Contraception. It’s an awkward word for an awkward subject, whether you’re standing at a drugstore counter or engaged in one of the touchiest political and cultural conversations of 2012.
In public discussion, birth control is often lumped into the category of “women’s issues.” The reason for this is plain enough: in the majority of situations where a baby is conceived, the woman is the one who ends up carrying it. (Notable exceptions include seahorses and Arnold Schwarzenegger.)
But as they say, it takes two to tango. Should all the responsibility for long-term family planning be left to women? Or should males take a more active preventive role?
The primary male-centered contraceptive in our society, the condom, is by definition a last-minute intervention. It’s a vital public health tool, but to count on it for all birth control purposes is to rely on our judgment at precisely the moment when it is least reliable.
Vasectomy, the only other birth control option for men, represents the opposite extreme: a semi-permanent surgery, generally reversible but only with some difficulty and expense. A vasectomy itself, however, is quite simple and cheap as operations go (about $350-1000). That in itself may be a bit threatening: the realization that our future legacy in life’s rich pageant can be neutralized with one delicate snip.
Men are widely lampooned as being squeamish and protective when it comes to the family jewels, and the numbers lend some support to this stereotype: the vastly more expensive and invasive equivalent for women (tubal ligation) is performed over twice as often. Gentlemen, somehow this just doesn’t seem chivalrous.
Dr. Adam Hollander, a urologist at Baylor College of Medicine, agrees that vasectomies are underutilized, but says that doesn’t surprise him, “it is a pretty uncomfortable procedure for most men, because there is a lot of tugging on the testicles that the local anesthesia can’t block.”
I apologize to any readers (about half) who may have winced at that quote. Even setting aside any knee-jerk aversion, the difficulty of reversal will always limit the appeal of vasectomy. Why shouldn’t men have more options, some happy medium between latex and laceration? It’s been more than half a century since “the Pill” hit the U.S. market, setting off the sexual revolution. Will there ever be a Pill for men?
Actually, it feels like a news item pops up at least once a year claiming that male birth control is finally on the horizon. The interest is clearly there. Yet somehow these discoveries never seem to make their way onto the market. At this point, all the false alarms have created a bit of a “boy who cried wolf” effect. Still, there’s a first time for everything. Here are just a few of the contenders currently being touted:
(A giant caveat: it’s crucial to note that none of the treatments discussed in this article should ever be considered a substitute for protected sex, in terms of STDs.)
1. Vasalgel (RISUG)
Reversible inhibition of sperm under guidance, or RISUG, is a treatment that has been developed in Asia and is being pushed for FDA approval in the States under the brand name Vasalgel. The procedure itself is perhaps uncomfortably close to vasectomy. The only difference is that rather than severing the vas deferens, the doctor injects it with a polymer gel that destroys sperm cells as they pass through by zapping them with a positive electric charge.
The hope is that RISUG will be more easily reversible than vasectomy, though this has not been proven yet. It also shows a tantalizing potential for reduced HIV transmission.
2. The male Pill
Call it ovum envy: why can’t we just pop a daily oral contraceptive like the ladies do? In truth, for a long time there has been no one monolithic Pill, but rather a variety of formulations for women to choose from. Likewise, many different compounds with diverse methods of action have been proposed for men.
Side effects are a big concern with any hormone-based treatment. Again, women have long been dealing with this problem themselves, but as Dr. Hollander points out, “it is very difficult to alter male hormonal patterns like female contraceptive pills do. Women have normal hormonal cycles and are used to some variation in hormones as caused by the pill, while men are used to a relatively constant level of testosterone and start to have bad side effects when it is decreased: fatigue, difficulty concentrating, mood swings, hot flashes.”
Fortunately, many novel non-hormonal possibilities are being explored as well, including drugs that rely on gene therapy or protein inhibition to sabotage sperm cells.
Most of us probably associate this technology with a bun already in the oven. Aside from their use in imaging, ultrasound waves can also be focused for other medical purposes like cleaning teeth and breaking up kidney stones. Early this year, a study funded by the Bill and Melinda Gates Foundation showed ultrasound’s potential as a male contraceptive, capable of zapping the sperm counts of rats and monkeys down to nil.
“The monkeys didn’t seem to mind the treatment a bit,” attested Dr. Catherine VandeVoort in an unusally detailed and hilarious press release, “but we were having a rough time of it. Thirty minutes of treatment three times a week is a lot of monkey testicular massage.”
Boy, ain’t that the truth. Researchers eventually found that the best treatment consisted of two ultrasound sessions of fifteen minutes each, two days apart. This procedure would be painless, if perhaps embarrassing, but any commercial application is still a long way off.
Other options being tested include heat-treated testes, plant-based supplements, a “clean sheets” pill that decouples ejaculation from orgasm, and a supposedly less threatening “no-scalpel” vasectomy involving lasers. (Alas, says Dr. Hollander, this “isn’t really much different from a normal vasectomy. It’s more of a marketing tool.”) And so the quest continues….
Give it to me straight, doc: what’s the bottom line?
“The most likely of these contenders is RISUG, though it’s not yet clear to me how reversible it will end up being. None of these options is perfect, and the best option for contraception is one that is agreeable to both partners in a relationship.”