Women overwhelmingly carry the burden of taking contraception to avoid pregnancy. It is certainly a hot topic for debate with people on all sides of the arguments. However, it doesn’t change the fact that women currently need to be the ones to take care of contraceptive choices.
Things are changing though!
With more emphasis on finding a male contraception, solutions are on the horizon, so let’s explore it here.
Condoms
For many hundreds, if not thousands of years, condoms have been used to avoid pregnancy. In modern times, condoms come in all shapes, sizes, colours and flavours. Along with the female condom, they help to prevent the spread of STIs too. The effectiveness of them though is highly user dependent, ranging from 82-98%, so not great if used incorrectly, but it’s better than the pull-out method which is another popular method among men.
Myths about vasectomy as a “reversible” male contraception
There is a call online for men to have a compulsory vasectomy which is reversed once they are ready to have children. The logic is there, but it’s more complicated than that.
Unfortunately, reversals don’t always work.
According to Bupa:
The chances of getting pregnant after vasectomy reversal are:
- 75% if the reversal is within 3 years of the original vasectomy
- 50–55% if it’s been 3 to 8 years since the vasectomy
- 40–45% if it’s been 9 to 14 years
- 30% if it’s been 15 to 19 years
- less than 10% if your vasectomy was more than 20 years ago
So if a man had a vasectomy at 18, and then at 38 decided he was ready for a family, there is a 90% chance it wouldn’t work.
Boys start producing sperm when they go through puberty, so in theory, a boy of age 11 would need to have a vasectomy followed by reversal at a later stage, but as you’ve seen, results of how this would work are currently not favourable.
The reasons for the failure include things like scarring, obstruction and anti-sperm antibodies that can form following a vasectomy procedure. These stop the sperm from fertilising an egg. They can reduce after a reversal, but there is no guarantee.
What’s new?
So if vasectomy isn’t the answer, what is? Here’s the lowdown on what’s been happening in the world of male contraception.
Hormonal Solutions
Male contraceptive gel (NES-T)
NES/T is a gel that contains synthetic forms of progesterone (nestorone) and testosterone – hence the name NES/T. The progesterone “switches off” sperm production in the testicles, and lowers levels of natural testosterone. The synthetic testosterone in the gel counters the effects of this. The gel is rubbed into the shoulders and chest every day. Early results of this are promising and in 2019 an international study began into the effectiveness and safety of the gel. It will be exciting to see the results, with completion of the study expected in 2024.
Male Contraceptive Pill
In the United States, there have been a couple of oral contraceptive pills for men that have been through early, successful trials. These are called 11-beta-MNDTC and DMAU. They work in a similar way to NES/T gel, by blocking sperm production through a lowering of testosterone in the body. In small phase I trials, the pills successfully caused the hormones required for sperm production to drop (when compared to placebo or fake pills), but some men experienced side-effects such as acne, fatigue and headaches. Some men reported low sex drive and erection difficulties, but none of the participants stopped the trial due to side effects.
Phase I trials are used to establish whether a drug is safe for use in humans. After this, larger studies are needed. There is still a long way to go though before these pills are deemed safe enough for mass use.
Male contraceptive injection
A contraceptive injection has previously been trialled and had reportedly a 96% success rate. The trial involved injections of two hormones, a long acting progestogen to “switch off” testosterone production, and some synthetic testosterone to counteract the side-effects of this.
However it was stopped early due to “unacceptable” side effects. These included acne, headaches, fatigue and change in sex drive. The researches were the ones concerned though, with 75% of men saying that the side effects didn’t cause them concern!
There have been no plans to create another injection like this, but it has paved the way for other contraceptives to be developed.
Non-hormonal solutions
Vasalgel (RISUG)
Vasalgel is a hydrogel that is injected into the vas deferens – the pipes that transmit sperm from the testicles to the outside world. A man can still ejaculate, but because of the physical barrier, sperm should not be in the semen. The gel has been through animal trials and the developers are looking to have clinical trials by the end of 2023. It is said (by the producers of vasalgel) that it is 99% effective and has shown to still be so at 10 years of use. Once a man is ready to have children, the hydrogel is simply dissolved with a quick, painless injection. It sounds promising, so watch this space!
Intra-vas device (IVD)
Like vasalgel, an IVD blocks the passage of sperm in the vas deferens. Unfortunately, this appears not to have progressed beyond initial first trials, but the concept is promising, so who knows what may happen in the future.
Final Thoughts
Even if these things come to market, will men take them? A yougov poll says that only a 1/3rd of men say they would. There are obvious concerns over side-effects and how effective these methods are, and as with many new drugs, it takes time to get the recipe right and it’s an expensive business too. But it’s encouraging that more is being done to share the burden of preventing pregnancy. I hope that men will embrace contraception!
What are your thoughts on male contraception?
Until next time,
Dr Nikki
P.S. if you’re based in or near Milton Keynes and you’re looking for a women’s only GP service, sign up to the waiting list to be the first to find out when it opens.
