Male Contraception - Mechanism of Action and Effectiveness - Literature review Example

Male contraception Name Course Instructor Institution Date Table of Contents Table of Contents 2 Introduction 4 Types of contraceptives 5 Male condom 5 Mechanism of action 5 Advantages and disadvantages of male condoms 5 Effectiveness 7 Side effects 7 Vasectomy 7 Method of action 8 Advantages 8 Disadvantages 9 Effectiveness 9 Side effects 9 Withdraw method 10 Mechanism of action 10 Advantages 10 Disadvantages 11 Effectiveness 11 Side effects 12 The Male Contraceptive Pills 12 Mechanism of action 12 Advantages 13 Disadvantages 13 Side effects 13 Effectiveness 14 Conclusion 14 References 15 Introduction Contraception is an acknowledged course for the control of the population increase on the planet. The ideal methods of contraception for men should be easy to use, cheap with no side effects and easily available. The methods should be easily revisable and should have no effect on libido. Male contraception is well appreciated globally. Diverse studies have suggested that male contraception is widely accepted and in excess of three quarters of men stating that they would use male contraceptive if they are available. Nevertheless, there exist various economical, educational, cultural and religious barriers that limit the usage of male contraceptives. Research shows that most of the methods of contraceptives have emphasized on the female methods of contraceptive. On the other hand, the concepts of male methods of contraceptive are extremely appealing due to the suitability and probable marketing projections if the methods come into use (Kogan & Wald, 2014). The methods of contraception available for men are few and mostly they are under used as opposed to methods of contraceptives used by females. The methods of male contraception which are currently readily accessible are condoms, withdrawal and vasectomy. Vasectomy and condoms constitute 8.9% contraceptive use globally (United Nations, 2009). Research has shown that almost 80% of men suppose that contraception is a responsibility which should be shared. In excess of 50% of the men globally, have shown interest in the use of male contraceptives (Heinemann, Saad, Wiesemes, White & Heinemann, 2005). This paper will discuss the currently available methods of male contraception, their advantages and disadvantages in addition to their side effects. Types of contraceptives Male condom Different types of male condoms as well as the ones manufactured from intestines and animal skins have been used at one time or another. In the 20th century, there was introduction of condoms that were manufactured from rubber (Bo, Lopes, Visconte & Nunes, 2006). These condoms have been used as contraceptive as well as prevention of sexually transmitted infections. The male condoms provide an effective protection from HIV/AIDS and unwanted pregnancies. The male condoms are well thought-out as a method of dual protection (Kogan & Wald, 2014: Bo, Lopes, Visconte & Nunes, 2006). Mechanism of action The male condom is a rubber covering which is fitted into the erect penis of a man (Bo, Lopes, Visconte & Nunes, 2006). The condom works through creating a physical barrier during the sexual intercourse between the partners. When this barrier is created, the bodily fluids like blood and semen cannot be shared by the partners. This barrier prevents sexually transmitted infection including HIV/AIDS and pregnancy (Lindberg, Ku & Sonenstein, 1998). Condoms are mainly made of latex rubber and rarely from intestinal caecum of lambs. They come in different sizes, shapes, colours and flavours. Majority of male condoms are lubricated with either spermicidal coating or dry lubricant (Hatcher, 2007). Advantages and disadvantages of male condoms Male condoms offer a variety of advantages to the users. According to Round up Condoms (2009) when used consistently and effectively, research has shown that they reduce the risk of contracting sexually transmitted infections including HIV/AIDS. Through the prevention of the sexually transmitted infections plus their consequences in the long run, they also protect infertility. Due to the fact that one does not need a medical examination or prescription from the physician to buy a condom, it makes it easy to access and obtain condoms from different sources making it easily accessible (Hatcher, 2007). Another advantage of the male condoms is that they are cheap. Condoms are the most cost effective and the cheapest form of contraceptives ('Round Up Condoms', 2009). However, there has been no evidence to substantiate that low cost condoms comes with low quality. In both the private and public sector, the condoms are available at a very low cost. They are also provided free by programs which are funded publicly (Kogan & Wald, 2014). Research has shown that condoms have minimal side effects among users since they are non-hormonal. This factor plus the condoms being easily portable and the fact that the use of condoms delay ejaculation among men leading to prolonged sexual intercourse add to the list of advantages of using condoms (Hatcher, 2007). Condoms have some disadvantages that may discourage its use among partners. Most men complain that there is reduced sensation when using the condoms (Lindberg, Ku & Sonenstein, 1998). Research has also shown that most people associate condoms with lack of trust between partners, immoral sex and sometimes practising sex with prostitutes and hence they disregard their use (Kogan & Wald, 2014: Lindberg, Ku & Sonenstein, 1998). People who are allergic to latex rubber find it hard to use condoms due to itching. If by any chance the condom slips off or bursts during sex, they will not serve their intended purpose. Another disadvantage is that some men cannot sustain an erection when they are wearing a condom (Hatcher, 2007). Effectiveness Warner, Gallo & Macaluso (2012) found out that male condoms are 97% effective in pregnancy prevention if they are used consistently and correctly. They have been proven to provide effective protection in the prevention of HIV transmission (Warner, Gallo & Macaluso, 2012). Research is still ongoing to establish how effective the condoms can be in prevention of sexually transmitted infections (STIs) transmission in both women and men (Hatcher, 2007). Side effects Some people have a belief that condoms have side effects and cause health risks like infections, illness, cancer in both men and women or diseases. Whereas there is no evidence to support that condoms cause any serious side effects (Hatcher, 2007). Vasectomy In the early 19th century, vasectomy was described as a procedure which was performed in dogs in the United Kingdom. The procedure later in the late 19th century became a clinical procedure. As a substitute to castration, it was used for the treatment of prostatic enlargement (Kogan & Wald, 2014). The method was popular by then until it came to be known that it never provided the assistance that it was thought to (Sheynkin, 2009). The method was later used as a treatment method for post prostatectomy epididymoorchitis. Around the year 1970 the method stopped being carried out with prostatectomy. It was first suggested by Oschner (1925), vasectomy be used as a method of contraception but not for elective purposes. He suggested that the procedure be used as a eugenic sterilization rather than castration for perverts, degenerates and criminals. Vasectomy was a fashionable method of eugenic vasectomy for the 1st half of the 20th century in Europe and United States. During the 2nd half of the same century, eugenic sterilization became unpopular in contrast, elective sterilization became popular worldwide (Kogan & Wald, 2014). Method of action Vasectomy is a permanent contraception method for men. The method involves a surgical procedure which is minor. In the procedure, the sperm duct or vas deferens is permanently cut and sealed or tied. When performed, vasectomy prevents the sperm from mixing with the semen. When ejaculating it means there are no sperms (Manetti & Honig, 2010). The absence of sperms means that fertilization cannot happen, therefore there is no pregnancy that can occur. In the recent past, the procedure is carried out in the hospitals under aseptic conditions (Labrecque, Paunescu, Plesu, Stacey & L\'egar\'e, 2010). Advantages Schwingl & Guess (2000) suggested that numerous changed strategies of vasectomy are being applied. In the no surgical blade system, a straightforward scrotal cut for the ID of vas is made, the vas is thus isolated and blocked. According to Moss, Russell, Moss, Stephens & Rollins (2012) the advantages of no surgical blade method incorporates insignificant loss of blood plus low rates of contamination. The rate of undesirable pregnancies after vasectomy is by and large less by 1%. The procedure does not interfere with the sexual pleasure of the partners (Hatcher, 2007). Disadvantages According to Jamieson et al. (2004), there is an interruption in the advancement of azoospermia and successful contraception after the surgery. This requires the utilization of another form of contraception like condoms amid this phase. An alternate setback of vasectomy is that the reversibility of methodology is not generally effective (Schwingl & Guess, 2000). As the time increases from when the procedure was performed, the reversibility rate descends. Indeed, numerous patients might likewise develop antibodies for anti sperms which might additionally cut down the rate of fertility. Independent of the surgical strategy utilized, the surgical skills may be an imperative player in the achievement rate of vasectomy and its inversion (Labrecque, Paunescu, Plesu, Stacey & L\'egar\'e, 2010). In talented doctors, intricacies like loss of blood and diseases are insignificant. In any case, countless number of men grumbles of testicular inconvenience post vasectomy (Hatcher, 2007). Effectiveness This is one of the highly effective methods of contraception with failure of less than 1%. The method is also highly reliable (Schwingl & Guess, 2000). Side effects The common side effects of vasectomy are: symptomatic hematoma which is about 1% to 2%. There are also incidences of infections which comprise about 3%. The greatest side effect is the scrotal pain which is in the range of 16% to 53 %. (Schwingl & Guess, 2000) However, a recent research conducted by Leslie, Illing, Cranston & Guillebaud (2007), found out that 15 % of men who had undergone vasectomy experienced some scrotal pain. However, only 0.04% experienced severe pain that affected their daily life (Leslie, Illing, Cranston & Guillebaud, 2007). Withdraw method This is a traditional method of contraception which is also known as coitus interruptus (Smoley & Robinson, 2012). It involves withdraw of penis from the vagina before ejaculation. The man ejaculates outside and should keep the semen away from her partner’s genitalia. This is done to prevent pregnancy (Horner et al., 2009). Mechanism of action The withdrawal method avoids the occurrence of fertilization through the prevention of ova and sperms uniting (Herdiman, Nakash & Beedham, 2006). In this method, the partners continues with the sexual intercourse until such a time when the man feel he is about to ejaculate (Guillebaud, 2009). He withdraws his penis from the vagina and away from the woman’s genitalia and he ejaculates. This ensures the sperms are not dropped on the labia where they could rise to the vagina and hence to the uterus and thus causing a pregnancy (Horner et al., 2009). Advantages This method requires no device and costs nothing. There are no chemicals that are involved, therefore there are no side effects (WHO & UNAIDS., 2005). Coitus interruptus is always available and can be used as a backup contraception method. There is also no prior planning required when using this method (Horner et al., 2009). Disadvantages This method of contraception has numerous disadvantages. Disruption of the sexual intercourse excitement may at times result in inconsistency of this method. The method decreases the sexual pleasure of both partners (Herdiman, Nakash & Beedham, 2006). Apart from not withdrawing in due course another disadvantage is that the pre ejaculatory fluid which is available when the penis is erected, this semen may contain sperms that may be entering the vagina without the consent of each partners. The current literature shows that the sperm found in the ejaculatory fluid is unlikely to cause pregnancy (Sznitman et al., 2009). On the other hand, that question is still unanswered. This means that the people using this method need to be educated and highly motivated. When the partners have sexual intercourse more than once, it reduces the effectiveness of pregnancy prevention. This method does not protect partners from sexually transmitted infections, including HIV/AIDS (Horner et al., 2009). Effectiveness Although the withdrawal method has mostly been condemned being and ineffective method of contraception, it almost certainly provides protection just like protection offered by other methods of family planning (Kosia, Djoleto-Fleischer, Pyande, Nkurunziza & Nkurunziza, 2000). According to Zlidar (2011), this is the least effective method of contraception on the basis that it entirely depends on the ability of the male partner to withdraw his penis from the vagina before ejaculation happens. However, if it is correctly used it has a 73% effective (WHO, 2007). There is a common belief that the pre ejaculate contains sperm, however, there is no evidence to substantiate that sperms are contained in pre ejaculate fluid as it is the common belief (Horner et al., 2009). Side effects There are no documented side effects of this method of contraception. The Male Contraceptive Pills The only available methods of contraception for men are vasectomy and condoms. Although vasectomy can be reversed, the reversal success is 55% within ten years and the success drops to 25% after ten years. Research shows that the forecast of male contraception pills is quite a few years away. In 2011 a research conducted by University of Cambridge examined the feelings about the projected male contraceptive pill indicated that 49.5% of those interviewed said that they would use it (Matzuk et al., 2012). The gender, age, education and duration of relationship did not have an effect on acceptability. The readiness to use the male pill is linked with the need to increase pregnancy protection. On the other hand, those unwilling cited feared the future effect of the pills on fertility. If the male pill is to be introduced in the market, there is a need for education on the effects of the pill on future fertility and the health concerns (Matzuk et al., 2012). Mechanism of action According to Kamischke & Nieschlag (2004), the new proposed pill would work as a temporary vasectomy by halting the release of sperms. The research tested on the pill showed that it works by combination of hormones to suppress the production of sperms in a reversible and a reliable way. An injection of progestogen and testosterone are injected into the participant every eight weeks (Cheng & Mruk, 2011). Progestogen is a synthetic type of hormone progesterone which occurs naturally (Matzuk et al., 2012). Advantages This new method of contraception is reversible and would therefore provide an alternative to the irreversible vasectomy (Kamischke & Nieschlag, 2004). This method would also make available an avenue for couples who are not in a position to use particular forms of contraception like the oral pills for women (Glasier et al., 2000). Another advantage is that it men would be allowed to share their responsibilities for the psychological and physical issues related with contraception like the cost and visiting the health professionals on a regular basis (Matzuk et al., 2012). Disadvantages One of the major disadvantages of this method is that it does not provide protection from sexually transmitted infections and HIV/AIDS. The method would take between 3-6 months for it to work, plus a similar period to wear off. This means that the couples have to use other methods of contraception within that time (Glasier et al., 2000). It would take decades for scientists to assess the long term side effects of the procedure which is a major disadvantage (Matzuk et al., 2012). Side effects According to Matzuk et al. (2012), the proteins to be used in this method have a task of blood control. This means that there is a possibility of effects on heart rate and blood pressure. On the other hand, the research on mice has shown a slight effect on the blood pressure. There is also an implication on the volume of ejaculate (Sanders, Graham, Bass & Bancroft, 2001). The pills are also capable of affecting the sexual activity of a man while causing irreversible effects on fertility. Research has also shown that the pills may have an effect on the future off springs (Matzuk et al., 2012). Effectiveness In Australia, the recent study showed that the contraceptive is approximately 100% effective. On the other hand, similar research in the United Kingdom found the pills to be 93 % effective in stopping the production of sperms (Matzuk et al., 2012). Conclusion This paper has discussed the different method of male contraceptive available, their mode of action, advantages, disadvantages, effectiveness as well as the side effects. Although there has been no new male method of contraception in the market since vasectomy was discovered, there has been a lot of research that has conducted in this field. Sporadically, the research that has been conducted in this field has turned out to be overwhelmingly disappointing (Kogan & Wald, 2014). The finding of the research has been marred with irreversibility, incomplete efficiency or side effects and hence more research is research is needed to further develop these methods. There is need to shift the narrative and attention of the male methods of contraception from funny headlines of the possibilities of the pills to recognition of the possible alternatives (Sanders, Graham, Bass & Bancroft, 2001). References Bo, M., Lopes, L., Visconte, L., & Nunes, R. (2006). Thermal Degradation of Natural Rubber Male Condoms, Macromol. Symp., 245(1), 668-676. Doi: 10.1002/masy.200651394 Cheng, C. & Mruk, D. (2011). Male contraception: Where do we go from here?. Spermatogenesis, 1(4), 281. Glasier, A., Anakwe, R., Everington, D., Martin, C., Van der Spuy, Z., & Cheng, L. et al. (2000). Would women trust their partners to use a male pill? Human Reproduction, 15(3), 646- 649. Guillebaud, J. (2009). Contraception: your questions answered. London England Pitman 1985. Hatcher, R. (2007). Contraceptive technology (1st ed.). New York, N.Y.: Ardent Media. Heinemann, K., Saad, F., Wiesemes, M., White, S., & Heinemann, L. (2005). Attitudes toward male fertility control: results of a multinational survey on four continents. Human Reproduction, 20(2), 549-556.) doi: 10.1093/humrep/deh574 Herdiman, J., Nakash, A., & Beedham, T. (2006). Male contraception: Past, present and future. Journal Of Obstetrics \& Gynecology, 26(8), 721-727. Horner, J., Salazar, L., Romer, D., Vanable, P., DiClemente, R. & Carey, M. et al. (2008). Withdrawal (Coitus Interruptus) as a Sexual Risk Reduction Strategy: Perspectives from African-American Adolescents. Arch Sex Behav, 38(5), 779-787. doi: 10.1007/s10508- 007-9304-y Jamieson, D., Costello, C., Trussell, J., Hillis, S., Marchbanks, P. & Peterson, H. et al. (2004). The risk of pregnancy after vasectomy, Obstetrics \& Gynecology, 103(5, Part 1), 848- 850. Kamischke, A. & Nieschlag, E. (2004). Progress towards hormonal male contraception. Trends In Pharmacological Sciences, 25(1), 49--57. Kogan, P. & Wald, M. (2014). Male Contraception: History and Development. Urologic Clinics of North America, 41(1), 145-161. Doi: 10.1016/j.ucl.2013.08.012 Kosia, A., Djoleto-Fleischer, C., Pyande, M., Nkurunziza, T., & Nkurunziza, T. (2000) Improving access to quality care in family planning: assessment of the medical eligibility criteria wheel for contraceptive use in ghana. Health monitor. Labrecque, M., Paunescu, C., Plesu, I., Stacey, D. & L\'egar\'e, F. (2010). Evaluation of the effect of a patient decision aid about vasectomy on the decision-making process: a randomized trial. Contraception, 82(6), 556-562. Leslie, T., Illing, R., Cranston, D. & Guillebaud, J. (2007). The incidence of chronic scrotal pain after vasectomy: a prospective audit. BJU International, 100(6), 1330-1333. Doi: 10.1111/j.1464-410X.2007.07128.x Lindberg, L., Ku, L. & Sonenstein, F. (1998). Adolescent males' combined use of condoms with partners' use of female contraceptive methods. Maternal And Child Health Journal, 2(4), 201-209. Manetti, G. & Honig, S. (2010). Update on Male Hormonal Contraception: Is the Vasectomy in Jeopardy?. Int J Impot Res, 22(3), 159-170. doi: 10.1038/ijir.2010.2 Martin, C., Anderson, R., Cheng, L., Ho, P., Smith, K. & Glasier, A. et al. (2000). Potential impact of hormonal male contraception: cross-cultural implications for development of novel preparations. Human Reproduction, 15(3), 637-645. Matzuk, M., McKeown, M., Filippakopoulos, P., Li, Q., Ma, L. & Agno, J. et al. (2012). Small- molecule inhibition of BRDT for male contraception. Cell, 150(4), 673-684. DOI: 10.1016/j.cell.2012.06.045 Moss, D., Russell, T., Moss, J., Stephens, M. & Rollins, A. (2012). Advantages of the no-scalpel vasectomy technique. Family Physicians Inquiries Network. Ochsner, A. (1925). The surgical treatment of habitual criminals, imbeciles, perverts, paupers, morons, epileptics, and degenerates. Annals of Surgery, 82(3), 321-332. Round Up Condoms. (2009). Round up Condoms. Reproductive Health Matters, 17(33), 190-193. doi: 10.1016/S0968-8080(09)33449-7 Sanders, S., Graham, C., Bass, J. & Bancroft, J. (2001). A prospective study of the effects of oral contraceptives on sexuality and well-being and their relationship to discontinuation. Contraception, 64(1), 51-58. Schwingl, P. & Guess, H. (2000). Safety and effectiveness of vasectomy. Fertility And Sterility, 73(5), 923-936. Sheynkin, Y. (2009). History of vasectomy. Urologic Clinics of North America, 36(3), 285-294. Smoley, B., & Robinson, C. (2012). Natural family planning. American Family Physician, 86(10), 924-928. United Nations, Department of Economic and Social Affairs, Population Division (2009). World Contraceptive Use 2009 (POP/DB/CP/Rev2009). Available at: http://www.un.org/esa/population/publications/WCU2009/WCP_2009/Data.html. Accessed September 25, 2014 Sznitman, S., Romer, D., Brown, L., DiClemente, R., Valois, R., & Vanable, P. et al. (2009). Prevalence, correlates, and sexually transmitted infection risk related to coitus interruptus among African-American adolescents. Sexually Transmitted Diseases, 36(4), 218. Warner, L., Gallo, M., & Macaluso, M. (2012). Condom use around the globe: how can we fulfill the prevention potential of male condoms? Sexual Health, 9(1), 4-9. WHO. (2007) Family Planning: A Global Handbook for Providers. Available at: http://www.who.int/reproductivehealth/publications/family_planning/9780978856304/en/ Accessed September25, 2014 WHO & UNAIDS. (2005). Selected Practice Recommendations for Contraceptive Use (1st ed.). Geneva: World Health Organization. Zlidar, V. (2011). Family planning (1st ed.). [Baltimore]: CCP. Read More