A comprehensive overview of male contraception: from condoms and gossypol tests to the physiological truth behind vasectomy [i]

Most men are familiar with the small rubber sheath of a condom[i]. Although some may find it "not satisfying enough," it is, after all, the most widely used contraceptive tool[i]. However, due to improper use, condoms can sometimes be unsafe[i]. The advantage of this method is that it has almost no side effects on both partners and can prevent the transmission of diseases, making it the first choice recommended by doctors[i]. The effective contraceptive rate is around 90%, but it cannot be used by a small number of men or their wives who are allergic to rubber[i]. Hormonal contraception is divided into oral and injectable methods[i]. Gossypol is a representative oral male contraceptive and the only drug that has ever been used clinically[i]. It has a strong inhibitory effect on sperm production, but it has many side effects, such as hypokalemia and general weakness, and most seriously, it may cause infertility. Experts do not recommend its use[i]. Testosterone depressant injection is hailed as "one injection a month for contraception" and is currently undergoing multicenter phase III clinical trials worldwide. The contraceptive rate among Asians is over 90%, but the drug does not take effect immediately and requires three consecutive months of injections to show results[i]. The procedure for sterilization may sound scary, but the whole process takes only 20 minutes, requires no stitches, and recovery takes only two days, leaving almost no scars [i]. Vasectomy, which cuts off the vas deferens, the tube that carries sperm, effectively prevents pregnancy [i]. The doctor only needs to make a small incision (about the size of a grain of rice) in the scrotum and cut the vas deferens to achieve contraception [i]. Many people worry that after the vas deferens is cut, there will be no more semen. In fact, this worry is unnecessary [i]. On average, a man ejaculates about 2 ml of semen each time, of which seminal vesicle fluid and prostatic fluid account for more than 90% of the semen volume, and this part will still be ejaculated [i]. After ligation, the epididymal fluid and sperm, which account for less than 10% of the semen volume, are blocked, so it will not have much impact on the amount of semen [i]. When pregnancy is desired, vas deferens anastomosis can be performed, with a patency rate of over 90% [i]. Vas deferens occlusion surgery avoids cutting the vas deferens; instead, a special carbolic acid material is injected into the vas deferens to form a scar and harden it. However, due to the difficulty in controlling the injection volume and the potential for needle-like discomfort, it has been abandoned by the vast majority of clinicians [i]. Non-obstructive vas deferens devices involve placing a nylon filter inside the vas deferens to intercept sperm. Removal restores fertility and avoids epididymal congestion [i]. The effects of male vasectomy on the body are negligible [i]. Sperm are continuously produced by the testes daily and transported to the epididymis for storage, becoming usable sperm after about a week [i]. During ejaculation, the prepared sperm are propelled outwards through the vas deferens [i]. After a vasectomy, a man can still ejaculate normally; the only difference is that his semen will lack sperm capable of producing sperm [i]! If sperm loses its delivery channel after a vasectomy, the tubules in the epididymis are responsible for recycling and reusing it. Sperm that have "expired" will be disposed of, which is entirely in line with the spirit of "environmental protection" [i]! Some people worry that a vasectomy might affect the secretion of male hormones. This is not the case, because the vas deferens is solely used to transport sperm, while the male hormones secreted by the testes belong to the endocrine system and are transported out through blood circulation. They are completely unrelated to the vas deferens and are not affected by the vasectomy [i]. Withdrawal is a method of contraception that involves interrupting intercourse at the moment the man is about to reach orgasm and ejaculate [i]. This method of contraception is unreliable [i]. To prevent semen from entering the vagina, both partners, especially the man, are under high stress, and the sudden interruption at the moment of orgasm can affect satisfaction. Over time, this can lead to neurasthenia, and some men may experience premature ejaculation or impotence [i]. Because this method of contraception is not very effective, it is best not to use it given the availability of other contraceptive methods [i].