Cishe u-60% wamadoda namuhla athi akulungele ukusebenzisa ukuvimbela inzalo. Kodwa-ke, i-spectrum yezindlela zokuvimbela inzalo zabesilisa zihlala zilinganiselwe okwamanje futhi ezinye izindlela ezijwayelekile azisebenzi kakhulu. Eqinisweni, ukuvimbela ukukhulelwa okungenzeka kusawela, ezimweni eziningi kakhulu, kowesifazane. Yiziphi izindlela ezivame kakhulu zokuvimbela inzalo yowesilisa namuhla? Yiziphi izindlela zokuvimbela inzalo zabesilisa ezinokwethenjelwa kakhulu? Uhlolojikelele.

Ikhondomu yabesilisa iyona ndlela yokuvikela inzalo yabesilisa esetshenziswa kakhulu: u-21% wezithandani eziyisebenzisa emhlabeni wonke.

Yini ikhondomu yabesilisa?

Ikhondomu yabesilisa ingenye yezindlela zokuvimbela inzalo ezibuyela emuva “ezithiyo” futhi iqukethe ulwelwesi oluncane, ngokuvamile olwenziwe nge-latex, oluzofakwa esithweni sangasese ngaphambi kocansi, ukuvimbela ukuphuma kwesidoda esithweni sangasese. Ikhondomu yabesilisa iyatuswa, ngokusho kwe-Haute Autorité de Santé, “uma engekho umlingani ozinzile noma njengendlela yokubuyisela okufanele igcinwe itholakala uma kwenzeka ukungafinyeleleki ngezikhathi ezithile noma ukwehluleka ukuhambisana nendlela yehomoni”.

Ingabe ikhondomu iyasebenza?

Ikhondomu yabesilisa ithathwa njengento yokuvimbela inzalo esebenzayo. Ngempela, inkomba yayo ye-Pearl, evumela ukuhlola iphesenti lokukhulelwa "ngengozi" phakathi nonyaka wokusetshenziswa kahle, ngempela 2. Kodwa empeleni, ikhondomu ayigculisi kakhulu ekuvimbeleni ukukhulelwa. engadingeki ngezinga lokuhluleka cishe kwe-15% ngenxa yemibandela yayo yokusetshenziswa. Lokhu kwehluleka kubangelwa ikakhulukazi ukuphuka kwamakhondomu, kodwa futhi nokusetshenziswa kwawo ngendlela engafanele, noma ngisho nokuhoxa kwawo ngesikhathi socansi.

Yiziphi izinzuzo kanye nokubi kwekhondomu yabesilisa?

Noma kunjalo, izinzuzo zekhondomu yabesilisa ziningi kanye nezinkinga zayo, kunalokho zilinganiselwe.

Phakathi kwezinzuzo zayo kukhona :

• Ukufinyeleleka kwayo : amakhondomu awabizi futhi atholakala kabanzi (izitolo ezinkulu, amakhemisi, njll.)
• Ukusebenza kwayo ekulweni nezifo ezithathelwana ngocansi : ikhondomu (owesilisa noma owesifazane) ukuphela kwendlela yokuvimbela inzalo esebenza ngempumelelo kuma-STI. Ngakho-ke kuyanconywa ebudlelwaneni obuyingozi (abalingani abaningi, ubudlelwano obujwayelekile) noma lapho bungekho ubudlelwano obuzinzile.
• Ukuhambisana kwayo nenye indlela yokuvimbela inzalo (i-hormonal wesifazane noma intrauterine contraception, spermicide, njll.), ngaphandle kwekhondomu yabesifazane.

Ngakolunye uhlangothi, ikhondomu inga...

• khuthaza ukuqala kokusabela kubantu abanokungezwani ne-latex. Lapho kufanele khona, amakhondomu enziwe nge-polyurethane, angeyona ingozi yokungezwani komzimba nezinto ezithile, kufanele akhethwe.

• lahlekelwa ukusebenza kahle uma isetshenziswe kabi, yingakho kubalulekile ukufunda ngemikhuba emihle (igqoke ikhondomu ngokuphelele ngaphambi kokuqala kocansi, yibambe ngesandla uma uyikhipha, njll.)
• zikhona izingozi zokushelela nokuphuka. Ngakho-ke, akunconywa ikakhulukazi ukusebenzisa izithambisi ezisekelwe kuwoyela ngekhondomu yabesilisa ye-latex, engcupheni yokwehlisa isithunzi se-latex eshiwoyo futhi kugqugquzelwe ukugqashuka kokuvimbela inzalo.
• nciphisa noma uguqule imizwa ngesikhathi socansi kwabanye abasebenzisi.

Ingakanani intengo yalokhu kuvimbela inzalo kwabesilisa?

Intengo emaphakathi yekhondomu yabesilisa iphakathi kuka-50 no-70 cents ucezu. Futhi ngokuphambene nenkolelo evamile, ikhondomu ingakhava kuMshwalense Wezempilo ngaphansi kwezimo ezithile. Ngempela, kusukela ngo-2018, amanye amabhokisi, atholakala emakhemisi, angabuyiselwa kuze kufike ku-60% uma enqunywe udokotela noma umbelethisi (ngesisekelo sentengo yokuthengisa engu-$ 1,30, € 6 ebhokisini 2,60, € 12 ebhokisini le-5,20 kanye ne-€ 24 yebhokisi le-XNUMX.). Angatholakala futhi mahhala ezikhungweni zokuhlela umndeni.

Ukuphazanyiswa kwe-coitus, okwaziwa nangokuthi indlela yokuhoxa, kusetshenziswa cishe u-5% wamadoda emhlabeni wonke, u-8% eFrance. Le ndlela yokuvimbela inzalo yowesilisa ngabe yathola ukuthandwa ngesikhathi “senkinga yamaphilisi” kanye nokubuzwa kokuvimbela inzalo kwabesifazane ngo-2012.

Ithini indlela yokuhoxa?

Indlela yokususa ifaka, njengoba igama liphakamisa, ukususa ipipi esithweni sangasese nasendaweni ezungeze isitho sangasese ngaphambi kokuphuma. Ngakho-ke, ingenye yezindlela "zemvelo" zokuvimbela inzalo kwabesilisa, enye yezindlela ezimbalwa ezibizwa ngokuthi "izinqubo ezishisayo".

Ingabe i-coitus ephazamisekile iyindlela yokuvimbela inzalo yabesilisa esebenzayo?

Ngokombono, nge-Pearl index ye-4, i-coitus ephazamisekile isalokhu ihlukaniswa, ngokusho kwe-Haute Autorité de Santé, esigabeni sokuvimbela inzalo kwabesilisa okuphumelelayo… inqobo nje uma isetshenziswa ngendlela efanele futhi njalo. Kepha ngokwenzayo, izinga lokwehluleka liphezulu kakhulu (27%). Ngakho-ke indlela yokuhoxa iyodwa ayinconywa ochwepheshe bezempilo.

Yiziphi izinzuzo kanye nebubi bendlela yokuhoxa?

Inzuzo enkulu yendlela yokuhoxa iyona "ukufinyeleleka" : mahhala, itholakala kuzo zonke izimo, ngaphandle kokuphikisana, ngakho-ke ngokuvamile ibhekwa "ngcono kunalutho".

Kodwa i-drawback yayo enkulu ihlala ikhona ukusebenza okulinganiselwe. Ngempela, le ndlela ayidingi nje kuphela ukulawula okuphelele kwe-ejaculation (okuyinto engeyona njalo), kepha noma ngabe kunjalo "ngokusobala," uketshezi lwangaphambi kwesidoda (olwandulela isidoda kanye nokujula futhi ngenxa yalokho lungafakwa esithweni sangasese sowesifazane) iqukethe isidoda ngakho-ke ingavundisa i-oocyte ngesikhathi sokuvuthwa. Futhi, ukuphazamisa i-coitus akuvikeli ezifweni ezithathelwana ngocansi.

I-Vasectomy iyindlela yokuvala inzalo ngezinhloso zokuvimbela inzalo (noma ukuvimbela inzalo okucacile ngolimi lwansuku zonke) esetshenziswa yi-2% yemibhangqwana emhlabeni, engaphansi kwe-1% eFrance. Isebenza kahle kakhulu, nokho ithathwa njengengenakuhlehliswa. Ngakho-ke kunconywa kuphela kumadoda afisa indlela ehlala njalo yokuvimbela inzalo futhi kufanele kube isihloko solwazi oluningi kanye nokuzindla.

Iyini i-vasectomy?

I-Vasectomy iwukuhlinzwa ukuze kuvinjwe i-vas deferens, okuvumela isidoda ukuthi sigeleze sisuka kumasende. Ngemuva kwe-vasectomy, isidoda asisaqukethe isidoda (i-azoospermia), ukuvundiswa kwe-oocyte ngemva kokuphuma kwe-ejaculation (ngakho-ke ukukhulelwa) akusanakwenzeka.

Ingabe i-vasectomy iyasebenza?

I-Vasectomy iyasebenza kakhulu. Inkomba yayo yethiyori yePearl ingu-0,1% ngokwethiyori kanye no-0,15% ekusebenzeni kwamanje. Ngakho-ke ukukhulelwa okungahlosiwe kuyivelakancane kakhulu.

Yiziphi izinzuzo kanye nokubi kwe-vasectomy?

Inzuzo enkulu ye-vasectomy ingaphezu kwakho konke ukusebenza kwayo. Amanye amaphuzu ayo amahle?

• Akuthinti ukusebenza kwe-erectile, ikakhulukazi ngoba ayithinti, njengoba umuntu engakholelwa kaningi, ukukhiqizwa kwamahomoni wesilisa. Izinga lokumiswa, umthamo we-ejaculate, izinzwa zihlala zifana.
• Ayinayo imingcele yansuku zonke futhi (kakhulu) ubude besikhathi.
• Ukuhlinzwa kuvame ukubekezelelwa kahle kakhulu.

Phakathi kwamaphuzu ayo amabi, kubalulekile ukukhumbula ukuthi i-vasectomy…

• ayinakuhlehliswa: amasu amanje okuhloswe ngawo ukwenza i-vas deferens ikwazi ukungena futhi ibe nemiphumela engaqinisekile kakhulu. Ngalesi sizathu, i-vasectomy ibhekwa njengokugcina, ingavumeli iphrojekthi yengane elandelayo. Yingakho kupholiswa isikhathi sokupholisa esiyizinyanga ezi-4. Ngaphezu kwalokho, udokotela angahlongoza ukwenza i-cryopreservation yesidoda (ukuqandisa kwama-gametes) esikhungweni sezokwelapha esizinikezele (CECOS).
• ayisebenzi ngokushesha. I-seminal vesicle (ekhiqiza isidoda) isengaba nesidoda phakathi kwamasonto ayi-8 ne-16 ngemuva kwenqubo noma ngemva kokuphuma kwama-20. Ngakho-ke ukuvimbela inzalo okuhambisanayo kunikezwa izinyanga ezi-3 ngemuva kokuhlinzwa futhi kunwetshwe kuze kube yilapho ukungabikho kwesidoda kuqinisekiswa yi-spermogram.
• ayivikeli kuma-STI,
• kungaholela ezinkingeni zangemva kokuhlinzwa (ukopha, imihuzuko, ukutheleleka, ubuhlungu, njll.) ku-1 kuya ku-2% wezimo. Nokho, lezi zingasekelwa.
• ine-contraindication ethile : I-WHO ihlale incoma ukucutshungulwa kwe-vasectomy ngakunye ukuze kubhekwe “zonke izimo nezimo ezidinga izinyathelo ezithile zokuphepha”. Ngaphezu kwalokho, izizathu ezithile zezokwelapha zingase ziholele ekuhlehliseni ukungenelela okufana nezifo zasendaweni (ama-STI, i-epididymitis, i-orchitis, njll.), izifo ezivamile noma i-gastroenteritis, ukuhlonzwa kwenqwaba ku-scrotum, njll.

Ingakanani intengo yalokhu kuvimbela inzalo kwabesilisa?

I-vasectomy ibiza ngokwesilinganiso sama-euro angama-65 futhi imbozwa kuze kufike ku-80% Umshwalense Wezempilo.

Izindlela zokuvimbela inzalo zabesilisa (noma i-CMT) zisekelwe emthelela olimazayo wokushisa ekuzaleni kwabesilisa. Uma zibalulekile kunalokho zikholisa, okwamanje azifinyeleleki kakhulu noma kusafanele zibe yisihloko sokuqinisekiswa kwesayensi.

Kuhlanganisani ukuvimbela inzalo kwabesilisa okushisayo?

I-CMT isekelwe ekuqapheliseni kokuphila okulula: ukuze i-spermatogenesis ibe yinhle, ama-testes kufanele ahlale unomphela ezingeni lokushisa elingaphansi kancane kunalelo lomzimba (phakathi kuka-2 no-4 ° C). Kungalesi sizathu ukuthi i-scrotum i-anatomically ngaphandle komzimba. Ngokuphambene nalokho, lapho izinga lokushisa kuma-testes liphezulu kakhulu, i-spermatogenesis ingaphazamiseka. Ngakho-ke i-CMT ihlose ukukhuthaza lokhu kuphakama kwendawo endaweni yokushisa ukuze yenze i-spermatozoa ingavundisi kancane, ihluleke ukukhiqiza i-azoospermia. Lo mphumela ungafinyelelwa ngezindlela eziningana. Ngokwesiko, i-CMT isekelwe ekugezweni okushisayo okuphindaphindiwe (ngaphezulu kuka-41 ° C). Muva nje, kuye kwasungulwa izindlela ezimbili zokwenyusa izinga lokushisa:

• ukugqoka izingubo zangaphansi usebenzisa i-thermal insulation (amahora angu-24 ngosuku)
• ukugcina amasende endaweni ephakeme (okuthiwa i-supra-scrotal) okungenani amahora ayi-15 ngosuku, futhi ngenxa yezingubo zangaphansi ezithile. Bese sikhuluma nge-cryptorchidism yokufakelwa.

Ingabe indlela yokuvimbela inzalo yabesilisa eshisayo iyasebenza?

Namuhla, i-cryptorchidism yokwenziwa iyindlela engcono kakhulu ehlolwe umsebenzi kaDkt Mieusset. Le nqubo ibhekwa njengesebenzayo, nakuba isadinga ukuba isihloko sezifundo ezintsha zokulawula ukuze kucatshangelwe inani labantu abaningi. Ihlolwe emibhangqwaneni engu-51 kanye nemijikelezo yokuchayeka engu-536, inikeze ukukhulelwa okukodwa, ngenxa yephutha ekusetshenzisweni kwendlela.

Yiziphi izinzuzo kanye nokubi ngokuvimbela inzalo kwabesilisa okushisayo?

Kulesi sigaba socwaningo kule ndawo, i-CMT inokufaneleka kokuba kokubili ngempumelelo, lapho indlela yokusetshenziswa kwayo isetshenziswa ngokuqinile, futhi ihlehliswa emuva. Kungaba futhi isikhathi eside: ubude besikhathi obunconyiwe bungaba iminyaka emi-4.

Nokho, ukuvimbela inzalo kwabesilisa okushisayo kunezihibe ezithile, okuyilezi:

• Ukunganaki okuxhunyaniswe nokugqoka izingubo zangaphansi ezenzelwe le njongo ngokuqondile (kuzwakala yindoda eyodwa kwababili)
• umkhawulo othile: uma izingubo zangaphansi zingagqokiwe okungenani amahora ayi-15 ngosuku noma uma zingagqokiwe nhlobo usuku, umphumela wokuvimbela inzalo awusavunyelwe. Ngaphezu kwalokho, ukusebenza kwe-spermograms evamile ngaphambi kokuqinisekisa ukusebenza kahle kwendlela kuyadingeka (njalo ezinyangeni ezi-3 eminyakeni emibili yokuqala, bese kuthi njalo ezinyangeni ezingu-6).
• ukuvimbela inzalo kwabesilisa okushisayo ayivikeli ezifweni ezithathelwana ngocansi (STIs).

Ngaphezu kwalokho, le ndlela ayiboniswa endabeni ye-cryptorchidism yemvelo (ukuphazamiseka kokufuduka kwama-testes, okuthiwa "awehli kahle"), i-ectopia ye-testicular, i-inguinal hernia, umdlavuza we-testicular, i-varicocele. ethuthukile futhi emadodeni akhuluphele kakhulu. 

• I-CMT ihlala ingafinyeleleki kakhulu, akukho ukukhiqizwa kwezimboni okwamanje okwenza kube nokwenzeka ukuthola izingubo zangaphansi ezishiwo ngezinga elikhulu.

Njengoba isetshenziswa kakhulu kwabesifazane, i-hormonal contraception ihlala iyimfihlo okwamanje emadodeni. Kodwa-ke, le ndlela ibilokhu iyisihloko sezifundo kusukela ngeminyaka yawo-1970 futhi isize yanikeza ithuba lokuvivinywa kwemitholampilo okugculisayo iminyaka eminingana.

Kuyini ukuvimbela inzalo kwabesilisa ngama-hormonal?

Kuyindlela ebuyiselwa emuva yokuvimbela inzalo okuhloswe ngayo ukuvimbela isidoda ngokwelashwa kwama-hormone. Izinhlobo ezimbili eziyinhloko zamaphrothokholi zenziwe kule ndawo:

• ukuvimbela inzalo okusekelwe ku-testosterone kuphela. Le monotherapy isekelwe kumjovo ovamile womthamo we-testosterone enanthate. Kamuva, kwahlongozwa iphrothokholi esekelwe ekukhishweni kwesikhathi eside kwe-testosterone ukuze kubekwe indawo imijovo, kodwa lena yakamuva ayisetshenziswa okwamanje eFrance.
• inhlanganisela ye-progesterone ne-testosterone. Le protocol ifundwa ngezindlela eziningana, kodwa ephumelela kakhulu namuhla ijeli esekelwe ku-progesterone ne-testosterone: i-Nestorone. Ukumaketha kwayo e-France akugunyaziwe okwamanje.

Muva nje, iphilisi lokuvimbela inzalo lamadoda elihlanganisa isenzo se-testosterone, i-androgen ne-progesterone liphumelele ngempumelelo isigaba sokuhlolwa kwemitholampilo yokuqala e-United States. Ibizwa nge-“11-beta-MNTDC”, izobuyiseleka emuva futhi ngaphandle kwemiphumela engemihle. Nakuba kuthembisa, lokhu okuhlukile kwephilisi labesifazane akufanele kutholakale emakethe yaseMelika cishe iminyaka eyishumi.

Ingabe ukuvimbela inzalo kwabesilisa ngama-hormone kuyaphumelela?

I-Monotherapy esekelwe ku-testosterone namuhla iyindlela ye-CMH lapho kukhona ubufakazi obuningi. Ucwaningo lusungula i-Pearl Index kusuka ku-0,8 kuya ku-1,4 yokuvimbela inzalo okusekelwe enanthate futhi phakathi kwe-1,1 ne-2,3 yendlela yokukhululwa okuqhubekayo. Lezi zindlela zokuvimbela inzalo ezimbili zabesilisa ngakho-ke zingathathwa njengezisebenzayo, noma zisebenza kakhulu. Ngaphezu kwalokho, abesilisa abayisebenzisayo ngokuvamile baphinde bathola i-spermatogenesis ejwayelekile phakathi kwezinyanga ezintathu kuya kwezi-3 ngemuva kokwelashwa.

Ngokuqondene neNestorone, kubonakala kuthembisa: izivivinyo zokwelashwa ezenziwa e-United States zikhombisa ukusebenza kwe-85% ngaphandle kwemiphumela emibi.

Yiziphi izinzuzo kanye nokubi ngokuvimbela inzalo kwabesilisa ngama-hormone?

Inzuzo enkulu ye-testosterone monotherapy ingaphezu kwakho konke ukusebenza kahle, uma kuqhathaniswa nokuvimbela inzalo kwabesifazane. Maviki onke, kuzomele futhi, kubabhangqwana, isithiyo esingabalulekile kangako kunokudla kwansuku zonke kwephilisi kwabesifazane.

Kodwa-ke, le ndlela yokuvimbela inzalo yowesilisa inezinkinga eziningi:

• Ayisebenzi ngokushesha : ngokuvamile kuyadingeka ukulinda izinyanga ezi-3 ngemva kokuqala kokwelashwa ukuze kube njalo.
• Ikhawulelwe ezinyangeni eziyi-18 zokusetshenziswa, ngenxa yokuntuleka kocwaningo lwesayensi ngemiphumela yayo yesikhathi eside.
• Ihlala inemingcele, ikakhulukazi mayelana nokuqapha : Akukhona nje kuphela, ukuvimbela inzalo kwabesilisa okusekelwe ku-testosterone kuphela kudinga umjovo ngezikhathi ezithile, kodwa ukugcwaliseka kwe-spermogram kunconywa njalo ezinyangeni ze-3 kanye nokuhlolwa kwezinto eziphilayo kanye nokuhlolwa komtholampilo njalo ezinyangeni ze-6.
• Ikhuthaza ukubukeka kwemiphumela ethile engathandeki njengezinduna (kaningi), kodwa futhi kwesinye isikhathi ukuba nolaka, i-libido eyeqile noma ukwehla kwe-libido, ukukhuluphala…
• Iqukethe ama-contraindication amaningi : amadoda angazuza kuyo kufanele abe ngaphansi kweminyaka engama-45 ubudala, angabi nomndeni noma umlando womuntu siqu womdlavuza wendlala yesinye, angabi nankinga yokuqhanyelwa, inhliziyo, ukuphefumula noma ukuphazamiseka kwengqondo, akumele (noma kancane) abheme kanye / noma aphuze utshwala , ungabi nesidudla ...