bubble_chart Overview

Male Family Planning Today, population control has become one of the world's major concerns. The World Health Organization has established institutions for research, development, and training in human reproduction, focusing on studies related to birth control. China has designated family planning as a fundamental national policy, advocating for "controlling population size and improving population quality," and has enacted family planning laws. Family planning refers to the deliberate regulation of childbirth, an essential measure for humanity to exercise self-control and achieve planned population growth. Strictly controlling population growth contributes to improving living standards and the overall quality of the nation.

bubble_chart Treatment Measures

(1) The purpose of vasectomy is to block the passage of sperm output, preventing sperm from being ejaculated and achieving sterility. It is a permanent contraceptive measure. After vasectomy, the testes can still continue to produce sperm, and mature sperm dissolve and are absorbed within the epididymal duct. Apart from infertility, vasectomy has no impact on overall health or sexual life (including libido, erection, intercourse, ejaculation, and orgasm). During intercourse, the normal ejaculation process and semen discharge still occur, except that the semen contains no sperm.

1. **Surgical Indications and Contraindications** Vasectomy is suitable for those who desire permanent sterilization. The following conditions should be considered contraindications or require postponement of the procedure: (1) Hemorrhagic diathesis; (2) Severe neurological Guanneng disorder; (3) Acute or chronic severe illness; (4) Genital infections, such as inflammation of the testes, epididymis, prostate, or scrotum.
2. **Preoperative Preparation** Explain the relevant scientific knowledge about vasectomy to the patient to alleviate concerns and increase confidence in the procedure. Inquire about any history of drug allergies and perform a procaine allergy test. Shave or trim pubic hair, wash the external genitalia with soapy water, and rinse the scrotum and penis with a 0.1% benzalkonium bromide solution.
3. **Surgical Methods** In recent years, there have been many improvements in vasectomy techniques. Currently, the clamp-puncture vasectomy method (Figure 47-1) is commonly used.
   Under local anesthesia, the left thumb, index, and middle fingers are used to fix the vas deferens. A specially designed pointed vas deferens dissecting forceps is inserted through the scrotal skin to separate the surrounding tissue. The vas deferens is then secured with a small-loop fixation forceps and lifted to the scrotal skin incision. A small scalpel is used to incise the vas deferens membrane, followed by lifting the vas deferens with a vas deferens hook. The distal end of the vas deferens (away from the epididymis) is freed for 1–1.5 cm. The intended ligation site is gently crushed with small hemostatic forceps, and medium-sized silk sutures are used to double-ligate the crushed area. A segment of the vas deferens, approximately 1 cm, is excised between the two ligation points. Before ligation and cutting, 2–3 ml of a 0.01% phenylmercuric acetate spermicidal solution is injected into the distal vas deferens lumen. The proximal end of the vas deferens (near the testis) is embedded within the fascial membrane. After carefully checking for bleeding or accidental ligation, the testis is gently pulled to reposition the vas deferens. The same procedure is performed on the contralateral side. Before concluding the surgery, the ligation sutures on the initially ligated side are lifted and trimmed separately. The incision does not require suturing.
   Additionally, there are other vasectomy methods, such as the needle-fixation technique and the threading method (Figure 47-2), which are modifications of the surgical procedure, each with certain advantages.
4. **Postoperative Care** After the procedure, the patient should rest appropriately and monitor the surgical site for bleeding or hematoma. Avoid strenuous activity and sexual intercourse for one week. For patients who did not receive spermicidal seminal vesicle irrigation during surgery, contraceptive measures should still be taken for two months postoperatively until semen analysis confirms azoospermia, after which contraception can be discontinued.
5. The prevention and treatment of postoperative complications can be completely avoided by carefully selecting indications, strictly adhering to aseptic techniques, performing meticulous operations, and conducting thorough publicity and explanation. Occasionally, the following complications may occur after vasectomy.

(1) **Bleeding and hematoma**: Mostly caused by inadequate hemostasis during surgery or slippage of ligatures. Oozing from the incision can be stopped with pressure bandaging. For smaller hematomas in the spermatic cord or scrotum, if they do not continue to enlarge, local cold compresses, pressure bandaging, and the use of hemostatic medicinal and antibiotics can help the hematoma resolve. In severe cases where bleeding persists and the hematoma rapidly enlarges, immediate surgical intervention is required to evacuate the hematoma, achieve complete hemostasis, and place a rubber drain. Postoperatively, hemostatic medicinal and antibiotics should be administered.
(2) **Infection**: Preoperative skin cleansing, thorough disinfection of the surgical area, and strict adherence to aseptic techniques are crucial measures to prevent infection. Inadequate cleaning and disinfection of the scrotal skin, incomplete sterilization of surgical instruments, excessive tissue injury during surgery leading to hematoma formation, or pre-existing latent inflammation in the genital tract are major factors contributing to postoperative infection. Once infection occurs, in addition to administering effective antibiotics, drainage should be performed as early as possible.
(3) **Painful nodules**: A small nodule at the ligation site after vasectomy is normal. However, due to local infection, hematoma, or reaction to the ligature, larger painful hard nodules may form. For persistent painful nodules, a local injection of 12.5 mg of hydrocortisone acetate and 1 ml of 1% procaine can be administered once a week for 3–5 sessions. If necessary, surgical excision of the nodule may be considered.
(4) **Epididymal congestion**: Some patients may experience epididymal swelling with a sensation of distending pain, which worsens after exertion. Symptoms may fluctuate or vary in severity. Local block therapy or physical therapy can be used. For severe cases unresponsive to medication, epididymectomy or vasovasostomy may be considered.
(5) **Recanalization after vasectomy**: In rare cases, live sperm may reappear in the semen after a certain period (usually over a year) following vasectomy, indicating recanalization. This may result from loose or slipped ligatures, or excessive tightness causing the vas deferens to split, leading to reconnection of the severed ends and restoration of the lumen. If necessary, repeat vasectomy may be performed.
(6) **Sexual dysfunction**: Vasectomy does not affect sexual function. If a patient experiences decreased sexual function postoperatively, a detailed analysis is needed. Some cases may be related to psychological factors, which can be avoided by preoperative counseling and education about sexual function. If organic sexually transmitted disease changes occur postoperatively and affect sexual function, active treatment of the complications is required. Inappropriate selection of surgical candidates, such as those with pre-existing chronic genital tract inflammation (e.g., chronic prostatitis), may lead to postoperative sexual dysfunction. Treatment should be tailored to the patient's specific condition.
In vasectomy, besides the ligation method, high-molecular-weight compounds (e.g., phenol 504 mixture) can be injected into the vas deferens to occlude the lumen and block sperm passage. This method is simpler and equally effective, with the advantage of avoiding surgery. Additionally, reversible vas deferens plugging has been applied clinically.
(2) **Condoms** are a widely used contraceptive method. They are simple to use and have no adverse effects on the health of either partner. When used correctly, condoms provide reliable contraception. The purpose of a condom is to prevent semen from entering the vagina during intercourse, so it must be placed over the erect penis before intercourse. The condom should fit properly, and after ejaculation, both the condom and penis should be withdrawn together to prevent the condom from remaining in the vagina. If the condom breaks and semen enters the vagina, the vagina should be rinsed immediately with warm water, and contraceptive jelly should be squeezed into the vagina to avoid pregnancy.
(3) External contraceptive membrane is a non-ionic surfactant with strong spermicidal effects. This membrane does not affect the health of either partner nor interfere with sexual pleasure. When used correctly, it is relatively reliable.
Usage method: Before intercourse, place a small contraceptive membrane over the erect glans penis. During intercourse, the membrane is inserted deep into the vagina along with the penis. It dissolves within 1-2 minutes, immediately exerting its spermicidal effect. Alternatively, the membrane can be inserted deep into the vagina 1-2 hours before intercourse. Due to its minimal and viscous solution, the membrane will not leak out during physical activity and will still effectively kill sperm during intercourse.