Modern Day Male Contraceptives: Why we may never have anything more than condoms.

Have you or your partner fumbled trying to put on a condom? Has the condom ever broken? Or worse: things are getting spicy and neither of you has one on hand—did the male partner forget to buy some this time? These are all common events when trying to have sexual intercourse, some of them potentially resulting in unplanned pregnancy. Of course, the female partner could have been using some form of contraception, which decreases the chances of unplanned pregnancy. She could have used The Pill, a Depo-Provera injection, female condom, intrauterine device (IUD), Levonorgestrel intrauterine system, a diaphragm, cervical cap, the sponge, spermicide, the vaginal ring, or a contraceptive patch. However, the silly male forgot the condom! They were left with the option of the withdrawal method, which has a failure rate of 22% (Sutton & Chalmers, 2017). Who is to blame here? Should someone have been more prepared? Is it fair to think the female should have been taking a hormonal contraceptive, or should they both be expected to carry around condoms? Many people would say that the female should have been more prepared (after all, it is easier to stop one egg from being released than it is to stop millions of sperm [is it really??]), but why must the burden of pregnancy prevention be borne by females all of the time?

 An increase in the number of male contraceptives may ease this socially constructed responsibility off females. To date, though, males have been provided with, at most, three methods of contraception. These methods include condoms, withdrawal, and vasectomy. The typical failure rates of these methods are, 15%, 19%, and 0.05% respectively (Sutton & Chalmers, 2017). At first glance, the latter rate seems wonderful. However, a vasectomy is invasive and pretty much irreversible. With these limited options in mind, researchers have been working hard to find a way to provide another form of male contraceptive.

 A popular idea is male hormonal contraception. There are many possible options, such as injections or pills. These hormonal methods are derived from exogenous testosterone or, much like the pill, include a combination of hormones, testosterone and progestin, or even androgen and progestin (Wang et al., 2016). These methods decrease testosterone production and, in turn, decrease sperm production. These methods have been shown to be effective and have few side effects, with the combination contraceptives being more effective (Wang et al., 2016). So, this is one form of a male contraceptive hormone that is in the works, but why is it taking so long? In addition to lengthy clinical trials, it is likely that researchers are looking for the next male contraceptive to be 100% effective. Yet apparently, such a contraceptive already exists. Created by Dr. Sujoy K. Guha in India, reversible inhibition of sperm under guidance, or RISUG, could be the biggest form of contraception since The Pill. The easily reversible “vasectomy” works by injection of a polymer, styrene maleic anhydride (SMA), into the vas deferens (Gifford, 2011). The sperm can still pass through, but in doing so, they become functionally inactive; the membranes are ruptured and motility is removed (Gifford, 2011). Proven to be close to 100% effective by Dr. Guha since 1979, the RISUG method of contraception has yet to hit the market. But why? There doesn’t seem the be a solid reason: A single injection could be effective for 10 years, unexpected pregnancies would decrease, family sizes would be limited, and males would be provided with a reliable and less frustrating contraceptive than what exists currently. This method has also been around for decades… one begs to know why such a revolutionary male contraceptive hasn’t been introduced to the public. Surely clinical trials don’t take that long!

So, what is the hold up? If we think about commonly available contraceptives, such as a birth control pill or condoms, they are in high demand. They are a one-use product that has to be repeatedly purchased, at a troubling price for some. At the end of the day, the companies who mass produce these products are multinational businesses. Their first priority is sales. With a technique like RISUG, people won’t have to pay continuously. To put it in perspective, if someone used one $0.50 condom and had sexual intercourse every day for a year, it would cost the individual $182.50. RISUG costs approximately $10 and would be effective for 10 years (Dayal, 2017). In 10 years, assuming one could keep the rate of 1 sexual interaction per day; with condoms, the cost comes to $1,825 but with RISUG it is still just $10.

 With unexpected pregnancies accounting for a large portion of total pregnancies, it seems like it’s time for a more reliable contraceptive. A male contraceptive like RISUG is not only effective and affordable, it takes the pressure off females to bear the burden of contraception. It puts the worry of contraception on the back burner and lets people enjoy sexual activities. It seems as though we have this contraceptive but foreign governments and businesses haven’t let it hit the market. Let’s place the right to birth control ahead of the bottom line. Let’s put Dr. Sujoy K. Guha’s lifework to use. Stop fumbling with the condom and just enjoy.

Joshua Wilson, BScH, Queen’s University

References

Anthes, E. (2017). Why We Can't Have the Male Pill. Retrieved from   https://www.bloomberg.com/news/features/2017-08-03/why-we-can-t-have-the-male-pill

Dayal, S. (2017). New male contraceptive is safe, effective, inexpensive - and can't find a company to sell it. Retrieved from https://nationalpost.com/news/world/new-male-contraceptive-is-safe-effective-inexpensive-and-cant-find-a-company-to-sell-it

Gifford, B. (2011). The Revolutionary New Birth Control Method for Men. Retrieved  from https://www.wired.com/2011/04/ff_vasectomy/all/1/

Sutton, S. S., & Chalmers, B. (2017). Contraception and Pregnancy Options. In C. F. Pukall, (Ed.), Human Sexuality: A Contemporary Introduction (second edition, pp. 153-177Don Mills, Ontario: Oxford University Press.

Wang, C., Festin, M. P. R., & Swerdloff, R. S. (2016). Male Hormonal Contraception:       Where Are We Now? Current Obstetrics and Gynecology Reports, 5, 38–47. http://doi.org/10.1007/s13669-016-0140-

Celebrities: They’re Just Like Us!

When reading through magazines detailing the similarities between famous and everyday people, the reader is often exposed to makeup and airbrush-free celebrities performing mundane activities like taking out the garbage, going for a run, or picking up a smoothie at the local health food store.  In fact, people share much more in common with celebrities than just household chores: health conditions, disorders, dysfunctions and struggles connect noncelebrities with celebrities who previously were just seen as famous, beautiful people in the spotlight.  Advocating for personal health issues and gender identity struggles is a relatively common phenomenon for celebrities, and while there are obvious benefits to attention being brought to these causes, negative consequences may also ensue due to these celebrities shining the spotlight on their conditions.

By bringing much-needed attention to valuable causes, celebrities sharing their stories of stigmatized health conditions can evoke positive responses, such as increased education and awareness, financial support, and lessening the perceived stigma.  Angelina Jolie used her celebrity status to educate the public on breast cancer awareness, prevention, and treatment options.  Jolie discovered in 2013 that she was a carrier of the BRCA1 susceptibility gene, which can be responsible for 45% of inherited breast cancer and more than 80% of inherited breast and ovarian cancer (Castilla et al., 1994), and opted for a preventative double mastectomy. She outlined her decisions in a personal article published in The New York Times, where she explained that she chose to share in order to help other women in the same situation (Jolie, 2013). The ‘Angelina Jolie effect’ is an actual phenomenon, representing the increased awareness of breast cancer treatment and surgical options that took place following the release of Jolie’s story, showing how influential celebrity advocacy can be on the general population (Parry, 2015).

Other celebrities, such as LGBTQ+ activist and transwoman Laverne Cox, have become role models for young people facing similar situations and through advocating their cause, can affect social change.  Cox herself was the first transgender person to ever be nominated for an Emmy award and was the first transgender person to appear on the cover of TIME magazine (Gjorgievska & Rothman 2014).  By using the media hype to her advantage, Cox is inspiring young LGBTQ+ individuals.  Laverne Cox has lessened the stigma on trans people by advocating her cause and she helped to empower other individuals with gender identity struggles.

Padma Lakshmi, television personality, model, and author has used her personal illness to inspire donations and financial support for endometriosis research.  Endometriosis is a reproductive disorder, affecting approximately 176 million women and girls worldwide (Endofound.org, 2015), where endometrial tissue implants in abnormal locations. In 2009, in partnership with her doctor Dr. Tamer Seckin, Lakshmi founded the Endometriosis Foundation of America, or Endofound for short. Padma Lakshmi admitted that she had never heard of the disease until her diagnosis at the age of 36, and felt that the lack of available information was problematic (Endofound.org, 2015). The organization holds a yearly medical conference and numerous campaigns to fund research for the painful disease (Endofound.org, 2015).  Padma Lakshmi’s openness about her seemingly personal reproductive disorder has helped to open the floor for research on, and discussion about, treatment options for the millions of women worldwide silently suffering from endometriosis.

While sharing their stories and advocating for change can lead to progress in research, education and treatments, there are also downsides to having stars talk about their personal battles with health.  Celebrities have access to elite and expensive care, or radical and unconventional treatments that may not represent what is available to the general public.  Caitlin Jenner’s transition represents a transgender experience that is “far from the norm.”  While her impact on the transgender community may have been a positive step towards awareness and equality through the extensive media coverage, Jenner had access to the best doctors, treatments and stylists, which is far from the case for most transgender individuals (Grinberg 2015).  Jenner’s coming out was a positive step for the transgender community—working towards lessening the stigma of gender identity struggle—but it nevertheless displays an unrealistic expectation of a gender transition.

Similarly, Lena Dunham’s (creator, writer, and star of the HBO series Girls [2012-2017]) experience with endometriosis, ultimately leading to the removal of her uterus is a radical treatment option that would not be recommended to most women inflicted with endometriosis (Dunham, 2018).  By sharing their stories, people may be lead to think that the particular treatment is the only option, like Angelina Jolie’s double mastectomy or Lena Dunham’s hysterectomy.  These therapies are not conventional, and advocating for uncommon treatments may be risky.  While a treatment option may be successful for one person, it may not be universally effective, showing how important it is to seek individualized attention, rather than information based on stories in the media.

It is important to recognize that while a celebrity with a similar experience may give valuable advice and education on the topic, ultimately, stars are not physicians.  Opening the floor to discuss their health stories has many great benefits to improve awareness and decrease stigma on all sorts of issues—even sexuality-related health problems; however, celebrities should not be treated as experts.  People need to be proactive with regards to their own health, and use the testimonies of celebrities as inspiration to advocate for themselves.

Amanda Szpindel, BAH, Queen’s University

References

Gjorgievska, Aleksandra, and Lily Rothman. “Laverne Cox Becomes First Transgender Person Nominated for an Emmy.” Time, Time, 10 July 2014, time.com/2973497/laverne-cox-emmy/.

Grinberg, Emanuella. “What it's like to be transgender and not Caitlyn Jenner.” CNN, Cable News Network, 15 July 2015, www.cnn.com/2015/06/03/living/caitlyn-jenner-transgender-reaction-feat/index.html.

Jolie, Angelina. “Opinion | My Medical Choice by Angelina Jolie.” The New York Times, The New York Times, 14 May 2013, www.nytimes.com/2013/05/14/opinion/my-medical-choice.html.

“Padma Lakshmi's Personal Cause: The Endometriosis Foundation of America - Women’s Health.” Endometriosis : Causes - Symptoms - Diagnosis - and Treatment, 12 Mar. 2015, www.endofound.org/padma-lakshmi-s-personal-cause-the-endometriosis-foundation-of-america.

Parry, Lizzie. “'Angelina Jolie effect' IS real: Actress' double mastectomy and reconstruction has raised awareness of cancer treatment.” Daily Mail Online, Associated Newspapers, 28 Sept. 2015, www.dailymail.co.uk/health/article-3252402/Angelina-Jolie-effect-real-Actress-double-mastectomy-reconstruction-raised-awareness-cancer-treatment.html.