Conducta sexual en adolescentes varones y anticoncepción / Sexual behavior in male adolescents and contraception

Se realiza un estudio prospectivo y longitudinal con el objetivo de determinar el grado de conocimiento, utilización y responsabilidad sexual ante la anticoncepción de adolescentes varones en nuestro medio. Se aplicó el método porcentual a las variables y para este fin se confeccionó una encuesta que fue aplicada de forma anónima y voluntaria a 400 varones de la enseñanza media, en el mes de mayo de 1999 en el municipio de Guane; las edades extremas de la muestra fueron los 13 y 18 años. Se encontró un elevado porcentaje de jóvenes con conocimientos sobre los métodos anticonceptivos, lo cual pone de manifiesto una disociación entre el conocimiento y la utilización de los métodos anticonceptivos del adolescente varón. La principal vía de conocimiento sobre los métodos está inculcada a la supuesta disminución de las sensaciones durante el coito que provoca el uso del condón; por último, se encuentra una tendencia machista respecto a la responsabilidad sexual del adolescente varón, lo que está dado por el no conocimiento de su responsabilidad ante la anticoncepción, así como el criterio de sentirse con el derecho de exigir a su pareja una relación segura(AU)

A prospective and longitudinal study was conducted in order to determine the degree of knowledge, use and sexual responsiblity of male adolescents in relation to contraception in our environment. The percentage method was applied to the variables and an anonymous and voluntary survey was done among 400 males aged 13-18 from the middle educational level, in the municipality of Guane, in May, 1999. It was found that a high proportion of teenagers knew about the contraceptive methods, which shows a dissociation between the knowledge and the utilization of contraceptive methods in the adolescent male. The main way of knowldege about these methods is associated with the supposed reduction of sensations produced by the use of condom during the sexual intercourse. It was also observed a trend toward machism concerning the sexual responsibility of the male adolescent due to the fact that they ignore their responsibilty as regards contraception and that they consider having the right to demand from their partners a safe sexual relation(AU)

Gossypol blood levels and inhibition of spermatogenesis in men taking gossypol as a contraceptive. A multicenter, international, dose-finding study.

The safety and efficacy of gossypol continues to be controversial. The aim of this study was to evaluate gossypol as a contraceptive pill for men at doses lower than those previously prescribed and in men from various ethnic origin. A total of 151 men from Brazil, Nigeria, Kenya, and China were divided into two groups. Both groups received 15 mg gossypol/day for 12 or 16 weeks to reach spermatogenesis suppression. Subjects were then randomized to either 7.5 or 10 mg/day for 40 weeks. In addition, 51 men were enrolled as a control group. In all, 81 subjects attained spermatogenesis suppression. Only one man discontinued treatment because of tiredness. Potassium levels fluctuated within the normal range. FSH increased consistently. Testicular volume decreased, but after discontinuation, values returned to levels not statistically different from admission. Of 19 subjects on the 7.5 mg/day dose group, 12 recovered sperm counts >20 million/mL within 12 months of discontinuing gossypol. In the 10 mg/day group, sperm counts recovered in only 10 of 24 subjects. Eight of the 43 patients remained azoospermic 1 year after stopping gossypol. All men diagnosed with varicocele failed to reverse spermatogenesis suppression. Gossypol blood levels indicated that sperm suppression occurs independently of concentration, whereas spermatogenesis recovery appears to be concentration-dependent. Gossypol may become a medical alternative to surgical vasectomy when the delay in onset of infertility is acceptable. When taken for 1 year, gossypol causes no reduction in sexual desire or frequency of intercourse. The possibility of reversal, occurring in 51% of the men on this regimen within 1 year after stopping gossypol, is an advantage of this compound as compared with surgical sterilization in many parts of the world.

PIP: The safety and efficacy of gossypol continues to be controversial. The aim of this study was to evaluate gossypol as a contraceptive pill for men at doses lower than those previously prescribed and in men from various ethnic origin. A total of 151 men from Brazil, Nigeria, Kenya, and China were divided into two groups. Both groups received 15 mg gossypol/day for 12 or 16 weeks to reach spermatogenesis suppression. Subjects were then randomized to either 7.5 or 10 mg/day for 40 weeks. In addition, 51 men were enrolled as a control group. In all, 81 subjects attained spermatogenesis suppression. Only 1 man discontinued treatment because of tiredness. Potassium levels fluctuated within the normal range. FSH increased consistently. Testicular volume decreased, but after discontinuation, values returned to levels not statistically different from admission. Of 19 subjects in the 7.5 mg/day dose group, 12 recovered sperm counts higher than 20 million/ml within 12 months of discontinuing gossypol. In the 10 mg/day group, sperm counts recovered in only 10 of 24 subjects. 8 of the 43 patients remained azoospermic 1 year after stopping gossypol. All men diagnosed with varicocele failed to reverse spermatogenesis suppression. Gossypol blood levels indicated that sperm suppression occurs independently of concentration, whereas spermatogenesis recovery appears to be concentration-dependent. Gossypol may become a medical alternative to surgical vasectomy when the delay in onset of infertility is acceptable. When taken for 1 year, gossypol causes no reduction in sexual desire or frequency of intercourse. The possibility of reversal, occurring in 51% of the men on this regimen within 1 year after stopping gossypol, is an advantage of this compound as compared with surgical sterilization in many parts of the world.

[Information on advances in sciences and technology. Advances in contraceptive technology]. / Informacoes sobre avancos em ciencia e tecnologia. Avancos da tecnologia anticonceptiva.

PIP: Hormonal contraceptives include oral pills with lower steroid concentrations such as the triphasic gestodene. A dose of less than 20 mcg of ethinyl estradiol in the combined pill is effective. The use of RU-486 or mifepristone to inhibit ovulation or as a postcoital method is still being investigated. The vaginal rings that release 20 mcg of levonorgestrel (LNG) have a 97% rate of efficacy. There are newer types that release 30 mcg of LNG or desogestrel. A progesterone-releasing ring used during lactation is being studied. Among implants Norplant has been approved in many countries, including by the US Food and Drug Administration, with excellent results. In Brazil it continues to be banned. Studies have been initiated about implants, such as Norplant 11 and UNIPLANT. The studies conducted by the World Health Organization on injectables such as Cyclofem (which contains 5 mg of estradiol cypionate and 25 mg of medroxyprogesterone acetate) as well as Mesigyna (5 mg of estradiol valerate and 50 mg of norethindrone enanthate) are awaited. These two monthly injectables have minor side effects, produce regular cycles, and are highly effective. The use of GnRH analogues for ovulation inhibition are held back because of cost, dosage, and routes of administration The hormonal IUD releasing 20 mcg of LNG holds promise for high efficacy, probable protection against inflammations, and pronounced reduction of menstrual bleeding, particularly in long-term use. The frameless IUD, called Flexigard, consists of 6 fixed copper cylinders placed in the myometrium, which causes less endometrial irritation and less incidence of inflammation, pain, and bleeding. It has been in an experimental testing phase for some years. The female condom helps prevent STDs and is under the woman's control. Among male contraceptives, a hormonal method awaits development, while gossypol with the ability to inhibit HIV proliferation and the Chinese method of scalpel-free vasectomy are effective methods.^ieng

Clinical experience with gossypol in non-Chinese men: a follow-up.

Gossypol monoacetic acid was administered to 12 Brazilian volunteers. The initial dose was 20 mg daily for 4 months. The dose was then reduced to 60 mg weekly (20 mg three times weekly). A significant reduction in sperm motility was detected in all subjects. An increase in the number of immature cells in the ejaculate was also detected in all subjects. Severe oligospermia or azoospermia developed in all subjects at the end of the loading phase. Two years following discontinuation, 3 men were still azoospermic. Only 1 man who was azoospermic 2 years after discontinuation had a late (3 years) recovery. Two of the 3 men who were subjected to high spermatic vein ligation because of varicocele remained azoospermic 2 years after the operation. The third patient, who did not have the operation, also remained azoospermic. Of the 9 patients who recovered, 3 had fathered children during the last 2 years.

Zoapatle. XII. In vitro effect of kaurenoic acid isolated from Montanoa frutescens and two derivatives upon human spermatozoa.

Zoapatle aqueous crude extract (ZACE) from Montanoa tomentosa has been used as an oral contraceptive in traditional Mexican medicine for centuries. Kaurenoic acid, as isolated from Montanoa frutescens, and the methyl esters of 15-hydroxy-dihydro-kaurenoic acid and 15-keto-dihydro-kaurenoic acid were tested in vitro on human sperm motility and viability. The estimated ED50 concentrations immobilization were 374, 126 and 58 micrograms/ml, respectively using 15 X 10(6) sperms/500 microliter. Kaurenoic acid and both of its derivatives displayed only weak to negligible capacity for killing human sperms.

PIP: The effects on human sperm motility and viability of 3 compounds isolated from an aqueous extract of Montanoa frutescens Cerv (Compositae, Heliantheae) were tested. The plant is related to the zoapatle, traditionally used as a contraceptive, and known to have uterotonic and luteolytic activity. Kaurenoic acid, its 15 hydroxy- and its methyl ester were prepared from the polar fraction, and dissolved in 95% ethanol at a concentration of 10 mg/ml. Human sperm, suspended in Bigger's Whitten and Wittingham medium at a final concentration of 15 million sperm per 500 mcl were incubated at 37 degrees C. for 60 seconds. Judging sperm motility under phase contrast microscopy, kaurenoic acid was 0.89 times less effective, and the hydroxy kaurenoic acid 2.6 times more effective than verapamil, while the keto derivative was 5.7 times more potent than verapamil at the same concentration. Sperm viability assessed by vital staining was hampered only about 10% by the keto-kaurenoic acid, 21% by kaurenoic acid, and 33% by hydroxy-kaurenoic acid. Doses required for immobilization of 50% of human sperms ranged from 58 to 374 mcg/ml. This is 225 times lower than that reported for gossypol in vitro, and much lower than the millimolar range needed to inactivate sperm with nonoxynol. Thus these drugs may prompt a search for analogs useful in vaginal contraceptives.

FPA withdraws from CSM project in Guatemala.

PIP: Guatemala's family planning association, the Asociacion Pro-Bienestar de la Familia (APROFAM) recently cut its ties with the nation's contraceptive social marketing program. The announced reasons for the disassociation was APROFAM's concerns about the legality of selling donated commodities. APROFAM helped create the program served as a member of the marketing program's board of directors, and was expected to function as the channel for the commidities donated by the US Agency for International Development (USAID). The marketing program will now be managed by the newly created Importadora de Farmaceuticos (IPROFA), a for-profit organization. This alters the legal status of the marketing program, and as a result, the program will be required to pay duties on USAID donated contraceptives. USAID cannot legally pay duties on its own contributions. Instead, the duies will be paid by IPROFA out of the revenues generated by the project. IPROFA will finance the 1st consignment of products with a bank loan, and the loan and duties on subsequent shipments will be paid out of the program's revenues. This strategy is not expected to pose legal problems for USAID, since the agency has no control over how programs use the revenues generated by selling the agency's commodities. As a result of the changed status, the marketing program must acquire it own storage and packaging facilities. According to Manuel DeLucca, the program's resident advisor, these problems will not delay the launch of the program's products scheduled for early 1985. The program plans to sell an oral contraceptive, a vaginal spermicidal tablet, and a condom. Orginal plans called for selling the low dose OC, Norminest; however, Norminest may not be approved for distribution in Guatemala, and USAID may replace Norminest with another product. As a result, the program may market Noriday, a normal dose pill instead of Norminest. Guatemalan registration of the spermicidal tablet the program is planning to sell is pending. The program is engendering considerable interest because of its unique legal status as a commercial enterprise and its freedom from bureaucractic constraints.^ieng

[The history of research on contraceptive methods in the Dominican Republic]. / Historia de la investigacion sobre metodos anticonceptivos en RD.

PIP: The Center for Investigation and Services in Human Reproduction and Contraception (CINSERHA), under the auspices of the Dominican association for Family Welfare (PROFAMILIA), conducts research in human reproduction and on the efficacy, effectiveness, seconardy effects, and other characteristics of contraceptive methods, as well as providing family planning services to more than 15,000 women each year. CINSERHA's research activities began in 1974 and have primarily involved development of Norplant subcutaneous implants, vaginal contraceptive rings, different models of IUDs, and male injectable methods. The most significant results to date have been contributions to the successful development and acceptance of the Norplant system, proff that IUDs do not entail "microabortions", and demonstration that the periovulatory period is the time of optimal conditions for sperm migration in the female genital tract. The objectives of CINSERHA studies are to develop new contraceptive methods, to achieve a better understanding of female physiology, and to explain the mechanisms of action of current contraceptive methods. CINSERHA participates in collaborative international studies with the US, Finland, Sweden, Chile, Brazil, and Jamaica under the leadership of the Population Council. 400 implants have been placed over 9 years and only 2 pregnancies have occurred, giving a failure rate of .4. The only side effect has been menstrual irregularity, which has tended to clear up with time. The only male method studied was a monthly injection of medroxyprogesterone and testosterone, which was abandoned as unpromising after 2 years of study. The cottonseed extract gossypol may be studied in the future, and studies on the vaginal ring have been successful except that some women complained of excessive vaginal discharge.^ieng

Mexican plants and human fertility.

PIP: Synthetic steroids are obtainable cheaply and in abundance from sapogenins, substances originating from plants of the Discorea family. Some 40 years ago, Russell Marker, an American chemist, discovered this source, which grows abundantly in Mexican jungles and is now exploited and cultivated commercially. Today synthetic steroids prepared from extracts from a wide range of vegetable sources are used in the treatment of rheumatoid arthritis, allergies, inflammatory diseases, sterility, and various heart conditions, and form the basis of modern oral contraceptives. Nevertheless, oral contraceptives in current use are still fairly costly, and women have to be educated in their use. What is needed urgently is a cheaper contraceptive pill with a long-term effect, and research is continuing. For example, scientists from the People's Republic of China have reported significant anti-fertility effects associated with 2 substances, anordin and dinordin, prepared with steroids derived from the sisal plants Agave sisilana and Agave americana. These agents, whose anti-fertility properties have been confirmed by scientists in Sweden and the United States, constitute a new family of contraceptives with the great advantage of having to be taken only once or twice instead of 20 times per month necessary with the ordinary pill. Also from China, scientists have reported the effectiveness of gossypol as an orally administered male contraceptive, although gossypol is not a steroid. It may become, however, a leading candidate for a male contraceptive.^ieng

[Present investigations for the development of male hormonal contraception]. / Investigacion actual para el desarrollo de la anticonception hormonal masculina.

PIP: researchers began in the early 1970s to study the development of hormonal contraceptives for men. Clinical studies with progesterone and progesterone derivates, both strong spermatogenesis-blocking agents, have given satisfactory but not excellent results. Azoospermia was never obtained, and a number of side effects were noted, such as decreased libido, increase in body weight, and also hepatic toxicity. Other studies employed androgens, especially testosterone, with less side effects, but still without ever achieving azoospermia. Ongoing studies are trying to use progesterone and androgens in a combined regimen. Preliminary data indicate the same results as with preceding studies. With male hormonal contraception reversibility is always possible although not complete till about 2 years after termination of treatment.^ieng

[Hormone regulation of male fertility]. / Regulación hormonal de la fertilidad masculina

PIP: An innocuous, sure, reversible means of male fertility control which does not disturb the libido is being sought. 20 healthy volunteers from ages 20 to 36 participated, using a 2nd form of protection when necessary. 10 received implants of 60 mg testosterone equally divided into 3 tubes, and began oral ingestion of 100 mg weekly, divided into daily doses, of R2323 (13-ethyl-17-hydroxy-gonen 4,9,11, trien-3-one) until the sperm became ineffective. Then oral doses were given according to personal requirements from 50 to 25 mg. The 2nd series of 10 received no testosterone implants, but followed the same scheme for oral ingestion. All patients but 1 reduced their sperm count and 80% were low enough to consider the sperm inactive. For those who used the hormone treatment as the only protection against pregnancy, no pregnancy occurred. Of the 1st group, 2 had excessive weight gain, 3 felt their libido reduced, and 1 had pain in the nipples and 1 had pain in the hepatic region. Recuperation of normal sperm characteristics was slow, especially motility and vitality. The spermogram is so altered during treatment that any accidental pregnancy could result in a defective egg and serious complications. It should definitely be avoided.^ieng