The Cochrane Collaboration – a widely respected, independent nonprofit that undertakes systematic reviews of health care techniques – has released a new report on the importance of physician training in no-scalpel vasectomy (NSV) procedures. The study showed that NSV is a faster procedure than traditional vasectomy, that it results in fewer post-operative complications, and that men resumed their sex lives more quickly. Typically, an NSV does not even require a stitch.
However, the Cochrane review showed that experienced NSV doctors had significantly better results than those who had just been trained. In one of the reviewed studies, a regular vasectomy doctor did a few NSVs after watching an instructional video. Those few NSVs had the same rates of complication one would expect from traditional vasectomies.
What does this mean for physicians? First, be prepared for increasing demand for NSV. Dr. Marc Goldstein, executive director of the Men's Service Center at Cornell University’s Weill Medical College, estimates that one-third of the vasectomies performed in the US are NSVs. He says men are now requesting NSVs specifically.
Second, understand that for vasectomy, "factory medicine" appears to be the best approach. Some top vasectomy surgeons have now done over 10,000 procedures, and Dr. Goldstein advises men to ask their doctors how much experience they have with the NSV technique. Family planning providers will want to either have a referral to such a surgeon ready for their patients, or turn to organizations such as EngenderHealth for training to become such an expert themselves.
For your client resources file, MCIP can recommend NSV specialists in Quebec, Ottawa, Vancouver, and Florida. Websites such as vasectomymedical.com (commercial) and EngenderHealth (non-commercial) offer NSV provider lists, and vasectomy-information.com (non-commercial) has helpful hints.
Read more:
No-scalpel vasectomies by skilled surgeons may speed recovery, April 17
Scalpel versus no-scalpel incision for vasectomy, Cochrane Database Systems Review, April 18
Over 550,000 vasectomies are performed each year in the US and Canada. Would vasectomy be an even more widespread form of contraception if there were no needles involved?
There is an alternative for local anesthetic: high pressure jet injection uses no needle. Drs. Charles Wilson and Ron Weiss are among the doctors who have pioneered the use of a MadaJet device for anesthetizing the vas through the scrotal skin prior to a no-scalpel vasectomy. Men describe the sensation of the jet injection as similar to the snap of a rubber band against the scrotal skin. The anesthesia takes effect immediately.
The small risk of spermatic cord hematoma associated with needle injection is eliminated by the use of the high pressure jet. Dr. Weiss has reported no hematomas in the 1,391 no needle procedures he has performed, whereas the risk of hematoma during a traditional vasectomy is 2%.
Read more:
No-Scalpel, No-Needle Vasectomy Described, April 23
MadaJet XL Medical product specifications
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This study is an epidemiological survey following the health of men for a mean of 13 years after a vasectomy. Because vasectomy is associated with an immune-antibody response, the researchers wanted to determine if the procedure had any longer term effects on men’s susceptibility to immune-related disease. They found a short-term increased risk of epididymitis, but “no evidence that vasectomy increases the subsequent long-term risk of immune-related diseases.”
Read more:
Immune-related disease before and after vasectomy: an epidemiological database study, Michael Goldacre et al., April 30.
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All 90 volunteers have been recruited and enrollment is closed in Shepherd Medical Company’s US study of the Intra Vas Device, a set of tiny silicone plugs designed as a vasectomy alternative. Thanks to those of you who have passed on study information to interested colleagues and patients.
Shepherd Medical Company only started their study last fall, so men have signed up quite quickly at the 3 participating centers. This is good news for anyone waiting for the IVD, because the sooner enrollment is full, the sooner Shepherd will have their 6-month results. Those results will help determine their chances at getting venture capital and additional grant funding. It's too soon to say for sure, but we hear that the device’s effectiveness and men’s satisfaction are looking very promising.
The IVD's developers hope to have it on the US market in 2010. From the perspective of consumers, the IVD may be the first male contraceptive to go from an abstract future availability (“It will be on the market 5 to 10 years from now…” repeated indefinitely) to a concrete prediction of availability in 4 years.
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A group of researchers at several prestigious universities have collaborated to study the factors which affect young men’s use of sexual health care services in the US. They looked at data from a nationwide survey of nearly 1,700 adolescent boys between the ages of 15 and 19. Two-thirds of the boys interviewed had seen a doctor for a physical exam in the preceding year.
The researchers found that the older the boys got, and the more traditional their beliefs about masculinity, the less likely they were to see a doctor. Boys who had already had sex, had a sexually transmitted infection, or used drugs were no more likely to use health care services than their lower-risk peers.
The researchers also identified several characteristics which made the boys in the study more likely to use sexual health services. Boys with health insurance were significantly more likely to use health care services. (85% of those in the study were insured, which is about the same as the national average.) Communicating directly with their fathers or both parents about sex also raised the likelihood of doctor visits.
The researcher conclude that adolescent sexual health care will improve most if we focus our efforts on better access to health insurance, good parent-child communication, and teaching that use of health care services is not an unmanly characteristic. As family planning service providers work toward the inclusion of young men in their services, the conclusions of this study will shape program design and social marketing campaigns. We predict that family planning clinics will become one of the main venues for the distribution of new male contraceptives.
Read more:
Myths About Manhood Keep Teen Boys From Sexual Health Care, Medical News Today, April 11
Masculine Beliefs, Parental Communication, and Male Adolescents' Health Care Use, Arik Marcell et al., April 4
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The National Institutes of Health (NIH) fund three contraceptive research centers, and they've managed to hang onto that funding through severe federal budget cuts because the funding is congressionally mandated.
The newest contraceptive researcher center is at the University of Kansas (KU). Dr. Joseph Tash at the KU Medical Center "has been awarded more than $7.5 million in funding from NIH to lead a team, including researchers at seven universities, in a collaborative effort to develop male contraceptives.
"This five-year grant will establish the Interdisciplinary Center for Male Contraceptive Research and Drug Development, a multi-institutional organization that will work to develop new non-hormonal, reversible male contraceptive agents for drug production.” The KU center will collaborate with researchers at the University of Minnesota, Duke University, the University of California-San Francisco, and the University of Medicine and Dentistry of New Jersey.
Under the grant, the researchers will continue working on Gamendazole, a drug that has reversibly suppressed sperm production in rats. The KU facility is also one of the few universities in the country with a high throughput screening lab, which radically speeds the evaluation of new drugs. Dr. Tash also plans to use protein analysis to identify promising candidate compounds.
The NIH’s choice to direct these funds towards nonhormonal male contraceptive development is a savvy one. Survey data collected at MaleContraceptives.org show that 60% of men would select a nonhormonal male contraceptive as their first or second choice.
We hope methods already in clinical trials – such as the US and Chinese IVD designs, and RISUG – will also benefit from this scale of funding in future budgets, potentially providing men with expanded family planning options before the end of the decade.
Read more:
KU Medical Center to lead $7.5-million male contraceptive research and drug development program, April 10
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Planning to attend a family planning or male reproductive health-related event that's not listed here? Let us know so we can post it and alert your colleagues to interesting upcoming events.
May 15 |
Providing Male Exams and Male Services: A Clinician’s Course for Region III Title X Grantees; Philadelphia, PA |
May 21-24 |
Family Planning Male Training Center’s 2nd Annual Male Health Training Institute for Title X program administrators and managers; Cincinnati, OH |
May 29 - June 28 |
East-West Center’s 38th Summer Seminar on Population “Communicating with Policymakers about Population and Health” Workshop; Honolulu, HI, USA |
June 22 |
Creative Methods for including Males in Clinic Services and Contraceptive Decision-making for Region VI Oklahoma Title X Grantees; Multisite videoconference |
September 26-29 |
Joint meeting of the Association of Reproductive Health Professionals and the Planned Parenthood Federation of America, Reproductive Health 2007; Minneapolis, MN |
September 27-28 |
2nd Future of Male Contraception conference; Seattle, WA, USA |
November 3-7 |
American Public Health Association 2007 Annual Meeting “Politics, Policy & Public Health”; Washington, DC |
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Editors
Elaine Lissner, Director of the Male Contraception Information Project (MCIP)
Email: info@NewMaleContraception.org
MCIP is entirely nonprofit and works in three areas: raising public awareness of promising nonhormonal male contraceptives, advocating increased and expedited government research, and serving as a resource for journalists who wish to write about the subject.
Kirsten Thompson, Director of the Male Contraception Coalition (MCC)
Email: info@MaleContraceptives.org
The Coalition’s objectives are to speed the development of new male contraceptives through increased legislative and institutional support, to raise funds for applied male contraception research and development, and to educate the public about the work of the research community.
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