Male Contraception

Cervical caps. Condoms. Diaphragms. Implants. IUDs. The Pill. Plan B. The Ring. Shots. Sponges. Despite the large variety of contraceptives available, a majority of non-permanent contraception methods are designed for female use, leaving few options for men.

Men need reliable, non-permanent contraception for the same reason women do: enhanced sexual agency and personal control over family planning. The only options currently available are male condoms, which bring difficulties with pleasure and are only effective for a single use, and vasectomies, too permanent of a solution for many men.

However, this may change with a new trial drug, Reverse Inhibition of Sperm Under Guidance (RISUG), predicted to break into the market in 2014-15. RISUG passed small scale Phase I and II testing in India back in 1997 and started large scale Phase III testing in 2002; the last phase of clinical testing needed before a drug can be approved for sale to the general public. Whether this drug succeeds beyond clinical trials depends not only on effectiveness but also on societal acceptance.

Background

In 1873, the United States passed the Comstock regulations banning contraceptive devices and the dissemination of information about abortion. The regulations held strong until 1938 when judges in a case involving Margaret Sander, the founder of the first US birth control clinic, repealed the federal ban.

Diaphragms became the popular birth control at that time. In 1960, the first birth control pill was developed by Gregory Pincus and despite its complications became immensely popular. Since then, there has been a great deal of research into finding new and better approaches to female birth control. Unfortunately, development into male alternatives has not been as plentiful.

The issue is partially due to the difficulty in making long term male birth control using the classical hormone based methods used in many female contraceptives. Many methods of female birth control aim to trick the woman’s body by mimicking natural hormones. Ovulation is blocked by suppressing the estrogen peaks that trigger the release of the egg from the ovaries. A similar process occurs during pregnancy: The body uses a natural hormonal reaction. In the past, the claim has been that because men do not have hormonal methods of controlling fertility, it is too difficult to develop methods of altering fertility.

Another roadblock is, due to the duration needed for male birth control and the likelihood of it needing an implant, similar profits to those of the pill are just not possible. With less money to be gained, male contraceptives are a lower priority to for-profit pharmaceutical companies.

However, RISUG has been able to make substantial headway without the promise of large profits because despite corporate disinterest, the demand for male contraception is there.

Details of the Contraceptive

RISUG’s main advantages are its duration, non-hormonal method and reversibility, not to mention there is a possibility for HIV inhibiting functions. The treatment lasts up to 10 years, with reports of trial users having effectiveness for over 15 years.

RISUG acts by coating the insides of the vas deferens and damaging the makeup of the sperm membranes as they pass through the altered area. This effect is theorized to be caused by the positive charge of the injected styrene maleic anhydride (SMA) coating which disrupts the negatively charged sperm.

This procedure can be performed by simply injecting the SMA compound directly into the vas deferens.  The procedure is over in only 15 minutes and is considered effective in about ten days.

A second injection is required to reverse the procedure and flush out the SMA. One study showed that this injection can be as simple as a mixture of baking soda dissolved in water and it restores normal function in a matter of months.

A secondary version of RISUG – named Smart RISUG – was developed that allows the procedure to be reversed without an injection by using magnetic fields. Formal reversal tests for RISUG and Smart RISUG have only been performed in animals, but so far they have all been successful.

The RISUG trials stopped in 2002 due to concerns over potential prostate damage and the appearance of albumin in urine. Trials were restarted in 2007 due to the lack of manifestation of any adverse effects. In early 2010 the Parsemus Foundation, a not-for-profit organization, worked to obtain the property rights to RISUG in the United States. Once the rights were obtained, they developed a version of the drug for the US, and other countries outside of India, called Vasalgel. At the time of writing, Vasalgel has over a year of successful birth control in rabbits. The company is looking to expand into its first clinical trials in 2014, with a market release in 2015.

By its nature, Vasalgel is also not expensive to produce. Parsemus’ intent to keep it affordable means that big profits are unlikely. Therefore the company plans to publicly fund the trials through crowd-sourcing and Paypal donations, due to the lack of interest from larger pharmaceutical companies.

Social Forces

One possible inhibitor to the progress made in male contraception is the backlash it may receive from multiple fronts socially. Conservative and religious mindsets may have strong objections to any form of birth control, citing moral reasons. From another angle, stereotypes about the relation between masculinity and fertility are still prevalent. If one cannot father a child, he may be looked at differently or called inferior. Also, many people believe that the responsibility of birth control should stay in the hands of women alone.

Developments in contraception tend to attract notice from religious opponents. The belief that sex should be used for creating new life is common  among many religions, and is clearly expressed in Roman Catholic doctrines. Documents like the Papal Encyclical ‘Casti Connubii’ emphasize the importance of marriage and purpose of sex lying in the creation of life. Birth control is strictly forbidden and any sex that is “deliberately frustrated in its natural power to generate life is an offense against the law of God.” Although this document was written in 1930, this stance holds true for many strict followers of religion to this day. Historically speaking, male contraceptives are likely to encounter some level of religious controversy.

Similar opposition arises when cultures define fertility as a summation of manhood. “Guys take pleasure in their fertility,” says Brian Barry, associate professor of sociology and psychology currently teaching the changing family course at RIT. Men often associate their fertility with performance capabilities and confidence. Sexual dysfunction is unrelated but is stereotyped as the cause of infertility, making it a very difficult diagnosis for men to deal with. In fact, men dealing with infertility often experience depression and feelings of inadequacy. When using RISUG, despite not being truly infertile, the same negative connotations could potentially arise causing fewer men to be interested in using the drug.

Some men may also use these new developments to manipulate their way to unprotected sex. Associate professor of sociology at RIT Vincent Serravalo theorized that, while this deception might not become very common, “How does the female know whether that person’s telling the truth?” Obviously a violation of trust and agency, there are likely people willing to try such an approach for their own benefit. Complaints about the lack of sensation with condoms are common despite the industries work at making them thinner, while maintaining the level of protection. To avoid using condoms, in a rather Machiavellian way, some men could falsely claim to be using RISUG.

Another opposing opinion is that birth control is a woman’s responsibility. This idea may have arisen due to the fact that women physically carry the pregnancy. “Some people feel that there shouldn’t be a limitation on male fertility, that women should handle [birth control],” says Barry. Still, it takes two to get pregnant. Even though the guy does not physically carry the child through pregnancy, he is still equally responsible for that child’s wellbeing or conception.

Also, the availability of long-term male contraceptives would shift the relationship dynamic to a truer balance. “We’d get more egalitarian relationships,” Barry muses. Availability of male contraceptives would also take an undue burden off woman using oral contraceptives, which can raise cancer risks.

Men of all ages stand to gain significantly from these advances in birth control. Despite the social forces aligned against it, the large majority seems to be in favor of more personal and reliable control over their ability to have children. Younger, college age men often “view procreation as a disaster and not a blessing,” says Barry. These men generally try to avoid starting families until some security and commitment has been established. When men are older, and ready to begin a family, RISUG is reversible without damage. Aside from the family planning aspect, RISUG opens men up to much safer expression of sexual agency. This will allow the same freedom that birth control currently allows women: An active sex life, free from unwanted risks and complications.