Contraception; More Responsibility Put On Men…Finally!

The earliest documentation of contraceptive goes back to 1850 BC when Egyptians would use acacia leaves, honey and lint to block the vagina; preventing sperm from fertilizing the egg. Later research showed that acacia leaves and gum have spermicidal chemicals present but there is no word on the effectiveness of this method. Abortion was also a well documented practice that was a part of family planning for many religions and cultures as it didn’t have the social backlash it does today. Since then however, a vast majority of the responsibility for family planning has been placed on the shoulders of  the female partner. Let’s have a look at current contraceptives and where we’re going.

Current Contraception

There are an array of contraceptives currently available and they can be broken up into 5 categories; natural, hormonal, intrauterine device (IUD), emergency and barrier. The first 4 will be addressed, finishing with barrier methods as there is a new one for men that is showing positive results in animal models.

NOTE: There are advantages and disadvantages to using these different types of contraceptives. Please talk to a medical professional and your partner about which method is best for you.

Natural Contraception

This is a method that requires both parties to be very aware of the different things that their bodies are experiencing. It involves a lot of communication as well as reading cycles and rhythms. They involve, in descending effectiveness:

  • Abstinence (*≈100% effective)
    • zero penetrative sex
  • Lactation Awareness (≈98%)
    • a method that is effective for approximately 6 months AFTER giving birth that relies on excessive breast feeding. This works because the hormones responsible for milk production also prevents the release of an egg from the ovaries. Only works if the female doesn’t have her period.
  • Fertility Awareness (≈75%)
    • identifying points of fertility and infertility within a woman’s cycle determining when to have sex
  • Withdrawal or ‘pull-out’ method (≈73%)
    • withdrawing before ejaculating

*≈ represents approximately

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Hormonal Contraception

This method uses hormones to infer with the natural fluctuations of hormones released within the female cycle, to alter or inhibit particular physiological responses. They prevent pregnancy by either preventing the release of an egg, thinning the lining of the uterus preventing implantation of the egg, thickening of the cervical mucous making it difficult for sperm to make it to the uterus or a combination. They include:

  • Implant (≈99%)
    • a plastic, bar-like implant injected under the skin that secretes progesterone that works for up to 3 years. Works by preventing the release of an egg and thickening the mucus covering  the cervix.
  • Depo Provera (≈97%)
    • uses progestin that is injected every 12 months (requires a prescription).
  • Combined Oral or CHC (≈92%)
    • uses both estrogen and progestin that is taken daily.
  • Patch (≈92%)
    • uses both estrogen and progestin that is absorbed by the skin and into the bloodstream. It follows a 4 week plan; Patch is replaced every week for 3 weeks then a week rest. A new patch can be used afterwards.
  • NuvaRing (≈92%)
    • uses both estrogen and progestin that is absorbed through the walls of the vagina. It too follows a 4 week plan; the NuvaRing is left in for 3 weeks then a week rest. A new ring can be used afterwards.
  • Progestin-only Pill or POPs (≈92%)
    • similar to CHC except it only contains progestin and not estrogen, and is taken daily.

Intrauterine Device (IUD) Contraception

IUDs are small T-shaped devices that can either uses hormones or not. They are implanted into a person’s uterus and can be left there from anywhere from 3 to 10 years.

  • Progesterone IUD (≈99%)
    • a plastic IUD that contains progestin and is effective from 3 to 5 years approximately. It prevents the release of an egg, thins the lining of the uterus, and thickening of the cervical mucous making it difficult for sperm to make it to the uterus.
  • Copper IUD (≈99%)
    • a plastic and copper IUD that is effective from 3 to 10 years approximately. It works be preventing the sperm from fertilizing the egg and limits their movement. Can also be used as a form of emergency contraceptive 7 days after sex with ≈99% effectiveness .

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Emergency Contraception

A form of contraceptive that is used days after having unprotected sex or in instances where an unreliable form of contraceptive has been used.

  • Copper IUD (≈99%)
    • needs to be used within 7 days of unprotected sex. Works by preventing fertilisation and implantation into the uterine wall.
  • Ulipristal Acetate Pill (≈60%)
    • used 120 hours after intercourse by stopping an egg from being released. It will NOT end a pregnancy.
  • Progestin Pill (≈50%)
    • used 72 hours after with decreased effectiveness over time up to 120 hours. Stop the release of an egg but will NOT end a pregnancy.
  • Yuzpe Method (≈40%)
    • used 72 hours after by stopping an egg from being released. It will NOT end a pregnancy.

Barrier Contraception

The final form of contraceptive is the barrier method in which the sperm is prevented from reaching the egg; and can be combined with spermicides.

  •  Vasectomy (≈99%)
    • a technique that is consider a permanent sterilization of men by cutting and tying the vas deferens. The prevents sperm from exiting the body entirely (men still ejaculate semen, just no sperm).
  • Tubal Ligation (≈99%)
    • similar to the vasectomy, the fallopian tubes are cut and tied preventing the movement of the egg from the ovaries to the uterus.
  • Male Condom (≈85%)
    • a latex, polyurethane or natural membrane that catches and holds ejaculate.
  • Female Condom (≈79%)
    • similar to a male condom but it is used internally not externally.
  • Spermicide (≈71%)
    • usually contains the chemical nonoxynol-9 that traps and chemically kills the sperm, preventing fertilization.

New Male Barrier

Vasalgel is the new direction that male contraception is taking. It is a reversible vasectomy where a polymer is injected into the vas deferens (allows sperm to leave the testes) that blocks sperm movement. It is a plug that can be easily removed with the use of a sodium bicarbonate solution.

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It has already been proven to work on rabbits but researchers from Revolution Contraceptives LLC wanted to test their product on rhesus monkeys as they have a very similar reproductive system to us. The article publish in Basic and Clinical Andrology has excited experts as it showed to prevent the pregnancy of rhesus monkeys. Some tests resulted in complications but researchers advised that this is because you can’t give them instructions to rest; unlike humans. The reversal of the vasectomy has been performed on rabbits but not on the monkeys yet so effectiveness of it still needs to be assessed.

It will take a while for people to be able to  get this treatment performed on them from their local doctor. Though this is the case, researchers are currently pushing for funding and approval to be able to start human trials. The sign up for said trials can be found on the Parsemus Foundation website. Though there is no word of human trials yet, this is an awesome development that puts more pressure on men to be a more active part of family planning.

 

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