MGCA are sequestered behind the Sertoli cell barrier in seminiferous tubules. Here, we have shown that only some murine MGCA are sequestered. Nonsequestered MCGA (NS-MGCA) egressed from normal tubules, as evidenced by their ability to interact with systemically injected antibodies and form localized immune complexes outside the Sertoli cell barrier. NS-MGCA derived from cell fragments that were discarded by spermatids during spermiation. They egressed as cargo in residual bodies and maintained Treg-dependent physiological tolerance. In contrast, sequestered MGCA (S-MGCA) were undetectable in residual bodies and were nontolerogenic. Unlike postvasectomy autoantibodies, which have been shown to mainly target S-MGCA, autoantibodies produced by normal mice with transient Treg depletion that developed autoimmune orchitis exclusively targeted NS-MGCA. We conclude that spermiation, a physiological checkpoint in spermatogenesis, determines the egress and tolerogenicity of MGCA. Our findings will affect target antigen selection in testis and sperm autoimmunity and the immune responses to CTA in male cancer patients.
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 μm'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.
Davis, Susan Stanik; Viosca, Sharon P.; Guralnik, Mordechai; Windsor, Clara; Mehta, Arun J.; Korenman, Stanley G.; Buttiglieri, Matthew W.; Baker, J. Dennis
Careful evaluation was carried out in 93 men older than 50 with erectile dysfunction. Their mean age was 61 years and the disorder had been present for a mean of 4.5 years. While 14 men (15%) had psychosocial factors that may have been pertinent, only 2 scored poorly on an Affect Balance Scale and 3 were receiving psychoactive medications. Results of nocturnal penile tumescence were abnormal in 91%. In 39% penile-brachial pressure indices were suggestive of pelvic vascular disease and in 9% were consistent with a pelvic “steal syndrome.” Pelvic or peripheral nerve conduction disorders were also commonly seen in 54%. Endocrinopathy may have contributed to the dysfunction in 35%. Twenty-one men had diabetes mellitus, two new cases of hypothyroidism were discovered and hypogonadism was diagnosed definitely in four and considered likely in five others. Coexisting medical conditions were found in more than 90% of the men, especially hypertension, use of antihypertensive medications and atherosclerotic disease. Previous prostatectomies (19%) and vasectomies (30%) were common in the surgical histories. Given the wide range of disorders uncovered in older men complaining of impotence, diagnostic study of potential causes may lead to a more rational approach for the evaluation and management of these men. PMID:4013264
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 PGF2α 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.
The development of steroid-based oral contraceptives had revolutionized the availability of contraceptive choice for women. In order to expand the contraceptive options for couples by developing an acceptable, safe and effective male contraceptive, scientists have been experimenting with various steroidal/non-steroidal regimens to suppress testicular sperm production. The non-availability of a long-acting androgen was a limiting factor in the development of a male contraceptive regimen since all currently tested anti-spermatogenic agents also concurrently decrease circulating testosterone levels. A combination regimen of long-acting progestogen and androgen would have advantage over an androgen-alone modality since the dose of androgen required would be much smaller in the combination regimen, thereby decreasing the adverse effects of high steroid load. The progestogen in the combination regimen would act as the primary anti-spermatogenic agent. Currently, a number of combination regimens using progestogen or GnRH analogues combined with androgen are undergoing trials. The side effects of long-term use of androgens and progestogens have also undergone evaluation in primate models and the results of these studies need to be kept in view, while considering steroidal regimens for contraceptive use in men. Efforts are also being made to popularize non-scalpel vasectomy and to develop condoms of greater acceptability. The development of contraceptive vaccines for men, using sperm surface epitopes not expressed in female reproductive tract as source, still requires considerable research efforts.
Fridgen, Olivia; Sehovic, Ivana; Bowman, Meghan L; Reed, Damon; Tamargo, Christina; Vadaparampil, Susan; Quinn, Gwendolyn P
Little is known about oncology provider recommendations regarding best practices in contraception use during cancer treatment and through survivorship for adolescent and young adult (AYA) cancer patients. This review examined the literature to identify related studies on contraception recommendations, counseling discussions, and methods of contraception in the AYA oncology population. A literature review was conducted using PubMed, including all peer-reviewed journals with no publication date exclusions. A systematic review of the literature was conducted using combinations of the following phrases or keywords: "oncology OR cancer" AND "contraception, family planning, contraceptive devices, contraceptive agents, intrauterine devices OR IUD, vaccines, spermatocidal agents, postcoital, immunologic, family planning, vasectomy, tubal ligation, sterilization" AND "young adult OR adolescent" AND "young adult AND adolescent". Reviewers assessed articles using the "Quality Assessment Tool for Quantitative Studies" which considers: (1) selection bias; (2) study design; (3) confounders; (4) blinding; (5) data collection methods; and (6) withdrawals and dropouts. A total of five articles were included and all studies were quantitative. Results showed no consistent recommendations among providers, references to guidelines, or methods of contraceptive types. Provider guidelines for discussions with AYA patients should be expanded to provide comprehensive, consistent, and quality cancer care in the AYA population.
Mother's milk protects the newborn against various infections, especially against gastrointestinal infections, as well as strengthening the mother-child bond. Breast-feeding is also associated with birth spacing and plays an important role in the regulation of fertility in countries where the rate of use of contraceptives is low. In breast-feeding women amenorrhea may last several months or even a year, while in women who do not breast-feed menstruation returns 35-40 days postpartum. The risk of getting pregnant in women who rely on amenorrhea for contraception increases with the appearance of the first postpartum menstruation (spotting), with the introduction of food supplement into the diet of the infant, and approximately 6 months after childbirth. Family planning programs have to collaborate with maternal health programs with respect to the need for contraception, including postpartum contraception, which involves the training of nurse-midwives or traditional birth attendants. The choice of contraceptives includes the IUD, with a high degree of efficacy, which is particularly advantageous during breast-feeding. Tubal ligation has no negative effect on breast-feeding, but it also requires proper counseling. Other methods are vasectomy, implants and injectables containing progestational hormones, and estrogen-progesterone containing pills, which should not be used for 6 weeks after childbirth.
At a press conference on March 29, 1982, the Family Planning Association of Hong Kong launched a 1-year campaign to encourage men to assume more responsibility in family planning. The campaign will publicize the message that "real men" share family planning responsibilities with their wives. The campaign was developed in response to the Association's recognition that its male clinics were underutilized. Although the Association established its 1st male clinic in 1960, only 1.3% of the Association's clients in 1981 were men. Futhermore, the number of vasectomies performed in recent years had not increased. The campaign will seek to overcome the prevailing attitude that family planning is a women's issue, the reluctance of men to discuss fertility with their physicians, and various misconceptions about male methods. Activities initiated during the 1st few months of the campaign included 1) broadcasting a 30-second television spot to promote the male responsibility message; 2) setting up a mobile exhibit in railway stations and commercial complexes to inform the public about male birth control methods and about the services offered at the Association's male clinics; 3) giving away items which publicize the male clinics such as stickers, match boxes, condom samples, and literature; and 4) selling T-shirts which promote 2 as the ideal family size. In addition, a contest aimed at publicizing male birth control was undertaken jointly by a television magazine, Durex Products, and the Association. The contest engendered considerable interest and 2600 entries were received from men.
Reproductive health programs have focused their attention on women; in general, they have not worked much with men. Gender is not only a determinant of inequality, but it also provides explanations for the different factors that have an impact on men and women's health, their disease and their death. This article addresses the factors that are prioritized over the information and decisions concerning the exercise of sexuality and how to regulate reproduction. With regards to the beginning of sexual life, men seem to start earlier, in average, they have their first sexual relation at 16.8 years old. As to the use of contraceptive methods, currently 54.2% of men declare to use them. Out of these, 39.5% choose modern methods whereas 14.5% prefer traditional ones. In Peru, among the modern methods available are the barrier methods (the condom being the most used), the chemical methods or spermicides, and the surgical methods (vasectomy). Among the traditional ones are the "rhythm" based on abstinence during the fertile phase of the menstrual cycle, and the coitus interruptus. The father's role is one of power. Gender relations are relations of power, and parenthood is part of these relations. The father is, above all, the provider of filiation. Marginalization of men in the reproductive process is evident. Their support to their partner is suboptimal, whether it is during pregnancy, during delivery or to prevent the death of the mother.
Soleymani Majd, Hooman; El Hamamy, Essam; Chandrasekar, Ramya; Ismail, Lamiese
Patients with complex medical problems should be counselled about the need for highly effective contraception. As failure resulting in pregnancy, could cause significant morbidity and mortality. The LNG-IUS has gained great popularity and generally has a low side effect profile; however, perforation of the uterus and migration of the device is a potentially serious complication known to be associated with its use. The current accepted management is removal of the device from the abdominal cavity in order to prevent further morbidity. However this is not always a simple matter in patients who have complex medical problems and who are deemed unfit for surgery. Each time the patient comes for renewal of the contraceptive method, clinicians need to reassess the risks and benefits. This is particularly relevant in patients who have complex medical problems where special attention needs to be given, not only to immediate risks but also to long-term ones. Careful individualised counselling and consideration are paramount and perhaps it would have been prudent to discuss vasectomy with this patient and her husband (as the first line of contraception), as this may have avoided the ensuing complications arising from the chosen method.
Espiridião, P; Amorim, R; Costa, L; Oliveira, V; Xambre, L; Pereira, M; Amaral, L; Ferraz, L
The ambulatory surgery includes those surgical procedures that require a small period of post-operative recovery so that the patients will be discharged from the hospital in the same day of the surgical intervention. In Urology, the vast amount of pathology that allows the cure with medium and low complexity surgical procedures makes this specialty a privileged one in which ambulatory surgery is concerned. In this paper the authors propose to describe how their Urology group works in the ambulatory field. 472 patients where reviewed in an evaluation period from January 2006 to April 2008. The medical appointment protocol is summarized as well as the most common surgical procedures and complications. Annually we operate an average of 200 ambulatory patients and this represents about 22% of the hole surgical activity of the Urology group. The majority of the surgeries are circumcisions and vasectomies (always associated with other small procedures). There is a 5 hours weakly period where a total of 5 to 6 patients are operated. Surgical complications represented 1.6% of total procedures, all of them late ones. With this specific ambulatory program our service managed to reduce drastically the waiting time for this kind of procedures (now-a-days is about 3-4 weeks), with a satisfaction rate of about 95%. According to the great outcomes, low complications rate and great acceptance of the patients, the development of this unit is without doubt a winning project in patients care.
Ramareddy, Raghu S.; Alladi, Anand
Aim: To report a series of scrotal abscess, a rare problem, their etiology, and management. Materials and Methods: A retrospective study of children who presented with scrotal abscess between January 2010 and March 2015, analyzed with respect to clinical features, pathophysiology of spread and management. Results: Eight infants and a 3-year-old phenotypically male child presented with scrotal abscess as a result of abdominal pathologies which included mixed gonadal dysgenesis (MGD) ; three anorectal malformations with ectopic ureter , urethral stricture , and neurogenic bladder ; meconium peritonitis with meconium periorchitis , ileal atresia , and intra-abdominal abscess ; posturethroplasty for Y urethral duplication with metal stenosis  and idiopathic pyocele . Transmission of the organism had varied routes include fallopian tube , urethra ejaculatory reflux , hematogenous , and the patent process of vaginalis . Two of the nine required extensive evaluation for further management. Treating the predisposing pathology resolved scrotal abscesses in eight of nine patients, one of whom, required vasectomy additionally. Idiopathic pyocele responded to needle aspiration and antibiotics. Conclusion: Scrotal abscess needs a high index of suspicion for predisposing pathology, especially in infants. Laparoscopy is safe and effective in the management of the MGD and ectopic ureter. PMID:27695207
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.
Borrero, Sonya; Abebe, Kaleab; Dehlendorf, Christine; Schwarz, Eleanor Bimla; Creinin, Mitchell D.; Nikolajski, Cara; Ibrahim, Said
Objective To assess racial differences in attitudes and knowledge about sterilization. Design Cross-sectional survey Setting Questionnaires were mailed to participants’ home addresses Patients 193 women aged 18–45 who had undergone tubal sterilization. Intervention(s) None Main Outcome Measure Attitudes and knowledge about tubal sterilization and awareness of contraceptive alternatives Results We received 193 completed surveys (64% response rate). AA woman were more likely to have a family member who had undergone tubal sterilization, to report that their mothers influenced their sterilization decisions, and to report that prior unintended pregnancy and desire to avoid insertion of a foreign object were very important factors in their decision to choose sterilization over other methods. Compared to white women, AA women more often thought that sterilization reversal could easily restore fertility (62 % vs 36%); that a woman’s sterilization would reverse itself after 5 years (60% vs 23%); and that a man cannot ejaculate after vasectomy (38% vs 13%). Fewer AA women had ever heard of intrauterine contraception (90% vs 98%). Racial differences in knowledge remained statistically significant after adjusting for socioeconomic confounders. Conclusions Misinformation about sterilization and limited awareness of contraceptive alternatives among AA women may contribute to racial disparities in tubal sterilization rates. PMID:20579640
Considerable effort has been made in the area of family planning in the State of Punjab. Family planning personnel has been recruited and trained at the State Family Planning Training and Research Center in Kharar; supplies of Nirodh, IUDs, oral contraceptives, and hospital equipment along with transportation facilities have been made available; and there has been some building construction. The State Health Education Bureau has worked to produce publicity material and has also used the mass media to create awareness of family planning among the people. As many as 120 rural and 49 urban Family Welfare Planning Centers are providing family planning services along with 856 subcenters in rural areas. 1123 other institutions are also doing family planning work in addition to the efforts of 34 mobile sterilization and IUD units attached to the District Family Planning Bureau and the contributions of some voluntary organizations. Although the state has adopted the cafeteria approach to family planning and the focus is on provision of family planning services on routine days in the various institutions to well-motivated couples, mass family planning camps for vasectomy, tubal ligations, and IUD insertions have been held with considerable success. Additionally, the State has integrated family planning programs with maternal and child health care in order to provide a totality of service. This precedes the total integration of this national program w ith general health services. Punjab has done well in achieving its targets for 1974-1975. Sterilization targets were set at 38,300 and 36,460 sterilizations, 95.2% of the target, were performed. IUD targets were 27,000, and the number achieved was 39,637 or 109.4%. The conventional contraceptive user target was 99,800, and 151,976 or 152.3% of the target figure became conventional contraceptive users.
Royster, M O; Lobdell, D T; Mendola, P; Perreault, S D; Selevan, S G; Rothmann, S A; Robbins, W A
Large, population-based studies of semen quality are encumbered by the logistics and expense of obtaining semen samples from men who live in a variety of locations. A prototype semen collection and transportation kit, the TRANSEM100, can be distributed to study participants and then directly shipped to a central laboratory for analysis. This study was designed to evaluate the ability of male volunteers to correctly use the kit. Thirty volunteers aged 20 to 44 years with no history of diabetes, recent chemotherapy, fertility problems, or vasectomy were recruited through a newspaper advertisement, interviewed to obtain demographic information, and instructed on the use of the kit. Twenty-six of the initial subjects provided at least 1 semen specimen using the kit and returned the specimens by overnight delivery to the laboratory for analysis, 25 completed a follow-up interview on the use of the collection kit, and 20 submitted a second semen sample using the same method. The average volunteer was white, 27.8 years old, and held at least a college degree. Forty percent of the volunteers were married. In general, participants correctly followed the instructions for collecting, packaging, and shipping the semen samples. Volunteers were instructed to collect samples after at least 2, but no more than 7 days of abstinence. For the first and second samples submitted, participants collected semen samples after an average of 3.3 and 3.9 days of abstinence, respectively. Seventeen (65%) of the samples from the first sampling period and 16 (80%) of the samples from the second period were received in the laboratory the day after they had been collected. In summary, the TRANSEM100 may prove to be useful for collecting human semen in field studies. Further testing of this method is warranted to evaluate preservation of sample quality and use of the kit by men among diverse socioeconomic groups.
The operations research and technical assistance (OR/TA) project in The Population Council has concentrated on fertility and infant mortality issues in Latin American and the Caribbean for more than a decade through INOPAL. INOPAL is an acronym for Investigacion Operacional en Planificacion Familiar y Atencion Materno-Infantil para America Latina y el Caribe (Operations Research in Family Planning and Maternal-Child Health in Latin America and the Caribbean). In March 1995, the project entered its third phase, INOPAL III, with the renewal of its contract from the United States Agency for International Development (USAID). To facilitate communication between INOPAL, collaborating agencies, and USAID, INOPAL Director James Foreit moved from Peru to a Council office in Washington, D.C. INOPAL has six objectives: 1) to test the integration of family planning and reproductive health services; 2) to increase access to family planning; 3) to develop strategies to reach special populations; 4) to improve the sustainability of family planning programs; 5) to improve service quality; and 6) to institutionalize operations research capability in the region. INOPAL II conducted 61 subprojects in 12 countries in collaboration with 24 USAID cooperating agencies and other international organizations. The project established new services for postpartum women, adolescents, and rural women; improved program quality and financial sustainability; increased vasectomy promotion and the range of available contraceptives; and developed new modes of service delivery. A key finding of INOPAL II operations research was the importance of increasing cost-effectiveness to ensure program sustainability. INOPAL III will work toward all six objectives, with an emphasis on integrating reproductive health and family planning services. Operations research and technical assistance (OR/TA) subprojects will focus on the prevention and treatment of sexually transmitted diseases, perinatal and postpartum
Since the end of World War 2 in the U.S., there has been a marked change in attitude towards and treatment of the mentally handicapped, and the result - in terms of sterilization - is that many States no longer use their compulsory sterilization laws and some have repealed them. In any event, the incidence of compulsory sterilization has decreased markedly. Yet, in the past decade there have been occasional attempts to resort to the procedure for punitive reasons. These efforts have generally involved women with illegitimate children who are supported by welfare payments. Over the same decade there has been in the U.S. a remarkable growth in the use of voluntary and contraceptive sterilization as the means of preventing additional children. Preliminary results from the national Survey of Family Growth 1973 revealed that 29% of couples between the ages of 15 and 44 years who did not want more children were sterilized - males and females about equally. In Britain the development of sterilization has followed a somewhat different path. During the 1st decades of the 20th century the people in Britain were very concerned about the extensiveness of mental subnormality in the population and with the care of this group. In 1930 the Eugenics society made its 1st formal statement on the use of sterilization, advocating its use for those individuals who might transmit severe physical or mental defects which might affect the health of their progeny. More evidence was determined needed before there would be an attempt made to initiate legislation, and no legislation was ever effected. Also, from 1925 onwards, there was a debate in medical and legal circles on the consequences for patients and doctors of sterilizing operations and on the risks of litigation in the criminal and civil courts. The most marked change came in 1972 when the National Health Service (Family Planning) Act empowered local authorities to provide facilities for vasectomy on the same basis as other
The basic elements of a successful family planning (FP) program are variable between countries. Providing better access to modern contraceptives, access to general and reproductive health care, and increasing economic and educational opportunities contribute to reducing fertility rates. Effective distribution is constrained by rural, isolated populations and cultural attitudes. Indonesia has used floating clinics located on boats to reach inaccessible areas; Norplant and hormonal injection availability also contribute to the 53% contraceptive prevalence rate. The Japanese Organization for International Cooperation in Family Planning has shipped bicycles to developing countries. The result has been improved status among peers and greater program success. Contraceptive social marketing programs (CSM) have been successful in some countries to distribute contraceptives through local channels such as shops and stalls; people seem willing to pay also. CSM has been successful in Egypt in increasing condom sales. IUD use increased from 11% to 42% between 1975-88 with CSM. Multimedia promotion that is carefully researched and targeted is another way to increase contraceptive prevalence (CP) rates. A Brazilian multimedia vasectomy campaign led to an 80% monthly increase in Pro-Pater male health clinics. 240,000 women in Turkey were encouraged through multimedia efforts to switch to modern methods. In Zimbabwe, men have been the target of efforts to educate them about the advantages of small families. Women are recruited to implement FP services in INdia and in poor neighborhoods; an increase from 12% to 61% was achieved. Highly motivated workers with a respect for the community's values is essential to any successful FP program as is government support. China's policy has drawn criticism; China has welcomed a UN program which provides financial motivation. Thailand has been successful due to the commitment between public and private sectors; in 17 years CP rose from 10% to
Schweinsberger, Gino R.; Cilip, Christopher M.; Trammell, Susan R.; Cherukuri, Harish; Fried, Nathaniel M.
Successful noninvasive laser coagulation of the canine vas deferens, in vivo, has been previously reported. However, there is a significant difference between the optical properties of canine and human skin. In this study, Monte Carlo simulations of light transport through tissue and heat transfer simulations are performed to determine the feasibility of noninvasive laser vasectomy in humans. A laser wavelength of 1064 nm was chosen for deep optical penetration in tissue. Monte Carlo simulations determined the spatial distribution of absorbed photons inside the tissue layers (epidermis, dermis, and vas). The results were convolved with a 3-mm-diameter laser beam, and then used as the spatial heat source for the heat transfer model. A laser pulse duration of 500 ms and pulse rate of 1 Hz, and cryogen spray cooling were incident on the tissue for 60 s. Average laser power (5-9 W), cryogen pulse duration (60-100 ms), cryogen cooling rate (0.5-1.0 Hz), and increase in optical transmission due to optical clearing (0-50 %), were studied. After application of an optical clearing agent to increase skin transmission by 50%, an average laser power of 6 W, cryogen pulse duration of 60 ms, and cryogen cooling rate of 1 Hz resulted in vas temperatures of ~ 60°C, sufficient for thermal coagulation, while 1 mm of the skin surface (epidermis and dermis) remained at a safe temperature of ~ 45 °C. Monte Carlo and heat transfer simulations indicate that it is possible to noninvasively thermally coagulate the human vas without adverse effects (e.g. scrotal skin burns), if an optical clearing agent is applied to the skin prior to the procedure.
Tworoger, Shelley S; Fairfield, Kathleen M; Colditz, Graham A; Rosner, Bernard A; Hankinson, Susan E
Although oral contraceptives are protective for ovarian cancer, it is unclear how long this protection persists. The authors prospectively assessed this question as well as associations of other, less studied contraceptive methods (tubal ligation, rhythm method, diaphragm, condoms, intrauterine device, foam, spousal vasectomy) and infertility with ovarian cancer risk among 107,900 participants in the US Nurses' Health Study. During 28 years of follow-up (1976-2004), 612 cases of invasive epithelial ovarian cancer were confirmed. Duration of oral contraceptive use was inversely associated with risk (p-trend = 0.02), but no clear trend was observed for years since last use. However, for women using oral contraceptives for >5 years, the rate ratio for ovarian cancer for
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.
Except for condoms, male contraception is very slightly utilized in France. Several male experimental methods are under study. A synthetic luteinizing hormone-releasing hormone (LHRH) analog has been used successfully in women and offers promise in men of blocking LHRH and thus blocking spermatogenesis. Several nonsteroid substances such an hypertensives and adrenaline would suppress follicle stimulating hormone and luteinizing hormone release, but are too toxic for use. The combination of 40 mcg ethinyl estradiol and 20 mg of methyltestosterone inhibits gonadotropin release and produces azoospermia in men, but at the risk of loss of libido, constant gynecomastia, and testicular atrophy. Several combinations of androgens and progestins have been evaluated. Percutaneous testosterone and medroxyprogesterone acetate appears to be the most effective, with good metabolic tolerance and maintenance of libido and sexual performance. Injections of inhibine, a testicular factor that controls secretion of follicle stimulating hormone by feedback, offer promise of suppressing spermatogenesis without affecting other systems. Numerous substances are known to inhibit spermatogenesis but are to toxic for use or entail an unacceptable loss of libido. Gossypol has been employed as a contraceptive by the Chinese for its action in inhibiting protein synthesis, but it is known to have serious secondary effects. Among male methods currently in use, the condom had a Pearl index of .4-1.6 in the most recent British studies. Coitus interruptus can seriously interfere with sexual pleasure and has a failure rate of 25-30%. Vasectomy is safe, effective, and easy to perform, but is not a reversible method. The combination of 20 mg of medroxyprogesterone acetate in 2 daily doses and 100 mg of testosterone applied in an abdominal spray has given very promising results in 2 small studies in France and merits further development and diffusion.
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
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.
Medina, Pascual; Segarra, Gloria; Mauricio, María Dolores; Vila, José M; Chuan, Pascual; Lluch, Salvador
We studied the role of K(+) channels and Na(+),K(+)-ATPase in the presynaptic inhibitory effects of prostaglandin E(1) (PGE(1)) and PGE(2) on the adrenergic responses of human vas deferens. Furthermore, we determined the effects of increasing extracellular K(+) concentrations ([K(+)](o)) and inhibition of Na(+),K(+)-ATPase on neurogenic and norepinephrine-induced contractile responses. Ring segments of the epididymal part of the vas deferens were taken from 45 elective vasectomies and mounted in organ baths for isometric recording of tension. The neuromodulatory effects of PGEs were tested in the presence of K(+) channel blockers. PGE(1) and PGE(2) (10(-8) to 10(-6)M) induced inhibition of adrenergic contractions. The presence of tetraethylammonium (10(-3)M), charybdotoxin (10(-7)M), or iberiotoxin (10(-7)M), prevented the inhibitory effects of PGE(1) and PGE(2) on the adrenergic contraction. Both glibenclamide (10(-5)M) and apamin (10(-6)M) failed to antagonize PGE(1) and PGE(2) effects. Raising the [K(+)](o) from 15.8mM to 25.8mM caused inhibition of the neurogenic contractions. Ouabain at a concentration insufficient to alter the resting tension (10(-6)M) increased contractions induced by electrical stimulation but did not alter the contractions to norepinephrine. The inhibition of neurogenic responses induced PGE(1), PGE(2) and increased extracellular concentration of K(+) was almost completely prevented by ouabain (10(-6)M). The results demonstrate that PGE(1) and PGE(2) inhibit adrenergic responses by a prejunctional mechanism that involves the activation of large-conductance Ca(2+)-activated K(+) channels and Na(+),K(+)-ATPase.
Soares-Vieira, José Arnaldo; Billerbeck, Ana Elisa Correia; Iwamura, Edna Sadayo Miazato; Zampieri, Ricardo Andrade; Gattás, Gilka Jorge Fígaro; Munoz, Daniel Romero; Hallak, Jorge; Mendonca, Berenice Bilharinho; Lucon, Antonio Marmo
The incidence of rape has increased, especially in metropolitan areas, such as the city of São Paulo. In Brazil, studies about it have shown that the majority of this type of crime is committed by the relatives and persons close to the victim. This has made the crime more difficult to be denounced, as only 10% of the cases are reported to competent police authorities. Usually, cytological exams are carried out in sex crime investigations. The difficulty in showing the presence of spermatozoa is frequent, but it does not exclude the presence of male DNA. The absence of spermatozoa in material collected from rape victims can be due to several factors, including the fact that the agressor suffers from azoospermia. This condition can be the result of a successful vasectomy. As the majority of DNA in the ejaculation sample is from spermatozoa, there is much less DNA to be analyzed. This study presents the application of Y-STRs (DYS19, DYS389I, DYS389II, DYS390, DYS391, DYS392, and DYS393) in DNA analysis of sperm samples from 105 vasectomized men. The study demonstrated a great variation in DNA concentration. DNA extraction and amplification was possible in all sperm samples even in the absence of spermatozoa. The same profile was observed, for each individual, from DNA extracted from blood, pre- and postvasectomy semen samples. The use of markers specific for Y chromosome in sex crime cases, especially in the absence of spermatozoa, is very important, mainly because in most situations there is a small quantity of the agressor's DNA in the medium and a large quantity of the victim's DNA.
Chilvers, C E; Pike, M C; Taylor, C N; Hermon, C; Crossley, B; Smith, S J
STUDY OBJECTIVE--The UK National Case-Control Study was carried out to investigate the relationship between oral contraceptive use and breast cancer risk. This study investigates whether general practitioner notes could be used as the sole data source for epidemiological studies of young women and what the effect would be on non-response and recall bias. DESIGN--Case-control study with data on gynaecological, obstetric, and contraceptive history collected at interview and from general practitioners' notes. Information from these two sources was compared. SETTING--This was a population-based study. PARTICIPANTS--Altogether 755 women with breast cancer aged under 36 years at diagnosis, each with an age-matched control, participated in the study. Response rates at interview were 72% and 89% for cases and controls but GP data were available for 90% of the 1049 case and first-selected control pairs. MAIN RESULTS--There was generally good agreement between the two data sources with respect to obstetric history and gynaecological procedures (hysterectomy, oophorectomy, and tubal ligation). The use of intra-uterine devices, or diaphragm, and partner's vasectomy were not reliably recorded in the GP's notes. The overall results of the UK study would have been qualitatively the same with respect to the relationship between oral contraceptive use and breast cancer risk if GP notes only had been used, in spite of the fact that only about half of all oral contraceptive usage was recorded in the notes. Response rates would have been higher, recall bias eliminated, and the cost of the study halved. CONCLUSIONS--When planning case-control studies in young women, the possibility of using GP notes as the primary data source should be considered. Lack of data on potential confounding factors is a possible drawback to such use. The practice of destroying GP's notes shortly after the death of patients seriously restricts the possibility of using these notes when studying rapidly fatal
Aitken, R J; Elton, R A
The value of Poisson distribution theory in describing and predicting the nature of sperm-egg interaction in vitro has been investigated using an interspecific in-vitro fertilization system, incorporating zona-free hamster oocytes and human spermatozoa. The frequency distribution of polyspermic oocyte penetrations in 72 experiments exhibited good agreement with the Poisson distribution at all levels of fertilization indicating that each oocyte must be of equal penetrability and that there can be no block to polyspermy in this interspecific system. Poisson distribution theory also accurately described the relationship between oocyte penetration and sperm motility in 50 out of 54 separate experiments spread across 10 serial dilution curves. For each dilution series the shape of the fitted curve was fixed but its location along the x-axis varied from donor to donor. The fixed nature of the relationship between sperm motility and egg penetration enables the results of such in-vitro fertilization experiments to be corrected for the number of motile spermatozoa in the incubation media. On the basis of these findings a protocol is described for assessing the results of the zona-free hamster oocyte penetration assay, which involves analysis of the degree of polyspermy followed by the application of Poisson distribution theory to correct the results to a standard concentration of motile spermatozoa. Changes in the penetrating ability of human spermatozoa after vasectomy and characterization of the degree of inter-ejaculate variation in penetrating potential are two clinical examples of such analyses given in the text. The statistical methods described in this paper should also be of general relevance to the study of fertilization mechanisms, in providing a rationale by which to analyse the quantitative nature of sperm-egg interaction in vitro.
Nair-Shalliker, Visalini; Yap, Sarsha; Nunez, Carlos; Egger, Sam; Rodger, Jennifer; Patel, Manish I; O'Connell, Dianne L; Sitas, Freddy; Armstrong, Bruce K; Smith, David P
Prostate cancer (PC) is the most common non-cutaneous cancer in men worldwide. The relationships between PC and possible risk factors for PC cases (n = 1,181) and male controls (n = 875) from the New South Wales (NSW) Cancer, Lifestyle and Evaluation of Risk Study (CLEAR) were examined in this study. The associations between PC risk and paternal history of PC, body mass index (BMI), medical conditions, sexual behaviour, balding pattern and puberty, after adjusting for age, income, region of birth, place of residence, and PSA testing, were examined. Adjusted risk of PC was higher for men with a paternal history of PC (OR = 2.31; 95%CI: 1.70-3.14), personal history of prostatitis (OR = 2.30; 95%CI: 1.44-3.70), benign prostatic hyperplasia (OR = 2.29; 95%CI: 1.79-2.93), being overweight (vs. normal; OR = 1.24; 95%CI: 0.99-1.55) or obese (vs. normal; OR = 1.44; 95%CI: 1.09-1.89), having reported more than seven sexual partners in a lifetime (vs. < 3 partners; OR = 2.00; 95%CI: 1.49-2.68), and having reported more than 5 orgasms a month prior to PC diagnosis (vs. ≤3 orgasms; OR = 1.59; 95%CI: 1.18-2.15). PC risk was lower for men whose timing of puberty was later than their peers (vs. same as peers; OR = 0.75; 95%CI: 0.59-0.97), and a smaller risk reduction of was observed in men whose timing of puberty was earlier than their peers (vs. same as peers; OR = 0.85; 95%CI: 0.61-1.17). No associations were found between PC risk and vertex balding, erectile function, acne, circumcision, vasectomy, asthma or diabetes. These results support a role for adult body size, sexual activity, and adolescent sexual development in PC development.
This critique of the World Bank's role in developing country population programs begins with a description of a 1987 case in which an 80-year- old Bangladeshi man was persuaded to undergo vasectomy and then robbed of his incentive payment by the health agent. For over 20 years, the World Bank has pressured 3rd World governments to implement population control programs. Although there are divergent opinions within the World Bank, the most dominant is the neomalthusian view that the poor through their high fertility help perpetuate their own poverty. This view hides the real source of poverty in the Third World: the unequal distribution of resources within these countries and between the developed and developing countries. The World Bank has always been blind to the inequalities, and has associated with the elites of developing countries who monopolize the resources of their countries and thereby impede authentic development. Furthermore, the emphasis on population control distorts social policy and hinders the implementation of safe and voluntary family planning services. In many countries the World Bank has required governments to give greater priority to population control than to basic health services. It has pressured them to relax contraceptive prescription norms and has promoted the more effective methods without regard to proper use or side effects. In Bangladesh the World Bank has sponsored sterilization programs that rely on coercion and incentives. In that country of enormous inequities, 10% of landowners control over 50% of lands, while nearly half the population is landless and chronically underemployed. Political power is concentrated in the military government, which annually receives over 1.5 billion dollars in external aid. External aid primarily benefits the wealthy. 3/4 of the population are undernourished and less than 1/3 are literate or have access to basic health care. The poor of Bangladesh, as in many other countries, feel that their only
Completed questionnaires were collected from 130 respondents attending child health clinics (CHCs) in Corringham, Stanford, East Tilbury, and Billericay to investigate the source chosen by patients using CHCs for family planning information and materials, and why they made this choice. Criteria for inclusion were that all subjects were attending a CHC and by definition had at least 1 child; all subjects were female and of reproductive age; and all were at that time using some family planning method. 23 respondents indicated that they went to more than 1 source for advice. No respondents went to their midwife and only 4% sought the advice of their health visitor. Approximately equal proportions of respondents indicated that they went to their general practitioner and to family planning clinics, these 2 groups together forming 4/5 of all answers. 8% of respondents indicated they were dissatisfied with the advice given or obtained. 24 respondents (partners) used the condom, 56 oral contraceptives, 5 the IUD, 9 the diaphragm, 2 the condom and rhythm, 1 the condom and withdrawal, 1 withdrawal, and 2 partners had had a vasectomy. In the Essex statistics, in addition 5% were not using any method of contraception and 1% were using chemicals only. The most interesting variation between this study and the Essex Family Planning Center statistics are: almost twice as many study respondents use the condom and 3 times as many Essex clients as survey patients use the IUD. 1/5 expressed dissatisfaction with their method of contraception. Respondents obtained their supplies free in equal numbers from the Family Planning Center and family doctor, but 19% chose or were forced by circumstances to pay for their supplies. 73% reported no problems in getting supplies; 7% indicated problems and 20% did not respond to this question. Criticism can be divided into 3 categories: variation in cost of supplies between sources of service; clinic too far away; and occasionally an overnight wait
Yasin, Ahmad Lotfi; Basha, Walid Salim
Introduction Anti sperm antibodies (ASA) can present in serum and semen and they may lead to impair the sperms function leading to infertility. The precise mechanism of generation of these antibodies is yet to be discovered. Aim This study was performed to determine the prevalence of anti-sperm antibodies (ASA) in patients with unexplained infertility. The study was initiated also to explore the possible factors that may associate with ASA formation and how ASA status is associated with pregnancy rates after going with in vitro fertilization – intracytoplasmic sperm injection (IVF-ICSI). Materials and Methods A cross-sectional study was conducted on 42 normal infertile couples consulting Razan Medical Center for Infertility & I.V.F. in Nablus, Palestine, from December 2012 – March 2013. Serum levels of immunoglobulins G (IgG) ASA were measured in participants (males and females) using enzyme-linked immunosorbent assay (ELISA). In addition, participants also filled a questionnaire about the presence of previous varicocele repair, inguinal hernia repair, orchitis, testicular trauma and vasectomy reversal among males and severe coitus bleeding and coitus during menses or puerperium among females. Couples were also asked about previous IVF-ICSI procedures and the outcome of the procedure in terms of either they got pregnant or not. Data was analysed using SPSS software. Results The prevalence of ASA was 14.3% (6/42) among all couples, 9.5% (4/42) among males and 4.8% (2/42) among females. There was no significant relationship between previous varicocele repair, previous inguinal hernia repair, or orchitis and formation of ASA (p value =0.64, 0.56, and 0.26 respectively). Previous trauma, vasovasostomy, severe coitus bleeding and coitus during menses or puerperium were not observed in any of the study sample. ASA did not seem to affect the outcome of IVF-ICSI (p-value =0.54). Conclusion Prevalence of ASA in infertile couples in the north part of Palestine is similar
Keeny, S M
Observations are made related to the review of family planning activities in East Asia in 1973. The number of new acceptors for the region increased from 2.7 million in 1972 to 3.4 million in 1973. The leaders were Indonesia, which almost doubled its achievement of calendar year 1972, the Philippines, and Korea. In Thailand, the number of new acceptors dropped by about 10%. South Vietnam is the only country in the region without an official policy. Most couples still think that the ideal number of children is 4, with at least 2 sons. Some religious opposition does exist, particularly with reference to sterlization and abortion. More attention is being paid to women in their 20s. Sterilization and condoms are becoming more popular. Korea reports a sharp increase in vasectomies. Better methods and continuation rates should be stressed. In Taiwan a couple who start with 1 method and continue to practice some method lower their reproduction rate by 80%. More responsibility is being delegated to nurses and midwives, but too slowly. In Indonesia, the number of field workers rose from 3774 in 1972 to 6275 in 1973. The Philippines and Thailand are experimenting to see what kind of workers get best results and under what kind of salary and incentive arrangements. In-service training tends to be neglected, but preservice training is improving. Costs, in general, have risen, though in Korea the cost per acceptor has dropped from US$8.00 to US$7.80. Korea and Taiwan have reduced their annual population growth rates by more than 1/3 in 10 years, from 30 to 19-20 per 1000 each. Singapore's rate is 17 and Hong Kong's 14 (exclusive of inmigration). The number of couples currently practicing contraception in Singapore is 71%. Target systems assigning quotas to clinics are generally used except in Thailand and Malaysia, where programs emphasize maternal and child health, rather than population planning. Most programs require about 10 years to get the annual growth rate down to 2% by
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
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
The Mayer Hashi Large-Scale Program to Increase Use of Long-Acting Reversible Contraceptives and Permanent Methods in Bangladesh: Explaining the Disappointing Results. An Outcome and Process Evaluation
Rahman, Mizanur; Haider, M Moinuddin; Curtis, Sian L; Lance, Peter M
ABSTRACT Background: Bangladesh has achieved a low total fertility rate of 2.3. Two-thirds of currently married women of reproductive age (CMWRA) want to limit fertility, and many women achieve their desired fertility before age 30. The incidence of unintended pregnancy and pregnancy termination is high, however. Long-acting reversible contraceptives (LARCs), consisting of the intrauterine device and implant, and permanent methods (PM), including female sterilization and vasectomy, offer several advantages in this situation, but only 8% of CMWRA or 13% of method users use these methods. Program: The Mayer Hashi (MH) program (2009–2013) aimed to improve access to and the quality of LARC/PM services in 21 of the 64 districts in Bangladesh. It was grounded in the SEED (supply–enabling environment–demand) Programming Model. Supply improvements addressed provider knowledge and skills, system strengthening, and logistics. Creating an enabling environment involved holding workshops with local and community leaders, including religious leaders, to encourage them to help promote demand for LARCs and PMs and overcome cultural barriers. Demand promotion encompassed training of providers in counseling, distribution of behavior change communication materials in the community and in facilities, and community mobilization. Methods: We selected 6 MH program districts and 3 nonprogram districts to evaluate the program. We used a before–after and intervention–comparison design to measure the changes in key contraceptive behavior outcomes, and we used a difference-in-differences (DID) specification with comparison to the nonprogram districts to capture the impact of the program. In addition to the outcome evaluation, we considered intermediate indicators that measured the processes through which the interventions were expected to affect the use of LARCs and PMs. Results: The use of LARCs/PMs among CMWRA increased between 2010 and 2013 in both program (from 5.3% to 7.5%) and
Kennedy, K I; Kotelchuck, M
Some attributes of LAM are unquestionably positive, such as the fact that it is effective. Clinical trials of LAM have upheld the Bellagio Consensus that the chance of pregnancy is less than 2% in the first 6 months postpartum in amenorrheic women who are fully or nearly fully breastfeeding. Secondary data analyses in numerous settings have drawn the same conclusion. Whether as a strategy or a method, used correctly or even if used imperfectly, LAM is a reliable way to avoid pregnancy. To the extent that LAM represents an additional contraceptive option, this is also clearly positive since a broad array of contraceptive options maximizes the likelihood of finding a good fit between user and method, and increases contraceptive use. Other characteristics of LAM represent potentially positive impacts. If LAM is shown to be an effective conduit to other modern methods, the implications are profoundly positive. If LAM is cost effective, for households and/or for programs, this will also make the method extraordinarily attractive. Conversely, some aspects of LAM are negative, such as the fact that it affords no protection against STDs, it requires counseling from a well-informed provider, and intensive breastfeeding can make heavy demands on the woman's time. Many of the remaining attributes of LAM may not be important to a policy decision about LAM promotion. For example, whether LAM is actualized as a strategy or a method may not be important to a decision to promote LAM, although it has a huge impact on how services are delivered. Some factors may be profound on a local or individual level. For example, one simple factor, such as the absence of full/nearly full breastfeeding, can rule out the method as an option, while another, such as the fact that it provides the needed waiting period during vasectomy counseling, can make LAM the method of choice. Although LAM seems unlikely to have widespread popularity in societies like the United States, within such settings are
bring free contraceptives directly to the people, and family planning motivators are found in almost all villages, neighborhood committees, factories, and military units. As a result of these efforts, China made great strides in controlling population growth and improving MCH during the last decade. The birth rate declined from 27.93 to 18.62, and the total fertility rate declined from 4.01 to 2.48. 124 million couples were practicing contraception by the end of 1983. 41% used IUDs, 37.4% relied on tubal ligation, 12.9% relied on vasectomy, 5.1% on oral contraceptives, and 1% on other methods. The quality of maternal and child care also improved. 92.7% of all deliveries are now performed by trained midwifes. Infant and maternal mortality rates declined considerablely in recent years. Currently the respective rates are 35.68/1000 live births and 0.5/1000 live births. In 1983 alone, the gross national agricultural and industrial output increased by 46.1%. Since 1979 per capita income increased annually by 18.3% among rural residents and by 10.7% among urban workers. China controls and operates its own population program, but in recent years, it increased its cooperation with UN Fund for Population Activities, other UN agencies, and nongovernment agencies. China recently completed its 3rd national census, and demographic research institutes have been established in 10 universities.
Colombia's 1990 Survey of Prevalence, Demography, and Health (EPDS) was intended to provide data on the total population and on the status of women's and children's health for use in planning and in formulating health and family planning policy. 7412 household interviews and 8647 individual interviews with women aged 15-49 years were completed. This document provides a brief description of the questionnaire, sample design, data processing, and survey results. More detailed works on each topic are expected to follow. After weighing, 74.8% of respondents were urban and 25.2% rural. 3.2% were illiterate, 36.6% had some primary education, 50.2% had secondary educations, and 9.9% had high higher educations. Among all respondents and respondents currently in union respectively, 98.2% and 997% knew some contraceptive method, 94.1% and 97.9% knew some source of family planning, 57.6% and 86.0% had ever used a method, and 39.9% and 66.1% were currently using a method. Among all respondents and respondents currently in union respectively, 52.2% and 78.9% had ever used a modern method and 33.0% and 54.6% were currently using a modern method. Among women in union, 14.1% currently used pills, 12.4% IUDs, 2.2% injectables, 1.7% vaginal methods, 2.9% condoms, 20.9% female sterilization, .5% vasectomy, 11.5% some tradition method, 6.1% periodic abstinence, 4.8% withdrawal, and .5% others. Equal proportions of rural and urban women were sterilized. The prevalence of female sterilization declined with education and increased with family size. Modern methods were used by 57.5% of urban and 47.7% of rural women, 44.0% of illiterate women, 51.8% of women with primary and 57.8% with secondary educations. Among women in union, 10.9% wanted a child soon, 19.7% wanted 1 eventually, 3.6% were undecided, 42.6% did not want 1, 21.4% were sterilized, and 1.2% were infertile. Among women giving birth in the past 5 years, the proportion having antitetanus vaccinations increased from 39% in 1986