Male contraceptives: what is available?

What is the first thing that comes to mind if someone says “contraception”? Hassle? Condoms or pulling out? The pill? The coil? The injection? I am beginning to list female contraceptives, but do you blame me? The stakes are a lot higher for females when it comes to contraceptives. It makes sense as to why the burden of birth control falls to women.

 

The simplest form of contraception would be the trusty condom. The first condoms, from 3,000 years ago would be unrecognisable compared to today’s standards. They were made of oiled silk paper, leather, linen sheaths, or thin hollow horn. The introduction of more familiar, latex condoms came in 1912 and their popularity boomed during the 1980’s HIV/AIDS epidemic. Condoms are now one of the leading contraceptives, and they are for males.

 

When I think of contraception, my mind immediately jumps to options available for women. It seems ironic that the most used contraceptive is the condom. Despite their widespread use, condoms aren’t loved by everyone. I’m sure you’ve been told, or thought yourself, that they interrupt the moment or don’t feel as good. So, if a couple decide not to use a condom, what is the next best form of contraception?

 

For women, there are a lot of options available with varying levels of invasiveness and commitment. For men, there aren’t so many options. After the condom, we are left with a vasectomy – a surgical procedure sealing or cutting the tube (vas deferens) that carry sperm. Yes, it is an effective method of contraception, but it is also rather drastic. The typical age range for the procedure is 30-56 years old, most likely after having children. Clearly, not a realistic option for younger men.

 

There are other options for men, most of which are in clinical trials. The approaches usually aim to block spermatogenesis. For example, a testosterone suppressing gel works to hormonally subdue sperm concentrations to levels associated with effective contraception. Non-hormonally, an injection which releases a positively charged gel into the vas deferens damages the negatively charged sperm, rendering them infertile.

 

Another, newly published, non-hormonal approach is introducing a contraceptive pill to men. The pill blocks a signalling protein, soluble adenylyl cyclase (sAC), stopping sperm from being able to swim. Tests in mice suggest the pill keeps sperm stunned for a few hours – long enough to prevent them from reaching the egg. This pill is described as an “on-demand” contraceptive. The idea is that it only needs to be taken an hour before sex to provide protection from unwanted pregnancy for the subsequent hours. I have many questions here. Would sex therefore have to be scheduled, killing spontaneity? What is the efficacy of the pill if one is to have sex in that hour window? As a woman, I am putting my trust in men not only to be carrying the pill, but also to take it in a timely fashion – would I rather take my chances with a condom?

As this pill gets further down the pipeline, I’m sure these questions will be answered. But does a simpler question need answering before we hand contraceptive responsibility over to men? Do we women trust men to take on contraceptive responsibility when men are not becoming pregnant?

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