State-of-the art of non-hormonal methods of contraception: VI. Male sterilisation

Abstract

A systematic Medline/PubMed and Cochrane Library review of the literature was carried out with regard to technique, effectiveness, safety and complications of male sterilisation. Vasectomy is an outpatient procedure which can be performed under local anaesthesia. The vas deferens is accessed by means of either a conventional incision with a scalpel or by using the 'no-scalpel technique'. A closed-ended vasectomy (by means of suture ligature, surgical clips or electrocautery) or the open-ended alternative is then carried out. Each of these techniques has both advantages and drawbacks. Fascial interposition has been shown to reduce the risk of failure. A promising alternative for occluding the vas consists of placing an intra-vas device. Haematoma and pain are the most common complications. Non-steroidal anti-inflammatory drugs, narcotic analgesics and neuroleptic drugs are effective for treatment of pain. The success of vasectomy reversal ranges from 30-60%. The data on record convincingly demonstrate that vasectomy is a safe and cost-effective intervention for permanent male contraception. The no-scalpel vasectomy under local anaesthesia is recommended. Occlusion of the vas is most successful when performed by means of an electrocautery; fascial interposition should complete the procedure.

Female sterilisation is becoming less popular

“…Moreover, men may fear that vasectomy will adversely affect their virility and sex life. That fear is ungrounded 1,7 . Testosterone levels are unchanged after vasectomy, and the volume of the ejaculate still amounts to 95-97% of what it was previously.…”

“…It is a fallacy to believe that sterilisation is 100% effective 1,8,9 . If patients have not been properly counselled beforehand, failures may occasionally be experienced as tragedies.…”

Non-hormonal methods of contraception

“…A series of review articles appearing in this issue of the European Journal of Contraception and Reproductive Health Care under the common title 'State-of-the-art of nonhormonal methods of contraception' summarises the history, clinical experience and research on mechanical barrier methods 3 , spermicides 4 , intrauterine contraception (excluding hormone-releasing systems) 5 , natural family planning 6 and female and male sterilisation [7][8] .…”

“…In the editorial phase of this series, the original group of authors was extended to include a sixth colleague invited by the Editor-in-Chief of the Journal: Dirk Michielsen, a staff member of the Department of Urology of the University Hospital Brussels in Belgium, and he is the senior author of the last article of the series, on male sterilisation 8 .…”

Nursing Staff’s Views Regarding Barriers to Vasectomy: A Cross-Sectional Survey

“…It is a simple and highly effective method with a low morbidity rate and an extremely low mortality rate [9,10]. Because this method does not create permanent changes in blood hormones and sexuality performance, even it has no risk for incidence of conditions such as cardiovascular diseases, prostate infections and cancers in comparison with other contraceptive methods [11].…”