Although there is a veritable spectrum of contraceptive options for women (from hormonal pills and injections to implantable devices), men face a far more limited choice. They can either use condoms (which have a failure rate of about 18 percent) or get a vasectomy (which is a permanent surgical procedure). As a consequence, the responsibility of using birth control falls largely on women. Realizing that this is wholly unfair, scientists have spent decades searching for a breakthrough in male contraception.
Unfortunately, these efforts have continually fallen flat on their face. Just last year, researchers testing a hormonal injection for men announced that while it successfully curbed sperm production and prevented pregnancies, they had to halt the study due to reports of side effects such as mood changes and depression — side effects women have been dealing with for over half a century thanks to The Pill.
While this latest setback was certainly disappointing, Millennials have loudly and publicly encouraged scientists to continue their work. We’re ready for something that’s easier to use and better for our health than what’s currently available. But what exactly will that look like?
More Than a Condom, Less Than a Vasectomy
Millennial men are clamoring for a new contraceptive — and rightly so. They want to have a say in their reproductive futures. What’s more, they want to help ease the burden that women have been carrying for the last 50 years. So what the hell is taking the medical community so long? Well, apparently it’s a lot more complicated than we might think.
Not long after the Food and Drug Administration (FDA) approved the first female birth control pill, researchers began to explore a hormone-based approach to male contraceptives. Though clinical trials in the subsequent decades showed that doses of testosterone (or combinations of testosterone and progestin) temporarily suppressed sperm production, it was a fairly hit-or- miss method. When taken orally, testosterone is quickly dispatched from the body — this meant that a hormonal contraceptive for men would have to be delivered via injection, implant, or topical gel. That wouldn’t be such a major issue if the hormones actually worked in all men — but, spoiler alert: they didn’t. And, much like female birth control, they led to some rather unpleasant side effects.
Another strike against hormonal birth control for men is the simple fact of reproductive biology. Most women of reproductive age release one egg per month and stop ovulating when they’re pregnant. This is how the pill suppresses ovulation — by releasing hormones that mimic pregnancy. Unfortunately, there’s no naturally released hormone that switches off sperm production. Men continue to produce sperm from puberty until death.
This is what has lead a number of medical scientists to ditch hormones and instead seek drugs that target the sperm more directly. Scientists at the University of Kansas have been looking into a compound called H2-gamendazole, which prevents sperm from maturing. Meanwhile, Eppin Pharma, Inc. is developing a drug that would stop sperm from swimming. However, neither of these options have received as much press as Contraline, a contraceptive company that has created a hydrogel, called Echo-V, that promises to be the future of male birth control.
Echo-V is injected into the vas deferens (the thin tube that transports sperm from the testes to the urethra), solidifies, and then blocks the flow of sperm while still allowing other fluid to pass through. When a man is ready to have children, a solution is injected to dissolve the gel. And the best part? No surgery or stitches are required. Doctors inject it directly through the skin using an ultrasound to guide its placement. The whole procedure will take a grand total of fifteen minutes!
Although clinical and animal trials in India have shown that the hydrogel method works with near-perfect results and no serious side effects, it still may be a while before Echo-V is on the market. Clinical trials done in America will cost a lot of money, and big pharma is unlikely to back Contraline, as hydrogel won’t be a moneymaker for them. A one-time procedure using materials that are relatively inexpensive to make and distribute isn’t as appealing as pills that need to be taken every day for the entirety of a person’s reproductive years. Hopefully, Contraline will find a way to raise capital without the help of giant corporations.
So Many Options — And Yet…
Women have no shortage of choices when it comes to preventing pregnancy. There are hormonal pills, implants, injections, patches, vaginal rings, and IUDs — not to mention diaphragms, sponges, cervical caps, spermicidal gels, foams, films, creams, and suppositories. Of course, these options are far from perfect. Some have failure rates that are a little too high for comfort, and others have side effects that make them unusable for certain people. Let’s take a look at a few of the methods at our disposal:
Easily the most popular contraceptive choice among women, the pill has now been in continuous use for 57 years. Unfortunately, it has a failure rate of 8 percent, which is a tad high. Though considered relatively safe, all hormonal contraceptives (including the pill) cause a slight increase in the risk of blood clots. However, this increase is far less than the blood clot risk associated with pregnancy. That being said, there are groups that may be more at risk for nasty side effects than others. These include:
- Anyone over the age of 35
- Cigarette smokers
- People who get migraines with an aura
- Those with a history of heart disease, deep vein thrombosis, or a pulmonary embolism
Aside from reducing the risk of unintended pregnancies, hormonal contraceptives have been known to help with a number of other health issues — such as relieving pain associated with PCOS and endometriosis, calming PMS and acne, and even lowering the risk of ovarian cancer.
Intrauterine devices (IUDs) are one of the most effective forms of birth control — their failure rate is less than one percent! There are four different brands of hormonal IUDs in the U.S., all of which are considered safe unless the user has a history of liver disease, breast cancer, or a high risk for that type of cancer. The copper IUD, Paragard, has no hormones. Unfortunately, it cannot be implanted if the user has an allergy to copper or Wilson’s disease. Copper IUDs are often associated with heavier bleeding and cramping during the menstrual cycle.
There are some rare but serious side effects associated with IUDs, including: bacterial infections, punctures in the wall of the uterus, ovarian cysts, ectopic pregnancy, and pelvic inflammatory disease.
The Nexplanon implant is relatively new to the market, but it has a fairly impressive resume. Its failure rate is even lower than that of IUDs at only 0.05 percent. Nexplanon contains progestin, and therefore has some of the same side effects associated with most hormonal birth control. Some people have irregular bleeding for up to a year after it’s inserted, as well breast pain and headaches.
Barrier Methods (Diaphragm, Female Condom)
The biggest risk with using a barrier method like a condom or diaphragm is that it won’t prevent pregnancy. Since they are not always used correctly, their failure rate is high. The failure rate for diaphragms (with spermicide) is 16 percent. The failure rate for female condoms is 21 percent.
Failure rates, ease of use, and side effects are just a few things to think about when deciding which type of birth control is right for you. Before making a decision, talk to your doctor about your health history and lifestyle. They’ll be able to help you choose the method that’s best for you.
When Trouble Arises
There’s no doubt about it, it’s going to be a hell of a lot harder to win approval for new male contraceptives than it has been for female versions. This is primarily because the potentially dangerous side effects of female birth control are weighed against the risks associated with pregnancy and childbirth. Since men don’t face this risk, contraceptive drugs and devices targeted for them have to have a very low chance of negative side effects.
Furthermore, when drugs and devices are approved and serious side effects come to light later, pharmaceutical companies end up fighting costly lawsuits. Take Essure, for example. Introduced to the American market in 2002, this permanent contraceptive device works by generating scar tissue that effectively blocks the fallopian tubes. According to the Washington Post, as of May 31, 2017, there have been 16,373 adverse events related to Essure reported to the FDA. These include accounts of devices that broke apart, migrated out of the fallopian tubes, and punctured other organs. There are also reports of systemic autoimmune reactions, pregnancies, miscarriages, and stillbirths. Unfortunately, removal of the devices often ends in a complete hysterectomy.
Conceptus, the company that produces Essure, failed to properly test the device and only followed the women in their clinical trials for one year. They also put lives in danger by not being upfront about the nickel content in the device. The original package listed a nickel allergy contraindication (meaning the device should not be used for patients with that condition) that also included a directive for physicians to screen patients for said allergy before implantation. Conceptus requested the FDA downgrade the contraindication to a “warning,” which doesn’t require physicians to screen patients. The FDA granted this request. As such, many users had autoimmune reactions that caused them to lose teeth and hair, have severe joint pain, and even develop conditions such as fibromyalgia.
Thanks to a number of very strong, very angry women, the FDA was forced to add a “black box warning” to the Essure package. This means that both patients and doctors are informed of the serious risks associated with the use of the device. What’s more, patients are required to fill out a checklist before implantation to prove that they have been given this information.
As it stands now, products like Echo-V are our best bet for a happier, healthier future. Envision it: a world with fewer unplanned pregnancies, where women aren’t forced to drown themselves in extra hormones or be subjected to dangerous surgical procedures just to ensure they remain childless. Imagine sex that is far better and more worry-free! Until then, we’ll just have to make do with what we have.
What are your thoughts on the current birth control situation?
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