Male contraception, largely forgotten by the institutions?

Over the past decade, the company has expressed a growing interest in male contraception. However, public authorities do not appear to be in a hurry to address the issue.

A column published in Liberation on 22 August slams his fist on the table and asks for concrete measures. But how to explain such reluctance? Are these social reasons the only ones responsible for this lack of resources? And since we are talking about it, what concrete means are currently available?

Male contraception: the progress in 2022

The emergence of the birth control pill in the 1960s enabled millions of women to have sex without risking pregnancy, even though no contraceptive method is 100% reliable.

If this historical progress of society remains important, it is accompanied by a more nuanced reality: the contraceptive burden rests exclusively on the shoulders of women, when men can spontaneously enjoy protected sexual relations. At least in theory, since we remind you that at the moment only condoms can protect against sexually transmitted diseases.
Fuck if I want and where I want, yes, but only if I went to my gynecologist first.

Taking a contraceptive is often restrictive, it is a fact. It requires a minimum of mental space and is sometimes accompanied by more or less unpleasant side effects. If these drawbacks are often bearable, it would be wrong to say that this liberation of female sexuality is not accompanied by some disadvantages.

In a society that is still very unequal, this burden, which is added to all the others, has a little taste of unbearable. Why should we, who are fertile one day a month, pay for those who can reproduce permanently?

The answer is social, yes, but not only. As Martin Winckler, a physician and militant feminist writer, explains, research on male contraception is much more complicated to set up than on female contraception. According to him, it is simple to block ovulation that occurs once a month or to neutralize the sperm. Spermatogenesis never stops and it is more complicated to block the germ cells.

Personally, before writing this article, I had never considered things from this point of view. However, the argument makes sense to me. But biological reality or not, which does not prevent a growing number of women from experiencing this lonely weight as yet another injustice.

Male contraception therefore seems to be an almost ideal solution to delegate part of our responsibilities to our partner. Laure Geisler, general practitioner, journalist and creator of the Instagram account Lecoeurnet.info, explains to me that more and more men are consulting her for these questions. They are often very young and probably more aware of equality issues.

I also questioned Marie Msika Razon, general practitioner, member of the MFPF and head of the sexual health center at the Pierre Rouquès les Bluets hospital in Paris. For her, if male contraception is still so little known, it is mainly because access to information is almost non-existent.

Public authorities and many health professionals completely hide male contraception, to the point that some patients, wanting to know more, are unaware of it.

Overall it is very little known, I am often asked if there is contraception for men, sometimes, I am also told that it is a pity that there is no contraception for men, as if we started from the principle that it just did not exist !

It is a vicious circle. Without access to information, the public does not know that methods exist and therefore cannot claim access to them from public authorities.

Having simple and easy to consult information would also allow us to demolish some myths such as the one that associates fertility and sexual capacity. We know: ignorance always opens the door to the most absurd fantasies.

Contraceptives available officially and unofficially …

Effective techniques exist, but they are struggling to make their way onto pharmacy shelves. As Erwan Taverne, co-founder of the association, tells me LAD (Groupe d’Action et de Recherche pour la Contraception), WHO currently recognizes only 3 methods of male contraception: withdrawal, condom and vasectomy.

This does not mean that these are the only reliable means (especially not withdrawal), but that they are the only scientifically accepted practices. However, thermal contraception, for example, which involves lifting the testicles slightly to raise their temperature, would cause spermatogenesis to collapse provided it is applied correctly.

For lack of sufficient studies, these methods, which nevertheless are gaining more and more followers, cannot be validated by public authorities. Testing such devices is expensive and time-consuming, as Martin Winckler points out:

It takes money, especially to recruit volunteers and several thousand have to be recruited (…), it’s been a long time since the last time that if you want to have reliable conclusions, you have to experiment for at least 5 years (…), that’s a lot heavy in western countries. We have to invest, scientists, money, resources, in something that is not of interest to the public authorities in France.

However, thermal contraception is recommended by some gynecologists, without them being able to prescribe it. Doctors then direct their patients to associations that can tell them what to do (it is now possible to make your own thermal device, through “sewing workshops”). The access to information and the “moving” to come to the aid of the men concerned are therefore articulated at an individual and associative level since currently the public authorities are not investing in male contraception.

The Tribune published in Liberation on 22 August 2022 denounces this inaction:

” In the spring, a report on means to promote male contraception was to be presented to the National Assembly (…) It was also to be about free access to condoms for men under 25 years of age. (…) This report has not yet been presented. “

Olivier Véran, Minister of Health, recently stated that the issue of male contraception had to make its way into our society even if it were essential. But how can society evolve and arouse the interest of the general public if no information is made available to them?

Vasectomy, effective, but difficult to access

It is people with a uterus who get pregnant and suffer the consequences of pregnancy. While many men are increasingly concerned, nothing currently forces them to get involved in pregnancy (whether it is interrupted or continued) when it occurs. Although pragmatic, this biological observation makes it possible to justify the permanent control that operates on the body of women.

Many doctors still position themselves knowing they are omnipotent and dictate with impunity what they think is best for their patients. A “best” that is often part of a pronatalist and sexist approach.

While the pill is systematically offered to women by requiring regular checkups, permanent sterilizations are discouraged, which could allow people to break free of the medical profession once and for all.

In France, no surgery requires a waiting period as long as that required for vasectomy (and tubal ligation). Doctors are still reluctant, despite the law, to sterilize young men and / or men who have not yet had a child, even though sperm conservation is systematically proposed. However, vasectomy is a very common practice in many countries, particularly Canada and Canada Great Britain.

Towards an evolution of society

Society evolves with or without pharmaceutical companies and governments. More and more men are becoming aware of the issues raised by this question that concerns them directly. After all, they too do not want to take paternity without having wanted to.

Erwan Tavern confirms it:

If the public authorities argue that the company is disinterested in justifying their inaction, the envy of the public is there. In 10 years, the number of vasectomies has multiplied by 10. In recent years, more than 10,000 contraceptive rings have been sold. Despite the ANSM marketing ban, it remains accessible, now presented as a “Talisman”.

Still according to Erwan Taverne, we need to go beyond the individual phase and organize ourselves collectively, on the one hand by committing to bring questions, knowledge and know-how closer to the people concerned, on the other by joining associations to give them more means, and weight when they turn to institutions.

Marie Msika Razon also detects a change in mentality and urges patients to put pressure on their doctor:

It is the evolution of mentalities that will advance medicine and not the other way around.

Finally, Martin Winckler recalls the importance of democratized access to permanent contraception and the need to combat the paternalism of too many doctors.

The lack of information, the lack of means to invest in studies, the convictions, the obstacles to the good development of male contraception in France are numerous and the enthusiasm is not there yet, even if more and more men take it over.

One thing is certain, however, if the matter of male contraception is important, many women expect their partner to be mainly involved in the contraceptive charge.

This may in fact imply that their mates take charge of the protection of the couple, but it can also simply mean that they are present and committed to this issue. Laure Geisler suggested very simple actions that can do a lot of good to the person contraceptive (sic) within the pair:

• Retrieve treatments from pharmacies;
• Provide the lubricant;
• Ask about symptoms, make sure contraception is well tolerated;
• Ensure that the decisions made are appropriate;
• Cover the costs;
• Accompany at the time of implant and IUD installation, or at least offer to accompany;
• Communicate, communicate, communicate.

If male contraception is not to replace female contraception, there are simple solutions and behaviors to adopt, starting today, so that women are supported on a daily basis and no longer carry this burden on their own.

Photo credit image of one: Motortion