Male contraceptive

Male contraceptive
Intervention

A rolled-up condom

Male contraceptives, also known as male birth control are methods of preventing pregnancy that primarily involve the male physiology. The most common kinds of male contraception include condoms, withdrawal or pulling out, outercourse,[1] and vasectomy.[2] In domestic animals, castration is commonly used for contraception. Other forms of male contraception are in various stages of research and development.[3] These include methods like RISUG/VasalGel (which has completed a small phase II clinical trial in humans in India)[4] and ultrasound (with results so far obtained in experimental animals[5][6]).

Methods

Surgery

Vasectomy is a surgical procedure for male sterilization or permanent birth control. During the procedure, the vasa deferentia of a man are severed, and then tied or sealed in a manner such to prevent sperm from entering into the seminal stream (ejaculate). Vasectomies are usually performed in a physician's office or medical clinic. CDC research has estimated there is a probability of 11 failures per 1,000 procedures over 2 years; half of the failures occurred in the first three months after the vasectomy, and no failures occurred after 72 weeks. Due to the presence of sperm retained beyond the blocked vasa deferentia, vasectomies only become effective about three months following the operation.[7]

Condoms

A condom is a sheath-shaped barrier device that may be used during sexual intercourse to reduce the probability of pregnancy and decrease the risk of sexually transmitted infections (STIs) such as HIV/AIDS. It is rolled onto an erect penis before intercourse and blocks ejaculated semen from entering the body of a sexual partner. [8] The perfect use pregnancy rate of condoms is 2% per year.[9][10]

Condoms may be combined with other forms of contraception (such as spermicide) for greater protection.[10] The typical use pregnancy rate among condom users varies depending on the population being studied, ranging from 10 to 18% per year.[11]

Withdrawal

The withdrawal method has a failure rate of about 4% per year if used correctly at every act of intercourse, with a failure rate of 22% per year for typical use.[12]

History

Dioscorides, ca. 40 A.D., described the contraceptive property of hemp seeds (Cannabis sativa) and rue (Ruta graveolens) in De Materia Medica, a text widely used into medieval times.[13] One test in rats (20 milligrams of the 80% ethanol extract) found that these reduced sperm count by more than half.[14] In medieval Persia (and in other traditions as cited) these herbs were used for male contraception, as well as Gossypium herbaceum (Malvaceae),[15] Cyperus longus (Cyperaceae), Vitex pseudonegundo (Verbenaceae), Chenopodium ambrosioides (Chenopodiaceae),[16][17] Aristolochia indica (Aristolochiaceae),[18] Punica granatum (Punicaceae),[19] and Sarcostemma acidum (Asclepiadaceae).[20] However, the compound isolated from Gossypium, as well as other cotton seeds and okra (gossypol) has been abandoned for contraceptive use because it was found to cause permanent infertility in ten to twenty percent of users.[21]

In Indian traditional medicine, uses of the neem tree were described in Ayurvedic medicine, by Sushruta and in the Rasarathasamucchaya, Sarangadhara, Bhavaprakasha and Bhisagya Ratnavali. Held traditionally to have antifertility effects, its leaves were demonstrated to reduce pregnancy rate and litter size in a test of male rats.[22]

In 1995, researchers isolated compounds from a plant used in Chinese herbal medicine called Tripterygium wilfordii (, lei gong teng).[23]

In 2002, researchers fed extracts from the seeds of papaya fruits (Carica papaya) to monkeys. Subsequently, the monkeys had no sperm in their ejaculate.[24] Traditionally used for contraception, papaya seeds had no apparent ill effects on the testes or other organs of rats tested with a long-term treatment.[25]

Heat-based contraception, dating in concept to the writings of Hippocrates, involves heating the testicles to prevent the formation of sperm. Requiring the maintenance of testes at 116 °F (47 °C) (just below the threshold of pain) for 45 minutes, it is not a widely appealing technique, but a variant employing ultrasound has been under investigation.[26]

Research

A goal of research is to develop a reversible male contraceptive, either pharmaceutical, surgical or other.

Medications

Two delivery methods are currently under active study: male hormonal contraceptives that can be taken in pill form by mouth, similar to the existing oral contraceptive pill for women.[27] and male hormonal injections.[28]

Surgical methods

Other

Abandoned research

[53]

References

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