According to WHO, about a million people become infected with sexually transmitted infections every day, and the UN Population Fund reports that the period of self-isolation, when people locked in their homes had a lot of free time, caused 1.4 million accidental conceptions. All this suggests that, despite the abundance and accessibility of various contraceptives, many people still neglect protective measures. On World Contraception Day, a holiday dedicated to education about the prevention of unwanted pregnancy and sexually transmitted diseases, we decided to draw attention to the issues of male contraception.
Most contraceptives are intended for use by women. These are hormonal pills, patches, injections, vaginal rings, coils, female condoms, a cervical cap (it is inserted into the vagina and closes the cervix, blocking sperm access to it), which can be filled with spermicides (substances that destroy sperm), etc. But Let's talk about “male” ways.
Condoms
Of the male contraceptives, we are very familiar with condoms - to this day they are the best barrier method that can highly effectively prevent both pregnancy and STD infection.
Previously, Roskachestvo examined condoms for density, permeability, and safety. In general, all the tested products turned out to be quite good, however, in some we found zinc and isopropanol, in one sample there was a small defect, in the majority there were deviations in the acid-base balance. What all this means and whether it is dangerous, as well as which “product number two” successfully passed the test, will be revealed in our study.
"Vazalgel"
Vasalgel is a serious competitor to RISUG and all other contraceptive methods. A report of its use in rabbits has just appeared in Basic and Clinical Andrology, authored by Donald Waller [11].
"Vazalgel" consists of styrene-alt-maleic acid dissolved in dimethyl sulfoxide. It is injected into the vas deferens in the same way as RISUG and, upon implantation, forms a hydrogel that tightly fills the lumen of the vas deferens (Figure 2). This semi-permeable gel barrier mechanically prevents sperm from passing through it. Small molecules and ions present in sperm in addition to spermatozoa freely cross the “obstacle” [12].
Figure 2. How does Vasalgel work?
Parsemus Foundation, picture adapted
The scientists tried two types of gel that differed in the ratio of styrene to maleic acid, and both were effective.
"Vazalgel" quickly caused azoospermia - already 29-36 days after its administration, sperm disappeared from the semen. Of the 12 rabbits, in 11 this effect persisted 12 months after the administration of the gels, and oligospermia was detected in one animal. The impact on the structure of the ducts is minimal, and after removal of the gel, nothing should interfere with the restoration of fertility. The developers are confident that Vasalgel can become the first male contraceptive of its kind, and continue to study it, focusing on the process of removing the hydrogel from the ducts. In addition, they believe that the development has advantages over RISUG: the new gel composition is easier to produce and more stable.
Hormonal contraceptives in tablets
The search for such a contraceptive has been going on for a long time, but so far there is apparently no way to make seminal fluid “safe” without significant risks to men’s health.
By the way! Female oral contraceptives in general are also not without risks. In particular, taking hormonal drugs for unwanted pregnancy may increase the risk of developing cardiovascular diseases. They are mainly affected by smoking women over 35 years of age while taking oral contraceptives. The higher the age and the number of cigarettes smoked per day (if there are more than 15, then this is already critical), the higher the likelihood of developing such conditions, reports WHO.
However, there are some developments that may appear in pharmacies in the coming decades. For example, The Journal of Clinical Endocrinology & Metabolism describes a trial of a contraceptive for men. According to the developers, the drug is administered as an injection once every two months, it contains a synthetic analogue of testosterone and progesterone - they act on the pituitary gland (the part of the brain that “gives the command” to the testes to produce sperm). Tests have shown the effectiveness of such injections, however, to make a final conclusion about the work of the drug, many more volunteers are needed. But there weren’t enough of them in the experiment anyway, and 20 people refused to continue participating due to side effects such as mood swings, depression, decreased libido, acne (remember that female contraceptives are also not without such “side effects”).
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“I avoided those women who could tie me down with the birth of a child […]. However, maybe there were children [...], but I pretended as if they weren’t there.” Lev Tolstoy. Kreutzer Sonata
The use of female contraceptives has become so widespread that even environmentalists are sounding the alarm: fish are dying from synthetic estrogens entering reservoirs along with wastewater [1]. But, despite the widespread use and availability of contraception, almost half of all pregnancies, even in the richest countries, are unplanned [2].
About 80% of men believe that women and men should bear equal responsibility for making decisions about contraception [3]. In addition, despite all the benefits of condoms, including those associated with the prevention of sexually transmitted diseases, up to 50% of men would like to use other methods of reversible contraception. If only they were [4], [5].
Folk and extreme methods
There are other hormonal contraceptives for men, but they are not fully tested and have undesirable effects.
All other methods are too poorly studied or even refer to “folk” methods, so it is too early to talk about them seriously. Such “contraceptives” include injections with a viscous substance (for example, polyurethane, which hardens after injection) that will block the seminal ducts, or thermal contraception. The latter method has been known for centuries and is based on regular overheating of the genitals (for example, a daily hot bath), because an increase in testicular temperature leads to impaired sperm production. Researchers at the University of California, Los Angeles Medical Center write that in theory, heating a man's genitals could be an effective and reversible method of contraception: when the heat is removed, function returns to normal over time. However, the method has not been studied enough and cases of male infertility have been recorded over several months and even years.
Selection recommendations and precautions
When choosing male hormonal contraceptives in tablets and alternative methods of protection against unplanned conception, it is recommended to pay attention to the following conventions:
- The need for reversible or irreversible loss of fertility.
- Having a permanent sexual partner.
- The general health of the man and the presence of chronic diseases.
Hormonal tablet contraceptives for men can be recommended if the man does not have severe diseases of the cardiovascular and endocrine systems, and only if he has contact with a regular sexual partner.
Regardless of age and health status, men are strongly discouraged from using homemade methods of contraception, since any chemicals and high temperatures can lead to irreversible consequences in the reproductive system.
Interrupted and prolonged sexual intercourse is also not able to fully protect against pregnancy, and especially against STDs. If your health does not allow the use of hormonal birth control pills for men, latex condoms are recommended as an effective alternative. Products selected in accordance with anatomical features will make intimacy as bright and safe as possible.
Sources
- Nausheen S., Bhura M., Hackett K., Hussain I., Shaikh Z., Rizvi A., Ansari U., Canning D., Shah I., Soofi S. Determinants of short birth intervals among married women: a cross -sectional study in Karachi, Pakistan. // BMJ Open - 2021 - Vol11 - N4 - p.e043786; PMID:33903142
- Karim SI., Irfan F., Saad H., Alqhtani M., Alsharhan A., Alzhrani A., Alhawas F., Alatawi S., Alassiri M., MA Ahmed A. Men's knowledge, attitude, and barriers towards emergency contraception : A facility based cross-sectional study at King Saud University Medical City. // PLoS One - 2021 - Vol16 - N4 - p.e0249292; PMID:33901184
- Reynolds-Wright JJ., Cameron NJ., Anderson RA. Will Men Use Novel Male Contraceptive Methods and Will Women Trust Them? A Systematic Review. // J Sex Res - 2021 - Vol - NNULL - p.1-12; PMID:33900134
- Idowu A., Ukandu GC., Mattu J., Olawuyi D., Abiodun A., Adegboye P., Chibu-Jonah C., Siakpere AE., Ishola AE., Adeyeye T., Alabi S. >Modern Contraception: Uptake and Correlates among Women of Reproductive Age-Group in a Rural Community of Osun State, Nigeria. // Ethiop J Health Sci - 2021 - Vol30 - N4 - p.531-540; PMID:33897213
- Sons A., Eckhardt AL. Health literacy and knowledge of female reproduction in undergraduate students. // J Am Coll Health - 2021 - Vol - NNULL - p.1-8; PMID:33891527
- Schwandt H., Boulware A., Corey J., Herrera A., Hudler E., Imbabazi C., King I., Linus J., Manzi I., Merritt M., Mezier L., Miller A., Morris H ., Musemakweli D., Musekura U., Mutuyimana D., Ntakarutimana C., Patel N., Scanteianu A., Shemeza BE., Stapleton M., Sterling-Donaldson G., Umutoni C., Uwera L., Zeiler M. ., Feinberg S. An examination of the barriers to and benefits from collaborative couple contraceptive use in Rwanda. // Reprod Health - 2021 - Vol18 - N1 - p.82; PMID:33874969
- Sato R., Rohr J., Huber S., Esmer Y., Okçuoğlu BA., Karadon D., Shah I., Canning D. Effect of distance to health facilities and access to contraceptive services among urban Turkish women. // Eur J Contracept Reprod Health Care - 2021 - Vol - NNULL - p.1-9; PMID:33874821
- Reynolds CA., Charlton BM. Sexual behavior and contraceptive use among cisgender and gender minority college students who were assigned female at birth. // J Pediatr Adolesc Gynecol - 2021 - Vol - NNULL - p.; PMID:33838331
- Singh J., Jaswal S. Marriage practices, decision-making process and contraception use among young married men in rural Odisha, India. // Cult Health Sex - 2021 - Vol - NNULL - p.1-17; PMID:33825613
- Sarmiento I., Ansari U., Omer K., Gidado Y., Baba MC., Gamawa AI., Andersson N., Cockcroft A. Causes of short birth interval (kunika) in Bauchi State, Nigeria: systematizing local knowledge with fuzzy cognitive mapping. // Reprod Health - 2021 - Vol18 - N1 - p.74; PMID:33823874
"Women's Lobby" against it?
On the Internet you can find loud statements that it is not side effects that are preventing the creation of male contraceptives, but “scandals caused by feminists.” According to the authors of these tests, women deliberately prevent male contraceptive drugs from entering the market because they want to make the sole decision about having children and thus manage the financial and other resources of men.
As a rule, the authors of these texts are poorly familiar with the history of clinical research on male contraceptives or deliberately ignore this data. They regularly mention drugs whose trials had to be stopped, but do not talk about the dangerous side effects of these drugs. For example, the author of the above text claims that gossypol (a polyphenol found in cotton seeds) was successfully tested in China as a contraceptive in the 1970s, but a “feminist scandal” prevented its release in the West.
There really was a scandal - at an international conference on population, which took place in 1974, the creator of a drug based on gossypol and the American feminist Betty Friedan communicated in a raised voice.
But the prospects for gossypol were dashed not by this dialogue, but by the test results in China themselves. After analyzing them, the World Health Organization concluded that the substance cannot be used as a contraceptive.
More than ten thousand volunteers participated in the trials, and gossypol was really good at preventing conception. But scientists have recorded many side effects of the drug: weakness, dizziness, stomach upset, decreased libido, problems with potency. In addition, fertility in many participants in the experiments was restored very slowly. 10% of 8,806 volunteers in one trial experienced oligozoospermia, a low concentration of sperm in the ejaculate that lasted from six months to several years. In another study involving 2067 men, long-term oligozoospermia was noted in 27% of volunteers. Animal testing has shown that high doses of the drug are toxic: several laboratory monkeys died during testing. In 1998, WHO experts called for an end to trials of gossypol as a contraceptive.
Market question
The male contraceptive industry has been growing slowly over the past decade as large pharmaceutical and biotech companies have largely withdrawn from the industry. Funding from governments and private individuals was also extremely low. As a result of limited funding from government and philanthropic supporters, most clinical trials of the effectiveness of male contraceptives have been relatively small [15].
Despite the uncompetitive entry into the market, Vazalgel, according to the manufacturer, will be an affordable product - its cost should not exceed the level of daily earnings in developed countries.
The original version of this article was published in the journal Urology Today.
Reviews from doctors
To the question that concerns many people about the likelihood of getting pregnant from lubricant, doctors answer that this is impossible. Example from the site https://sprosivracha.com/questions/278917-prervannyy-polovoy-akt:
Mechanism of action of male contraceptive pills
According to the group of birth control pills, their effect on the male body will vary. For example, spermatogenesis inhibitors contain steroid hormones. They suppress spermatogenesis and testicular function. With long-term use, such male contraceptives can inhibit the function of follicle-stimulating and luteinizing hormones.
Comment!
An increased level of testosterone in a man’s blood leads to a limitation of reproductive function, due to which a contraceptive effect is achieved.
Another group of birth control pills inhibits the spermatogenic epithelium and sperm enzymes. This leads to a decrease in their activity and mobility; such drugs are first taken in a reduced dosage. And then the content of the active substance is increased to maintain the contraceptive effect.
Clean sheets, sluggish sperm
Polymer gels are not the only way of non-hormonal contraception for men. For example, in April 2021, an organic compound that can slow down sperm movement was successfully tested in the United States. Like Vasalgel, the “inhibitory” drug was tested on laboratory rhesus monkeys - their anatomy is in many ways similar to that of humans.
The contraceptive compound, known as EP055, blocks the activity of the protein EPPIN (epididymal protease inhibitor), located on the surface of sperm. EPPIN binds the protein semenogelin, giving sperm the desired degree of viscosity. The consistency of the liquid affects how freely and quickly sperm move, and therefore the likelihood of conception: inhibited cell movement is one of the common causes of male infertility.
To “break” EPPIN and slow down sperm, the creators of the new drug used triazine derivatives. These substances are widely used in chemistry: they include components of many synthetic paints. A few hours after intravenous administration of EP055, sperm motility in macaques dropped to a level that reliably protected against conception, and began to recover only after three days; no side effects were found in the monkeys. Researchers are now working on a tablet formula based on EP055.
Another experimental method of non-hormonal contraception uses the anatomy of sexual intercourse. It is known that male orgasm does not always end with ejaculation. Typically, dry orgasm is considered a physiological disorder or an unpleasant side effect of certain drugs, such as phenoxybenzamine, which dilates blood vessels, but the creators of contraceptives were able to benefit from this phenomenon. The “Clean Sheets Pill” technique reproduces this condition artificially: such drugs do not allow the longitudinal muscles that push sperm through the vas deferens to contract. At the same time, the muscles associated with achieving orgasm still work - the pleasure from sex will not go away. According to the creators of the method, their drug was successfully tested on animals, but now development has been suspended (the reason is still the same: lack of funding).
There are also many experimental technologies: including targeted destruction of genes associated with the structure of the sperm, and effects on proteins specific to the testicles, and blocking spermatogenesis using derivatives of the antitumor agent lonidamine. All these methods are constantly being refined, acting more and more subtly.
Literature
- Blanchfield PJ, Kidd KA, Docker MF, Palace VP, Park BJ, Postma LD (2015). Recovery of a wild fish population from whole-lake additions of a synthetic estrogen. Environ. Sci. Technol. 49, 3136–3144;
- Kanakis G. and Goulis D. (2015). Male contraception: a clinically-oriented review. Hormones. 14, 598-614;
- Plana O. (2015). Male contraception: research, new methods, and implications for marginalized populations. Am. J. Men's Health. pii: 1557988315596361;
- Kogan P. and Wald M. (2014). Male contraception: history and development. Urol. Clin. North. Am. 41, 145–161;
- Heinemann K., Saad F., Wiesemes M., White S., Heinemann L. (2005). Attitudes toward male fertility control: results of a multinational survey on four continents. Hum. Reprod. 20, 549–556;
- O'rene D. A. (2013). The origin of the word "condom". Today I Found Out;
- Kruck WE Looking for Dr. Condom. University of Alabama Press, 1981. - 112 p.;
- Zdrojewicz Z., Konieczny R., Papier P., Szten F. (2015). Brdt bromodomains inhibitors and other modern means of male contraception. Adv. Clin. Exp. Med. 24, 705–714;
- Chao J. H. and Page S. T. (2016). The current state of male hormonal contraception. Pharmacol. Ther. 163, 109–117;
- Roth M. Y. and Amory J. K. (2016). Beyond the condom: frontiers in male contraception. Semin. Reprod. Med. 34, 183–190;
- Waller D., Bolick D., Lissner E., Premanandan C., Gamerman G. (2016). Azoospermia in rabbits following an intravasal injection of Vasalgel™. Basic Clin. Androl. 26, 6;
- Owen D. H. and Katz D. F. (2005). A review of the physical and chemical properties of human semen and the formulation of a semen simulant. J. Androl. 26, 459–469;
- Spermatogenesis: through thorns to the stars;
- Finally: a birth control pill for men!;
- Roth M.Y., Page ST., Bremner W.J. (2016). Male hormonal contraception: looking back and moving forward. Andrology. 4, 4–12.
Surgical contraception
Vasectomy is a blockage of the vas deferens to prevent sperm from passing through. Male sterilization is an inexpensive, reliable and simple method of contraception for men. After consulting a doctor and completing the necessary documents, you should collect an anamnesis to exclude the presence of bleeding, pathologies of the cardiovascular system, allergies, diabetes, urinary tract infections, and STDs. During an objective examination, blood pressure, pulse, the condition of the subcutaneous fat layer, skin, perineal area, the presence of cryptorchidism, varicocele, and inflammation of the scrotum are determined.
Vasectomy techniques:
- first. The vas deferens are crossed without ligation, subjected to electrocoagulation to a depth of 1.5 centimeters, and a fascial layer is applied;
- second. The vas deferens are fixed, the muscle layer and skin are cut, the duct is isolated, ligated, and transected. Each section is cauterized. For greater reliability, a segment of the vas deferens is sometimes removed;
- third. To release the ducts, they resort not to an incision, but to a puncture. Local anesthesia is performed, a ring-shaped clamp is applied to the duct without affecting the layer. An incision is made in the wall and skin of the vas deferens with a dissecting clamp, isolated, and occlusion is performed.
The contraceptive reliability rate of vasectomy is 99% during the first 12 months. The failure rate is associated with an unidentified congenital anomaly of the vas deferens or with its recanalization. Standard vasectomy is practically irreversible, but today a technique called “vasectomy reversal” has been developed, in which fertility is restored in 90-95% of cases.
Use of the drug "Vasalgel"
We turned to the developers of the innovative contraceptive about the use of Vasalgel in clinical practice.
“The first clinical trial will begin enrollment in the first quarter of 2021 in the United States, but the exact date, location, and protocol have not yet been established,” responded Ben Carlson, director of press for the Parsemus Foundation. — Presumably, the protocol will involve about 30 patients who are candidates for vasectomy. This choice regarding the profile of participants is due to the fact that we have not yet proven the reversibility of the contraceptive effect of Vasalgel.”
According to the official statement of the Parsemus Foundation, the development and research of Vasalgel is a social project and is not aimed at enriching pharmaceutical companies.
A larger clinical trial will be conducted at the end of 2021 or in 2021, after which it is planned to introduce Vasalgel to the market.
Male contraception - affordable solutions
Male contraception includes natural methods of contraception, the most effective of which, of course, is sexual abstinence during the woman’s fertile period. However, this method is problematic because it requires the correct determination of the time when fertilization can occur, for example, based on the observation of mucus (its consistency), temperature and characteristic symptoms associated with ovulation in women.
Sexual abstinence
Many couples, especially young and less experienced ones, practice coitus interruptus, forgetting that this is not the most effective method. It involves removing the penis from the vagina before ejaculation.
However, the male penis releases what is called pre-ejaculate, which also contains sperm. In addition, it is difficult to predict the exact moment of termination of sexual intercourse, so this method is intended only for couples who are still considering the possibility of pregnancy.
MAKE AN APPOINTMENT
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Abortion and contraception clinic in St. Petersburg - department of the medical gynecological association "Diana"
Make an appointment, tests or ultrasound via the contact form or by calling +8 (812) 62-962-77. We work seven days a week from 09:00 to 21:00.
We are located in the Krasnogvardeisky district, next to the Novocherkasskaya, Ploshchad Alexander Nevsky and Ladozhskaya metro stations.
The cost of a medical abortion in our clinic is 3,300 rubles. The price includes all pills, an examination by a gynecologist and an ultrasound to determine the timing of pregnancy.
Who's ready?
Creating a reliable and safe contraceptive drug for men is not everything: it is fundamentally important that people agree to use it. Despite doubts, sociological survey data show that many men would like to try such methods of contraception.
Cambridge sociologist Susan Walker conducted a survey of 188 Britons (134 women and 54 men) who were already using other methods of birth control. 49.5% of respondents said they would be willing to try male birth control pills. At the same time, 42% of survey participants were afraid that men might forget to take the drug on time - as expected, women expressed this suspicion much more often than men. Only 26% of respondents were concerned about the possible negative impact of male contraceptives on health.
In 2005, scientists led by Klaas Heinemann surveyed more than nine thousand men from the United States, Indonesia and several countries in Europe and Latin America. On average, 55% of men were not against trying a new method of contraception. In Indonesia, only 28% of respondents decided to do this, in Spain - 71%.
Most men named daily pills as the most convenient method of contraception, but residents of Europe, Asia and the Americas put different options in second place on the list.
Europeans preferred implants that need to be replaced once a year, and in Latin America, the second most popular form of implants was a gel form that needs to be rubbed into the skin. People with a higher level of education were more likely to agree to try male contraception, but the religion that the respondents adhered to had virtually no effect on their position towards contraception.
Male birth control pills
This includes oral contraceptives intended for temporary sterilization. And the very first representatives of such drugs were products whose composition included cyproterone acetate.
Daily use of pills not only reduces the amount of sperm produced, but also makes a man temporarily infertile. After discontinuation of the drug, the volume and quality of seminal fluid return to normal levels.
The next category of drugs is products containing androgens and antiandrogens. While taking pills, all sperm completely disappear from a man's semen, and, as a result, he develops temporary infertility. But a side effect of taking it can be the development of cancerous tumors in the testicles.
The following male contraceptive pills contain both androgen and estrogen. Taking drugs reduces sperm quality, but at the same time increases sexual desire.
Drugs from this category can only be used for a month. Then the body should rest for 3-4 months. This long break is explained by numerous side effects. These include mental disorders and loss of interest in life.
Who needs such drugs and why?
Today, we have many types and forms of contraceptives available to women: single-hormone or multi-hormone pills, injections, hormonal rings, intrauterine devices, subdermal implants, diaphragms and uterine caps. With such variety, why look for products suitable for men?
First, surveys show that many men in heterosexual relationships would like to share responsibility for contraception with their partner and are willing to take birth control pills. In addition, modern feminine products have many unpleasant side effects, so making a choice is difficult even among the existing variety.
OB/GYN Regan McDonald-Mosley, chief medical officer for Planned Parenthood, says:
“It’s important to note that contraceptive methods are not universal: what works best for one person may not work for another.”
According to the doctor, when choosing contraceptives, people take into account many factors: the effect of the method on the body, the risk of side effects (and willingness to put up with them), ease of use, partner consent and the cost of contraceptives. MacDonald-Mosley believes the new methods will give men and women more options to find the most convenient method of contraception.
She emphasizes: the ability to choose the right contraceptive from a variety of options directly affects not only the lifestyle of men themselves. Women, future children, and society as a whole will benefit from this. Planning a pregnancy means more stable families, more opportunities to freely distribute finances and provide children, for example, with a good education.
Perhaps the emergence of new methods of contraception will help reduce the number of accidental and unwanted pregnancies. Despite the abundance of contraceptives, this problem is still relevant throughout the world. For example, 49% of pregnancies in the United States are unplanned (this number includes both unwanted and untimely ones). In Russia, according to 2011 data, up to 23% of pregnancies were unwanted, and up to 44% were untimely. Reducing the number of such pregnancies will also help reduce the number of abortions, including illegal ones in countries where the procedure is prohibited.
Function restoration
Few people want to become infertile forever. Sooner or later, the couple will still want to have heirs. In such a situation, measures are necessary to restore fertility if it has been seriously impaired. Usually, in order for a representative of the stronger sex to be able to have children again, it is enough to simply stop taking the pills. But sometimes this is not enough, since the functionality of the genital organs is seriously impaired. Sometimes you have to take auxiliary medications. One of these is Prostatilen AC. It improves blood circulation, has a beneficial effect on the prostate gland, and improves spermatogenesis.
In case of hormonal disorders (if they have become persistent), medications are prescribed that can improve metabolism and the functioning of the glands. If the cause of infertility is surgical intervention, then reconstructive surgery is prescribed. Its success, however, is not guaranteed.
