20. Male contraception methods and an analysis of the advantages and disadvantages of common contraceptive methods.
Male contraception
Condom contraception
Condoms, also known as penile sheaths, are currently the most widely used method of male contraception. During sexual intercourse, a condom is placed over the penis to prevent semen from entering the woman's vagina. It is a sheath made of a thin latex film, shaped like a cylinder, with a slightly elastic opening at the proximal end to secure it tightly to the penis, and a small reservoir at the distal end to collect semen. The advantages of condoms are safety, effectiveness, and convenience; if used correctly, their success rate can reach 95%.
Contraceptive film
Contraceptive films are primarily used by men for contraception. They appear as small, paper-like films containing a medicinal ingredient: alkylphenylene oxide (alkylphenylene glycol), a highly potent spermicide, combined with a water-soluble film-forming material. One film is more than sufficient to kill sperm for each ejaculation. Currently used contraceptive films are approximately 5 x 5 cm in size, 7 micrometers thick, weigh 220 mg, and are semi-transparent and relatively soft. When the man is sexually aroused, urethral discharge may be present, which can adhere to the film. If there is no urethral discharge, the man can first moisten the woman's vulva or vaginal opening before applying the film to the glans penis and inserting it deep into the vagina. Leave it in for 1-2 minutes to allow the film to dissolve before intercourse. Statistics show that its contraceptive efficacy can reach 99.5%.
oral contraceptives
Gossypol is a male oral contraceptive first developed in my country in 1972. Animal experiments and examination of testicular tissue from users have confirmed that gossypol's main function is to interfere with the spermatogenesis process of the seminiferous tubule epithelium, without affecting the interstitial cells of the testes. With prolonged use and high cumulative doses, it can gradually reduce the number of sperm in the semen until it disappears completely. After discontinuation of the drug, the seminiferous tubule epithelium gradually regains its spermatogenic capacity, and the sperm count gradually increases until it can induce pregnancy. The dosage and onset of action are 20 mg of gossypol daily for approximately 75 days to achieve the goal of reducing or completely eliminating sperm count. If this is not achieved, the drug can be continued for another 1-2 weeks. Side effects during treatment include fatigue, nausea, and stomach discomfort.
Besides the three methods mentioned above, there are two other male contraceptive methods: withdrawal and urethral compression. Withdrawal involves the man pulling his penis out of the vagina just before ejaculation at the moment of orgasm, thus releasing the semen outside the body. Urethra compression involves the man forcefully pressing his hand towards the pubic symphysis towards the urethra just before ejaculation, creating artificial retrograde ejaculation and forcing the semen into the bladder, thus achieving contraception. Both methods aim to prevent semen from entering the woman's reproductive tract. However, these methods are not entirely reliable and can cause long-term health problems, such as reproductive tract inflammation. Furthermore, the high level of stress involved can have negative psychological effects. Therefore, both methods are not recommended.
A Discussion of the Advantages and Disadvantages of Common Male Contraceptive Methods
condom
A condom is a very simple male contraceptive tool. It's an extremely thin sheath made of special rubber, characterized by its thin film, good transparency, soft texture, smooth application, lack of discomfort, non-irritation, and harmlessness to the human body. Depending on individual body size, it generally comes in three sizes: large, medium, and small, with diameters of 33 mm, 31 mm, and 29 mm respectively. The tip of the sheath has a small reservoir to collect semen, preventing the condom from breaking due to increased tension after ejaculation. Condoms are highly reliable for contraception, simple and convenient to use. Generally, except for a few individuals with rubber allergies, all married men can use condoms for contraception. Especially when the female partner has vaginitis, condoms can prevent cross-infection of trichomoniasis or yeast infections. Condoms are also the preferred contraceptive tool for breastfeeding women and others who cannot take birth control pills. In some special circumstances, using a condom can still lead to pregnancy. This is because some infertile women develop antibodies against the man's sperm. After intercourse, these antibodies react with the sperm, preventing fertilization and causing infertility. If the man uses a condom during intercourse, the woman's antibodies gradually disappear over time. Subsequent intercourse often results in pregnancy.
So, how do you use condoms correctly?
First, before each use, blow air into the condom to check for any tears or leaks. If any are found, do not use it, otherwise contraceptive failure will occur. When using, pinch the small reservoir at the tip with your fingers to expel the air. Then, place the rolled-up condom on the glans penis and push it on while pulling it up until it reaches the base of the penis.
After ejaculation, before the penis fully softens, the man should pinch the tip of the condom with his fingers and pull the penis and condom out together.
In addition, before putting on a condom, you can apply some contraceptive cream or soapy water to the penis and the tip of the condom. This can lubricate the vagina, reduce the feeling of a foreign object, prevent the condom from breaking, and improve the contraceptive effect.
If the condom breaks after the man ejaculates, the woman should immediately squat down to allow the semen to flow out of the vagina, or insert contraceptive cream into the vagina. If contraceptive cream is unavailable, a clean, soft cloth wrapped around a finger, dipped in soapy water, can be inserted into the vagina to wash out the semen. If contraceptive cream or suppositories are available, they can be inserted into the vagina after washing out the semen to kill sperm and enhance contraceptive effectiveness. If neither of these medications is available, one oral condom tablet can be taken, followed by another tablet the next morning.
Condoms are arguably the most ideal contraceptive tool for men today. They produce no side effects and do not affect libido. Even if some men experience a slight decrease in sexual desire, they will gradually get used to it over time.
External ejaculation
Some young couples, when engaging in sexual intercourse, often resort to withdrawal (coitus interruptus) because they are unwilling to take medication, find condoms inconvenient, lack the ability to induce pleasure, or experience allergic reactions. While this method seems simple and easy, it actually does more harm than good and is not recommended. So what are its disadvantages?
1. May easily lead to contraceptive failure.
Withdrawal, or coitus interruptus, refers to the act of immediately stopping intercourse at the moment of ejaculation, withdrawing the penis, and releasing the sperm outside the woman's body. However, this natural method of contraception often fails. Why is this? During intercourse, due to the height of sexual arousal, a small amount of semen often leaks into the vagina along with the contraction of the vas deferens. Although the amount of semen is small, the number of sperm is considerable, making pregnancy more likely.
2. It can easily cause sexual neurasthenia in men.
Throughout sexual intercourse, a man's sexual response is controlled by the cerebral cortex. Psychological and physiological stimulation during intercourse triggers a series of changes and responses, with heightened excitement leading to mental tension, increased heart rate, and elevated blood pressure. Simultaneously, the reproductive organs experience penile vasocongestion and muscle contraction, resulting in an erection. If intercourse is abruptly interrupted at this point, leaving a feeling of unfulfilled desire, it will inevitably have a negative impact on sexual psychology. Over time, this can easily lead to sexual neurasthenia, causing conditions such as premature ejaculation and impotence.
3. May easily cause functional ejaculatory dysfunction.
During male intercourse, sexual arousal reaches its peak, and the penis becomes erect and firm before ejaculation. If intercourse is forcibly stopped at this point and the penis is withdrawn, it can impair the function of the central nervous system and the ejaculation center in the lower back. Over time, this can easily lead to functional ejaculatory dysfunction.
4. It can easily cause disharmony between husband and wife.
Normal, moderate, and harmonious sexual activity can enhance the relationship between husband and wife. However, the unscientific method of contraception, withdrawal, often creates a rift between them. If the woman becomes pregnant as a result, the man often doesn't believe it's due to a small amount of his semen entering the vagina, mistakenly accusing the woman of infidelity and causing arguments and family unhappiness. Forcibly interrupting sexual activity leaves the woman unsatisfied, suppresses her sexual desires, and develops an aversion to intercourse, similarly casting a terrible shadow over the couple's relationship.
5. May cause sexual apathy in the patient.
Because when the man reaches orgasm during intercourse, the woman has not yet achieved sexual satisfaction. If the man forcibly stops intercourse at this time and ejaculates outside the vagina, it can lead to female frigidity over time.
Therefore, withdrawal is not a viable method of contraception, and couples should adopt other scientific methods of contraception.
Male sterilization methods
Currently, the main method of male sterilization is vasectomy, which involves surgically ligating or blocking the vas deferens to prevent sperm from passing through, thus ensuring that the semen is sperm-free during ejaculation and achieving infertility. It is harmless to the body, has no adverse side effects, and does not affect sexual life. If vasectomy reversal is needed, it is also possible to reverse the vas deferens. Compared to other contraceptive methods, it is simpler, safer, and more reliable.
So, will vasectomy affect a man's sexual characteristics and function? The answer is no. This is because the development and maintenance of sexual characteristics depend on testosterone, which is produced only in the interstitial cells of the testes and directly enters the bloodstream to exert its effects. It has no relation to the spermatogenesis and ejaculation systems. Vasectomy blocks the pathway of sperm transport and does not affect the production and function of testosterone. Therefore, vasectomy does not change sexual characteristics, and since it does not change a man's sexual characteristics, it will not affect his sexual function. The cerebral cortex and the sexual center in the brain, which are responsible for sexual behavior, play a dominant role in sexual activity. When the cerebral cortex receives sexual stimuli from the brain and other parts of the nervous system, it becomes excited and transmits this excitement to the penis via the erectile nerves, causing the corpora cavernosa of the penis to become engorged with blood and achieve an erection. Vasectomy does not damage the interstitial cells and endocrine function of the testes, nor does it damage the activity of the nervous system; therefore, it will not affect sexual behavior, which is governed by nerves and the endocrine system.
Currently, vasectomy procedures in my country can be categorized as follows: vasectomy, vasectomy occlusion, vasectomy plugging, vasectomy clamping, and epididymal injection.
Vasectomy is a male sterilization procedure that blocks the passage of sperm through the vas deferens, preventing sperm from entering the woman's vagina and thus achieving contraception. Vasectomy does not affect testicular function; the testes continue to produce sperm and secrete male hormones as normal.
Vas deferens occlusion, also known as vas deferens injection occlusion, involves injecting a polymeric compound into the vas deferens percutaneously. The rapid coagulation of the compound creates mechanical obstruction, and the vas deferens wall's response to the drug causes fibrosis of the inner lining, leading to closure of the lumen and preventing sperm passage, thus achieving sterilization.
Vas deferens clamping is a sterilization procedure that uses silver clips to clamp the vas deferens, blocking sperm from passing through. Its advantage is that if vas deferens recanalization is needed, vas deferens anastomosis is unnecessary; the clamps can be removed for recanalization.
The above briefly introduces three common vasectomy procedures. Although the surgery is minimally invasive and generally does not leave any sequelae, it is not suitable for all married men. The following conditions must be ruled out before the surgery can be performed.
① Individuals with bleeding disorders, severe neurosis, mental illness, acute illness, or other serious diseases.
②Ligation can only be performed after the inflammation of the reproductive system, obvious symptoms of prostatitis, inflammation of the scrotum, eczema, lymphedema, severe varicocele, large inguinal hernia, hydrocele, etc. have been cured.