Prostate Cancer Prevention

Prostate Cancer Prevention

Prevention
Doctors cannot always explain why one person gets cancer and another does not. However, scientists have studied general patterns of cancer in the population to learn what things around us and what things we do in our lives may increase our chance of developing cancer.

Anything that increases a person's chance of developing a disease is called a risk factor; anything that decreases a person's chance of developing a disease is called a protective factor. Some of the risk factors for cancer can be avoided, but many cannot. For example, although you can choose to quit smoking, you cannot choose which genes you have inherited from your parents. Both smoking and inheriting specific genes could be considered risk factors for certain kinds of cancer, but only smoking can be avoided. Prevention means avoiding the risk factors and increasing the protective factors that can be controlled so that the chance of developing cancer decreases.

Although many risk factors can be avoided, it is important to keep in mind that avoiding risk factors does not guarantee that you will not get cancer. Also, most people with a particular risk factor for cancer do not actually get the disease. Some people are more sensitive than others are to factors that can cause cancer. Talk to your doctor about methods of preventing cancer that might be effective for you.

Purposes of this summary
The purposes of this summary on prostate cancer prevention are to:

* Give information on prostate cancer and how often it occurs.


* Describe prostate cancer prevention methods.


* Give current facts about which men or groups of men would most likely be helped by following prostate cancer prevention methods.

You can talk to your doctor or health care professional about cancer prevention methods and whether these methods would be likely to help you.

Prostate cancer prevention
The prostate is a gland in males that is involved in the production of semen. It is located between the bladder and the rectum. The normal prostate gland is the size of a walnut and surrounds the urethra, the tube that carries urine from the bladder.

Significance of prostate cancer
Prostate cancer is the most common nonskin cancer among men in the United States. Although the number of men with this disease is large, the number of men who are expected to die of the disease is considerably smaller, since the majority of men diagnosed with prostate cancer do not die of it.

Prostate cancer prevention
Prostate cancer can sometimes be associated with known risk factors for the disease. Many risk factors are modifiable though not all can be avoided.

Age: The risk of developing prostate cancer increases as a man gets older.

Chemoprevention: Chemoprevention is the use of specific natural or man-made drugs, vitamins, or other agents to reverse, suppress, or prevent cancer growth. Several agents, including difluoromethylornithine (DFMO), isoflavonoids, selenium, vitamins D and E, and lycopene have shown potential benefit in studies. Further studies are needed to confirm this.

Diet and lifestyle: The effect of diet on prostate cancer risk is under study. A diet high in fat, especially animal fat, may be associated with an increased risk of prostate cancer. More studies are needed to determine if a low-fat diet with more fruits and vegetables helps prevent prostate cancer.

Studies show that a diet high in dairy products and calcium may be linked to an increased risk of prostate cancer, although the increase may be small.

Hormonal prevention: Studies are underway to discover the role of certain drugs, such as finasteride, that reduce the amount of male hormone as preventive agents for prostate cancer.

Race: The risk of prostate cancer is dramatically higher among blacks, intermediate among whites, and lowest among native Japanese. However, this increase in risk may be due to other factors associated with race. Studies have shown a link between levels of testosterone and prostate cancer risk, with black men having the highest levels.





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Male Menopause

Male Menopause
Women may not be the only ones who suffer the effects of changing hormones. Some doctors are noticing that their male patients are reporting some of the same symptoms that women experience in menopause.

The medical community is currently debating whether or not men really do go through a well-defined menopause. Doctors have reported that male patients receiving hormone replacement therapy (testosterone) have reported relief of some of the symptoms associated with so-called male menopause.

What Is Male Menopause?
Since men do not go through a well-defined period referred to as menopause, some physicians refer to this problem as androgen (testosterone) decline in the aging male. Men do experience a decline in the production of the male hormone testosterone with aging, but this also occurs with some disease states such as diabetes. Along with the decline in testosterone, some men experience symptoms such as fatigue, weakness, depression and sexual problems. The relationship of these symptoms to the decreased testosterone levels is still controversial.

Unlike menopause in women which represents a well-defined period in which hormone production stops completely, male hormone (testosterone) decline is a slower process. The testes, unlike the ovary, does not run out of the substance it needs to make testosterone. A healthy male may be able to make sperm well into his eighties or longer.

However, as a result of disease, subtle changes in the function of the testis may occur as early as 45 to 50 years of age, and more dramatically after the age of 70 in some men.


How Is Male Menopause Diagnosed?
To make the diagnosis, the doctor will perform a physical exam and ask about symptoms. He or she may order other diagnostic tests to rule out any medical problems that may be contributing to the condition. The doctor will then order a series of blood tests which may include several hormone levels, including a blood testosterone level.


Can Male Menopause Be Treated?
If testosterone levels are low, testosterone replacement therapy may help relieve such symptoms as loss of interest in sex (decreased libido), depression and fatigue. But, as with hormone replacement therapy in women, testosterone replacement therapy does have some potential risks and side effects. Replacing testosterone may worsen prostate cancer, for example.

If you or a loved one is considering androgen replacement therapy, talk to a doctor to learn more. Your doctor may also recommend certain lifestyle changes, such as a new diet or exercise program, or other medications, such as an antidepressant, to help with some of the symptoms of male menopause.

Male menopause refers to the decline in testosterone production in men. As men age, they often experience many of the same symptoms that women experience in menopause, including fatigue, weakness, depression and sexual problems. Testosterone replacement therapy may relieve some of these symptoms.





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Your Guide to Masturbation

Introduction to Masturbation
Masturbation is the self-stimulation of the genitals to achieve sexual arousal and pleasure, usually to the point of orgasm (sexual climax). It is commonly done by touching, stroking, or massaging the penis or clitoris until an orgasm is achieved. Some women also use stimulation of the vagina to masturbate or use "sex toys," such as a vibrator.

Who Masturbates?
Just about everybody. Masturbation is a very common behavior, even among people who have sexual relations with a partner. In one national study, 95% of males and 89% of females reported that they have masturbated. Masturbation is the first sexual act experienced by most males and females. In young children, masturbation is a normal part of the growing child's exploration of his or her body. Most people continue to masturbate in adulthood, and many do so throughout their lives.


Why Do People Masturbate?
In addition to feeling good, masturbation is a good way of relieving the sexual tension that can build up over time, especially for people without partners or whose partners are not willing or available for sex. Masturbation also is a safe sexual alternative for people who wish to avoid pregnancy and the dangers of sexually transmitted diseases. It also is necessary when a man must give a semen sample for infertility testing or for sperm donation. When sexual dysfunction is present in an adult, masturbation may be prescribed by a sex therapist to allow a person to experience an orgasm (often in women) or to delay its arrival (often in men).


Is Masturbation Normal?
While it once was regarded as a perversion and a sign of a mental problem, masturbation now is regarded as a normal, healthy sexual activity that is pleasant, fulfilling, acceptable and safe. It is a good way to experience sexual pleasure and can be done throughout life.

Masturbation is only considered a problem when it inhibits sexual activity with a partner, is done in public, or causes significant distress to the person. It may cause distress if it is done compulsively and/or interferes with daily life and activities.


Is Masturbation Harmful?
In general, the medical community considers masturbation to be a natural and harmless expression of sexuality for both men and women. It does not cause any physical injury or harm to the body, and can be performed in moderation throughout a person's lifetime as a part of normal sexual behavior. Some cultures and religions oppose the use of masturbation or even label it as sinful. This can lead to guilt or shame about the behavior.

Some experts suggest that masturbation can actually improve sexual health and relationships. By exploring your own body through masturbation, you can determine what is erotically pleasing to you and can share this with your partner. Some partners use mutual masturbation to discover techniques for a more satisfying sexual relationship and to add to their mutual intimacy.

Just about everybody masturbates. Masturbation itself is the self-stimulation of the male or female genitals to achieve sexual pleasure or arousal to the point of orgasm. Masturbation involves stimulating the penis or clitoris. Masturbation is very common among people who have, or do not have sexual relations with a partner. Masturbation can relieve sexual tension that can build up over a period of time. It is also a safe alternative to avoid STDs or pregnancy. Masturbation generally is considered normal unless it becomes a problem by inhibiting sexual activity with a partner, done in public, or causes distress to the person masturbating. Some experts suggest that masturbation can improve a person's sexual health and personal relationships.





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Male Breast Cancer

Male Breast Cancer
What is male breast cancer?

Men possess a small amount of nonfunctioning breast tissue (breast tissue that cannot produce milk) that is concentrated in the area directly behind the nipple on the chest wall. Like breast cancer in women, cancer of the male breast is the uncontrolled growth of the cells of this breast tissue.

Breast tissue in both young boys and girls consists of tubular structures known as ducts. At puberty, a girl's ovaries produce female hormones (estrogen) that cause the ducts to grow and milk glands (lobules) to develop at the ends of the ducts. The amount of fat and connective tissue in the breast also increases as girls reach puberty. On the other hand, male hormones (such as testosterone) secreted by the testes suppress the growth of breast tissue and the development of lobules. The male breast, therefore, is made up of predominantly small, undeveloped ducts and a small amount of fat and connective tissue.

How common is male breast cancer?
Male breast cancer is a rare condition, accounting for only about 1% of all breast cancers. The American Cancer Society estimates that in 2008, about 1,990 new cases of breast cancer in men will be diagnosed, and that breast cancer will cause approximately 480 deaths in men (in comparison, over 40,000 women die of breast cancer each year). Breast cancer is 100 times more common in women than in men. Most cases of male breast cancer are detected in men between the ages of 60 and 70, although the condition can develop in men of any age. A man's lifetime risk of developing breast cancer is about one-tenth of 1%, or one in 1,000.

What are causes and risk factors of male breast cancer?
As with cancer of the female breast, the cause of cancer of the male breast has not been fully characterized, but both environmental influences and genetic (inherited) factors likely play a role in its development. The following risk factors for the development of male breast cancer have been identified.

Radiation exposure
Exposure to ionizing radiation has been associated with an increased risk of developing male breast cancer. Men who have previously undergone radiation therapy to treat malignancies in the chest area (for example, Hodgkin's lymphoma) have an increased risk for the development of breast cancer.


Hyperestrogenism (high levels of estrogen)
Men normally produce small amounts of the female hormone estrogen, but certain conditions result in abnormally high levels of estrogen in men. The term gynecomastia refers to the condition in which the male breasts become abnormally enlarged in response to elevated levels of estrogen. High levels of estrogens also can increase the risk for development of male breast cancer. The majority of breast cancers in men are estrogen receptor-positive (meaning that they grow in response to stimulation with estrogen). Two conditions in which men have abnormally high levels of estrogen that are commonly associated with breast enlargement are Klinefelter's syndrome and cirrhosis of the liver. Obesity is also associated with elevated estrogen levels and breast enlargement in men.

Klinefelter's syndrome is an inherited condition affecting about one in 1,000 men. A normal man has two sex chromosomes (X and Y). He inherited the female X chromosome from his mother and the male Y chromosome from his father. Men with Klinefelter's syndrome have inherited an extra female X chromosome, resulting in an abnormal sex chromosome makeup of XXY rather than the normal male XY. Affected Klinefelter's patients produce high levels of estrogen and develop enlarged breasts, sparse facial and body hair, small testes, and the inability to produce sperm. Some studies have shown an increase in the risk of developing breast cancer in men with this condition. Their risk for development of breast cancer is markedly increased, up to 50 times that of normal men.

Cirrhosis (scarring) of the liver can result from chronic alcohol abuse, chronic viral hepatitis, or rare genetic conditions that result in accumulation of toxic substances within the liver. The liver produces important binding proteins that affect the transport and delivery of male and female hormones via the bloodstream. With cirrhosis, liver function is compromised, and the levels of male and female hormones in the bloodstream are altered. Men with cirrhosis of the liver have higher blood levels of estrogen and have an increased risk of developing breast cancer.


Familial predisposition
Epidemiologic studies have shown that men who have several female relatives with breast cancer also have an increased risk for development of the disease. In particular, men who have inherited mutations in the breast cancer-associated BRCA-2 gene have a dramatically increased (about 80-fold) risk for developing breast cancer, with a lifetime risk of about 5%-10% for development of breast cancer. BRCA-2 is a gene on chromosome 13 that normally functions in suppression of cell growth. Mutations in this gene lead to an increased risk for development of breast, ovarian, and prostate cancers. About 15% of breast cancers in men are thought to be attributable to BRCA-2 mutation. The role of the BRCA-1 gene, which has been associated with inherited breast cancers in women, is not as clearly defined for male breast cancers.

What are the different types of male breast cancer?
The most common type of male breast cancer is infiltrating ductal carcinoma, which is also a common type of breast cancer in women. Ductal carcinoma refers to cancers with origins in the ducts (tubular structures) of the breast, and the term infiltrating means that the cancer cells have spread beyond the ducts into the surrounding tissue. On the other hand, lobular cancers (cancers of the milk glands), common in women, are extremely rare in men since male breast tissue does not normally contain lobules.

Other uncommon types of cancers of the breast that have been reported in men include ductal carcinoma in situ (cancer in the ducts that has not spread beyond the ducts themselves), cystosarcoma phylloides (a type of cancer of the connective tissue surrounding the ducts), and Paget's disease of the breast (a cancer involving the skin of the nipple). Some other types of breast cancer that occur in men are named for their growth patterns and microscopic appearance of the cancer cells, including papillary carcinoma, inflammatory carcinoma, and medullary carcinoma.

About 85% of breast cancers in men have estrogen receptors on their cell membranes. Estrogen receptors on the cell membranes allow estrogen molecules to bind to the cancer cells. Estrogen binding to the cancer cells stimulates cell growth and multiplication.

What are the signs and symptoms of male breast cancer?
The most common symptom of breast cancer in men is finding a firm, non-painful mass located just below the nipple. The average size of breast cancer in men when first discovered is about 2.5 cm in diameter. The cancer may cause skin changes in the area of the nipple. These changes can include ulceration of the skin, puckering or dimpling, redness or scaling of the nipple, or retraction (turning inward) of the nipple. Bloody or opaque discharge from the nipple may also occur.

Breast cancer that has spread (metastasized) to the bones may also produce bone pain at the sites of metastases. Advanced breast cancer can also produce symptoms typical of many cancers, including malaise, weakness, and weight loss


How is male breast cancer diagnosed?
Diagnosis of breast cancer requires identifying cancer cells in tissue specimens obtained by biopsy. Since men have little breast tissue, cancers in male breasts are easily palpable (located by feel) and, therefore, are easily accessible to biopsy. Fine needle aspiration or needle biopsy of a suspicious mass can usually establish a diagnosis. A needle is inserted into the mass and tissue from the suspicious area is withdrawn. Microscopic examination of the tissue by a pathologist establishes the diagnosis.

Other techniques that may be used to diagnose breast cancer in men include incisional (removing a portion of the suspicious tissue) or excisional (removing the mass in its entirety) biopsy of a breast mass. If nipple discharge is present, microscopic examination of a smear of the discharge can sometimes establish the diagnosis.

Imaging studies such as X-rays, CAT scans (CT scans), magnetic resonance imaging (MRI), ultrasound, and bone scans may be performed to evaluate the presence and extent of metastatic disease once the initial diagnosis of breast cancer has been made.


What is staging of male breast cancer?
Staging is carried out to determine the extent to which a cancer has spread within the body. Staging of breast cancer in men is carried out identically to the staging of breast cancer in women. The American Joint Committee on Cancer (AJCC) TNM system takes into account the tumor size, lymph node involvement by cancer, and presence of metastasis:

* T: tumor size and extent of local spread


* N: extent of tumor involvement of lymph nodes in the axillary (underarm) region. Since the nipple area is rich in lymphatic vessels, male breast cancer commonly spreads via the lymphatic channels to the axillary lymph nodes (When the tumor has spread to the lymph nodes, doctors sometimes use the term "lymph node-positive" cancer).


* M: presence of distant metastases (spread to other parts of the body through the bloodstream or lymphatic vessels)


Stage 0

Stage 0 refers to intraductal carcinoma, in which the cancer cells have not spread beyond the boundaries of the ducts themselves.

Stage I

In Stage I breast cancer, the tumor is 2 cm or less in greatest diameter and has not spread to the lymph nodes or to other sites in the body.

Stage II

Stage II cancers are divided into two groups. Stage IIA cancer is either less than 2 cm in diameter with spread to the axillary lymph nodes, or the tumor is between 2-5 cm but has not spread to the axillary lymph nodes. Stage IIB tumors are either larger than 5 cm without spread to the lymph nodes or are between 2-5 cm in size and have spread to the axillary lymph nodes.

Stage III

Stage III is considered to be locally advanced cancer. Stage IIIA means the tumor is smaller than 5 cm but has spread to the axillary lymph nodes, and the axillary lymph nodes are attached to each other or to other structures; or the tumor is greater than 5 cm in diameter with spread to the axillary lymph nodes, which may be attached to each other or to other structures. Stage IIIB tumors have spread to surrounding tissues such as skin, chest wall, and ribs, or to the lymph nodes inside the chest wall.

Stage IV

Stage IV cancer refers to metastatic cancer, meaning it has spread to other parts of the body. With breast cancer, metastases (sites of tumor elsewhere in the body) are most often found in the bones, lungs, liver, or brain. Stage IV cancer is also diagnosed when the tumor can be found in the lymph nodes of the neck.



How is male breast cancer treated?
Like breast cancer in women, treatment depends upon the stage of the cancer and the overall physical condition of the patient. Treatments are the same as for breast cancer in women.

Most men diagnosed with breast cancer are initially treated by surgery. A modified radical mastectomy (removal of the breast, lining over the chest muscles, and portions of the axillary lymph nodes) is the most common surgical treatment of male breast cancer. Sometimes portions of the muscles of the chest wall are also removed.

After surgery, adjuvant therapies are often prescribed. These are recommended especially if the cancer has spread to the lymph nodes (node-positive cancer). Adjuvant therapies include chemotherapy, radiation therapy, targeted therapy, and hormone therapy. In cases of metastatic cancer, chemotherapy, hormone therapy, or a combination of both, are generally recommended.

Chemotherapy refers to the administration of toxic drugs that stop the growth of cancer cells. Chemotherapy may be given as pills, as an injection, or via an intravenous infusion, depending upon the types of drugs chosen. Combinations of different drugs are usually given, and treatment is administered in cycles with a recovery period following each treatment. Some of the most common chemotherapeutic agents for treating breast cancer are cyclophosphamide, methotrexate, fluorouracil, and doxorubicin (Adriamycin). In most cases, chemotherapy is administered on an outpatient basis. Chemotherapy may be associated with unpleasant side effects including hair loss, nausea and vomiting, and diarrhea.

Radiation therapy uses high-energy radiation to kill tumor cells. Radiation therapy may be delivered either externally (using a machine to send radiation toward the tumor) or internally (radioactive substances placed in needles or catheters and inserted into the body).

Hormonal therapy prevents hormones from stimulating growth of cancer cells and is useful when the cancer cells have binding sites (receptors) for hormones. Male breast cancers usually have estrogen receptors and are most commonly treated with the drug tamoxifen, which blocks the action of estrogen on the cancer cells. Side effects of tamoxifen treatment can include hot flashes, weight gain, mood changes, and impotence.

While estrogen is the most common target of hormonal therapy, studies have also shown that treatments directed against the actions of male hormones (anti-androgens) can also reduce the size of male breast cancer metastases. The reasons why anti-androgens are effective in widespread disease are not fully understood. Orchiectomy (removal of the testes) was formerly performed to lower androgen levels, but newer nonsurgical methods are currently favored. Drugs known as luteinizing hormone-releasing hormone (LHRH) analogs affect the pituitary gland and result in lowered production of male hormones by the testes.

Targeted therapy involves agents that are designed to specifically target one of the cancer-specific changes in cells. An example of targeted therapy is trastuzumab (Herceptin), a monoclonal antibody that blocks the activity the protein known as HER-2-neu that is made by some breast cancers. This treatment is only used in breast cancers whose cells express the HER-2-neu protein and is given intravenously. Trastuzumab has been shown to be effective in women with breast cancer but has not been extensively tested in men with breast cancer. Similarly, Lapatinib (Tykerb) is a drug taken in pill form that also targets the HER2/neu protein. It is used in combination with other agents to treat HER2-positive breast cancer that is no longer responsive to trastuzumab.

If a cancer that has been surgically removed regrows at the original site, this is referred to as local recurrence. Locally recurrent cancers are usually treated by surgery along with chemotherapy, or radiation therapy combined with chemotherapy.


What is the outcome (prognosis) of male breast cancer?
The prognosis of a patient with male breast cancer is considered similarly to breast cancer in a woman. Overall survival rates for each tumor stage are similar for men and women. Since men have less breast tissue than women, it is more common for breast cancers in men to have spread beyond the breast when they are identified, resulting in a more advanced tumor stage at diagnosis.

Five-year survival rates (meaning the percentage of patients who live for at least five years following diagnosis) reported for male breast cancer by stage are:

* Stage 0 - 100%


* Stage I - 96%


* Stage II - 84%


* Stage III - 52%


* Stage IV - 24%

These survival rates were calculated using historical data, and it is likely that current treatments will lead to even greater survival rates for those recently diagnosed.
Male Breast Cancer at a Glance

* Male breast cancer is rare and accounts for only about 1% of all breast cancers.
* Breast cancer risk in men is increased by elevated levels of estrogen, previous radiation exposure, and a family history of breast cancer.
* Infiltrating ductal carcinoma is the most common type of male breast cancer.
* A lump beneath the nipple is the most common symptom of male breast cancer.
* Male breast cancer is staged (reflecting the extent of tumor spread) identically to breast cancer in women.
* Surgery is the most common initial treatment for male breast cancer; chemotherapy, radiation therapy, and hormonal therapy are also administered.
* The prognosis of male breast cancer, like breast cancer in women, is predominantly influenced by tumor stage.


Male breast cancer accounts for 1% of all breast cancers, and most cases are found in men between the ages of 60 and 70. A man's risk of developing breast cancer is one in 1,000. Signs and symptoms include a firm mass located below the nipple and skin changes around the nipple, including puckering, redness or scaling, retraction and ulceration of the nipple. Treatment depends upon staging and the health of the patient.





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Birth Contol Surgical Sterilization

Birth Control: Surgical Sterilization
Introduction to birth control
If a woman is sexually active and she is fertile and physically able to become pregnant, she needs to ask herself, "Do I want to become pregnant now?" If her answer is "No," she must use some method of birth control (contraception).

Terminology used to describe birth control methods include contraception, pregnancy prevention, fertility control, and family planning. But no matter what the process is called, sexually active people can choose from a plethora of methods to reduce the possibility of their becoming pregnant. Nevertheless, no method of birth control available today offers perfect protection against sexually transmitted infections (sexually transmitted diseases, or STDs), except abstinence.

In simple terms, all methods of birth control are based on either preventing a man's sperm from reaching and entering a woman's egg (fertilization) or preventing the fertilized egg from implanting in the woman's uterus (her womb) and starting to grow. New methods of birth control are being developed and tested all the time. And what is appropriate for a couple at one point may change with time and circumstances.

Unfortunately, no birth control method, except abstinence, is considered to be 100% effective.

Permanent methods of contraception (surgical sterilization)
Sterilization is considered a permanent method of contraception. In certain cases, sterilization can be reversed, but the success of this procedure is not guaranteed. For this reason, sterilization is meant for men and women who do not intend to have children in the future.

Vasectomy
A vasectomy is a form of sterilization of a man. A vasectomy ensures that no sperm will exit from his penis when he ejaculates during sexual intercourse.

A vasectomy is usually performed by either a urologist or a general surgeon. Under local anesthesia, the vas deferens (tubes that carry sperm from the testicles into the urethra, also known as spermatic ducts) from each testicle is severed. The open ends are then closed off. A vasectomy can be performed in the clinic and involves making two small openings in the scrotum. After a vasectomy, the man may feel tenderness or bruising around the incision site.

A vasectomy does not interfere with the ability of a man to have an erection or the quantity of his ejaculation fluid. After a man has a vasectomy, another second form of birth control should be used until his ejaculate fluid is found to be free from sperm. This usually takes 10 to 20 ejaculations.

Vasectomy reversals are possible, but they tend to be expensive and are not always successful. A vasectomy should be considered a permanent form of birth control.

A vasectomy does not protect a man or his partner from sexually transmitted infections.

Tubal ligation
Tubal ligation is also known as "having one's tubes tied," or having a "tubal." Tubal ligation is for women, and like a vasectomy, should be considered a permanent form of birth control.

A tubal ligation is performed under general, regional, or local anesthesia and can be performed as an outpatient procedure. The surgeon or ob/gyn uses one of several procedures in order to access a woman's Fallopian tubes (which run from the top part of her uterus to each ovary). A laparoscopy is a procedure in which a small incision is made just below the navel. A viewing tube (scope) can then be inserted through this incision to view and reach the Fallopian tubes. A minilaparotomy is a small incision in the lower abdomen that is sometimes used for tubal ligation most commonly in the postpartum period (after childbirth).

Once the physician has access to a woman's Fallopian tubes, they are closed off by using a clip, cutting and tying, or cauterizing (burning) the tubes. The procedure takes anywhere from 10 to 45 minutes.

Side effects of a tubal ligation may include infection, bleeding (hemorrhage), and those associated with being under general anesthesia.

A tubal ligation blocks a woman's Fallopian tubes. As a result of the procedure, about 1 inch of each tube is blocked off. An egg can no longer travel down the tube to the uterus, and sperm cannot make contact with the egg. Tubal ligation should have no effect on a woman's menstrual cycle or hormone production.

A woman's tubal ligation can be surgically reversed, usually with more success than in men who have had a vasectomy.

A tubal ligation does not protect a woman or her partner from sexually transmitted infections (sexually transmitted diseases, or STDs). It is also not an absolute method of birth control because about 2% of women become pregnant after a tubal ligation.

Hysteroscopic sterilization
Hysteroscopic sterilization is a nonsurgical form of permanent birth control in which a physician inserts a 4-centimeter (1.6 inch) long metal coil into each one of a woman's two Fallopian tubes via a scope passed through the cervix into the uterus (hysteroscope), and from there into the openings of the Fallopian tubes. Over the next few months, tissue grows over the coil to form a plug that prevents fertilized eggs from traveling from the ovaries to the uterus.

The procedure takes about 30 minutes, can be done in a doctor's office, and usually requires only a local anesthetic. During a 3-month period after the coils are inserted, women must use other forms of birth control until their physician verifies by an imaging test known as a hysterosalpingogram or HSG that the Fallopian tubes are completely blocked.

Like tubal ligation, this form of sterilization is permanent (not reversible) and is designed as an alternative to surgical sterilization which requires general anesthesia and an incision. About 6% of women who have the procedure develop side effects, mainly due to improper placement of the coils.

This form of sterilization, like other methods of surgical sterilization, does not protect a woman or her partner from sexually transmitted diseases (STDs).

Hysterectomy
A hysterectomy is the surgical removal of a woman's uterus and, depending on her overall health status and the reason for the operation, perhaps her ovaries as well. No woman who has had a hysterectomy can become pregnant; it is an irreversible method of birth control and absolute sterilization.

If a woman has other chronic medical problems that may be helped by a hysterectomy (such as abnormally excessive menstrual bleeding, uterine fibroids, uterine growths), than this may be an appropriate procedure for her to consider. Otherwise, contraception should be considered a secondary benefit and not a sole reason to have the procedure.




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Your Guide to Birth Control Condoms

Your Guide to Birth Control: Condoms

Birth control is a way for men and women to prevent pregnancy. There are many different methods of birth control; some types also protect against sexually transmitted diseases . Condoms are one type of birth control that in addition to preventing pregnancy also prevent the spread of STDs.

There are two types of condoms, the male condom an

d the female condom.

What Is a Male Condom?

The male condom, or "rubber," is a thin covering made of latex, plastic, or animal membrane that is rolled over an erect penis. The covering prevents semen, the fluid that contains sperm, from entering a woman's vagina.

What Are Male Condoms Made of?

Most condoms are made of a type of rubber called "latex." Recently, condoms made of polyurethane (a type of plastic) have become available.

These are more expensive than latex condoms and seem to break more easily. They are mainly useful for people who are allergic to latex. There are also "natural" condoms, which are made of animal membranes. These are expensive and probably not effective in preventing the spread of sexually transmitted diseases.

What Types of Latex Condoms Are There?

Condoms come in all shapes, sizes, and materials. Here are some characteristics to consider when buying condoms.

• Size. The standard size will fit most men. Extra-large condoms are available, as well as "snug" sizes that are a little smaller and fit tighter than the standard size.
• Shape. Some condoms come with a nipple in the end to hold the fluid when the man ejaculates. Others have a rounded end.
• Thickness. Extra-strength condoms are available. These are stronger and are especially useful for rectal sex and for men who have problems with condom breakage. Extra thin condoms also are available, but these are not recommended because they may break more easily.
• Lubrication. Many condoms come pre-lubricated with a substance that kills sperm (spermicide) and many disease-causing germs. Lubrication may give some extra protection, especially if the condom breaks. Lubricated condoms taste bad and are not recommended for oral sex.
• Flavored. These condoms are mea nt for the male to wear when receiving oral sex. They are not lubricated and have a mild flavor (usually mint).
• Color. Condoms come in many colors. The color of the condom doesn't make it any more or less effective.

When Should a Man Use a Condom?

A man should wear a condom any time he inserts his penis into the body of another person, if there is even the slightest risk that either person has a sexually transmitted disease. Men frequently become infected with STDs when receiving oral sex, so a condom should be worn then, too. The condom should be put on before there is any contact, and should be removed and thrown away promptly after the man has ejaculated.

How Is the Male Condom Used?

The condom is rolled over the erect penis before sexual activity begins. If the condom does not have a built-in nipple, leave 1/4-inch of the condom free at the tip of the penis so that semen has a place to collect. A new condom must be used each time you have sex. For the best protection, condoms should be used with a spermicidal foam or jelly . The condom must be in place before the penis gets near the vagina. If you use lubricants with a condom, be sure to only use water-based lubricants, such as K-Y Jelly. Oil-based lubricants, such as Vaseline, can cause condoms to leak or break.

What Causes Male Condoms to Break?

• Condoms too old. Modern condom wrappers have a date after which the condom should not be used.
• Improper storage. Heat damages latex condoms, so they should not be kept in a hot place, such as a car glove compartment or wallet.
• Not enough lubrication. Additional lubrication is always needed for rectal sex. It may also be needed for vaginal sex. The lubricant should be water-soluble, such as KY jelly.
• The wrong kind of lubricant. Lubricants that contain oil -- such as Vaseline, baby oils and vegetable oils -- should not be used with latex condoms since they weaken the rubber.
• Condom too small. Try a larger size.
• Partner too tight. Use an extra strength condom and more lubricant.

What Causes Condoms to Come Off During Sex?

• Condom too large. Try a snug condom.
• Loss of erection. Remove your penis, holding on to the rolled edge of the condom, as soon as you begin to lose your erection.

Where Can I Get Male Condoms?

Condoms can be purchased at most drug stores. Condoms also are sold in vending machines in public restrooms.

How Effective Are Male Condoms at Preventing Pregnancy?

Condoms are about 85 % effective. With careful use, they are even more effective. Keep in mind that the best way to avoid getting pregnant is to not have sex (abstinence).

How Do Male Condoms Prevent STDs?

Latex condoms provide protection from sexually transmitted diseases by preventing the infected area from coming into contact with the partner.

Should Foam be Used With Male Condoms?

Contraceptive foam can offer added protection against pregnancy and STDs in case a condom breaks.

How Effective Are Foam and Male Condoms?

When used together and properly, foam and condoms are about 97% effective in preventing pregnancy.

What Is a Female Condom?

The female condom is a lubricated polyurethane (plastic) tube that has a flexible ring at each end. One end of the tube is closed.

How Is the Female Condom Used?

Before sexual activity begins, the woman inserts the condom into her vagina so that the closed end of the tube covers the cervix, and the other end slightly covers the labia (lips on the outside of the vagina). The condom blocks sperm from entering the womb. Female condoms should be discarded after one use.

Where Can I Get Female Condoms?

Like the male condom, the female condom is available at drug stores without a prescription.

How Effective Is the Female Condom at Preventing Pregnancy?

The female condom is about 75% effective.

Do Female Condoms Protect Against STDs?

Female condoms provide some protection against sexually transmitted diseases, but the male condom provides the best protection if you have sex.

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Testosterone Injections Offer Hope for Male Contraceptive

Testosterone Injections Offer Hope for Male Contraceptive
TUESDAY, May 5 (HealthDay News) -- Injectable testosterone may be an effective form of male contraception, new research suggests.

Chinese researchers injected 1,045 healthy, fertile Chinese men aged 20 to 45 years with a 500 milligram formulation of testosterone undecanoate in tea seed oil once a month for 30 months.

All of the study participants had a normal medical history and had fathered at least one child within two years of beginning the study. The female partners of the study participants, aged 18 and 38 years, also had normal reproductive function.

Results showed a contraceptive failure rate of 1.1 per 100 men in the 24-month efficacy phase, resulting in pregnancy. The researchers noted that no serious adverse events were reported in any of the men and, in all but two men, reproductive function returned to the normal fertile reference range.

"For couples who cannot, or prefer not to use only female-oriented contraception, options have been limited to vasectomy, condom and withdrawal," said Dr. Yi-Qun Gu, of the National Research Institute for Family Planning in Beijing, China. "Our study shows a male hormonal contraceptive regimen may be a potential, novel and workable alternative."

The study will appear in the June issue of the Journal of Clinical Endocrinology & Metabolism.

This is the largest multi-center, male hormonal contraceptive efficacy clinical trial of an androgen preparation, Gu said in an Endocrine Society news release.

"Despite the present encouraging results, the long-term safety of this hormonal male contraceptive regimen requires more extensive testing with a focus on cardiovascular, prostate and behavioral safety," Gu said.




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