This May Sting a Little: Men, Contraception and the Burden of Responsibility

Contraception is a hot topic. In recent months, two stories have generated a huge amount of heated discussion, controversy and outrage. At the heart of both of these stories is gender.

In late October it was announced that a UN study into the effectiveness of an injectable male contraceptive had been abandoned due to unacceptable side-effects being experienced by the participants. The efficacy of the injection in the trials was almost as good as that of the hormonal contraceptive pill used by women, but it was found by an external review committee that “[t]he frequencies of mild to moderate mood disorders were relatively high.”

As is typical of mainstream media’s take on scientific studies, key details about the study tended to be overlooked or misrepresented. Getting to an original study means diving down a rabbit hole of links through tiny locked subscription doors and the end result tends to be very different. In this case, although adverse effects were reported by a significant number of participants in the study, the vast majority of effects were mild, and barely any could be directly attributed to the treatment. Nevertheless, the trials were called off early.

Reading between the lines of the report, it’s pretty easy to draw conclusions as to why that was. One man was diagnosed with depression which was probably caused by the treatment. One man’s overdose on paracetamol was possibly caused by the treatment. One man committed suicide. While his family were adamant it was due to study pressures and not to the treatment, it didn’t look good.

This story, and the cancellation of the study, drew the ire of women who, having suffered the side-effects of hormonal contraceptives for years, felt that men’s adverse effects had been given more weight than their own.

Science had finally verified what they had known for years: the Pill messes with your mood.

Then, around the same time, a study was released that found “[u]se of hormonal contraception, especially among adolescents, was associated with subsequent use of antidepressants and a first diagnosis of depression, suggesting depression as a potential adverse effect of hormonal contraceptive use.”

A lot of women felt vindicated. Science had finally verified what they had known for years: the Pill messes with your mood.

Just reading through comments (don’t read through comments), you’ll see accusations of men being whiny, women committing paternity fraud, health being biased in favour of men, and women not taking male mental health seriously enough. Some of these things are true, but others could easily be avoided with better understanding of the issues at hand. So, where better to start than with female hormonal contraception?

I first went on the Pill when I was fifteen years old. I wasn’t having sex, but I’d developed some pretty unsightly acne and our family doctor recommended I go on the Pill to help calm it down.

I was pretty militant about contraception, so when I started having sex, I used a combination of the Pill and condoms until I got into some more serious relationships in my twenties. I had an on-again, off-again boyfriend who suggested that we not use condoms, but considering he’d impregnated his previous girlfriend, I wasn’t taking any chances.

A doctor once suggested that I was being a bit overzealous and tried (unsuccessfully) to reassure me that he’d known a girl who’d missed the odd pill and it took “ages” until she got pregnant. Yeah. Okay.

I was always aware that condoms aren’t foolproof, too. I found myself heading to the chemist on more than occasion for the morning after pill when breakages occurred or the condom came off during sex. Bottom line: No accidental pregnancies on my watch.

Throughout this time, I was always a big proponent of the Pill. It fixed my terrible teenage skin. It protected me from pregnancy. It made me feel free and in control of my own biology. However, after more than a decade, even I was forced to admit that it wasn’t perfect.

First of all there was the cost. If you have a Medicare card, some types of the Pill are on the scheme and you only pay a few dollars for months’ worth. Lots of types aren’t covered, though, and if your doctor prescribes one that isn’t, the cost of the Pill can reach hundreds of dollars per year. I don’t think I ever had a boyfriend offer to cover the cost of the Pill. In instances where extra precautions are required, there’s also the cost of the morning after pill—never had a boyfriend offer to pay for that, either.

I was twenty-seven, and I’d been at risk of stroke for twelve years. My doctor made me stop taking the Pill immediately

Every year or so I’d go see a doctor because one side-effect or other was getting out of control. In 2012 my mood was all over the place. I have a distinct memory of crying while in my mind I was coolly aware that there was actually nothing wrong. So I’d go back to the doctor. A bit more progesterone here, a little less estrogen there. I’d tried so many different Pills my medical record probably looked like a pick-up artist’s little black book.

Until last year. Last year, after eighteen years, I finally figured out that my semi-regular blinding headaches, which were originally misdiagnosed as sinus headaches, were in fact migraines. One day at work I looked at my computer screen and there was a jagged, sparkly vortex in my vision. Googling the symptoms at my desk confirmed it: I had a migraine with an aura. Basically the blood vessels in my brain were constricting and it was affecting my vision. This is something that lots and lots of women experience.

My doctor was horrified. Being on the pill when you get migraines with aura puts you at risk of a stroke—like, a blood clot in your brain that can kill you. I was twenty-seven, and I’d been at risk of stroke for twelve years. My doctor made me stop taking the Pill immediately, and I found myself faced with having to make a choice: What was I going to do instead?

I’m in a long-term heterosexual relationship and condoms don’t really cut it for us. While I don’t think that sex has to end once the man ejaculates, a condom must be changed as soon as that happens, which kind of breaks the flow. Luckily, as a woman, there are all kinds of options for contraception other than the Pill.

I’d watched my friends experiment with IUDs (copper or hormonal), injections and implants, as well as all varieties of the Pill. I’ve had friends completely swear off hormonal contraception, relying on more “natural” methods such as the rhythm method (using dates and temperatures to try to avoid sex during ovulation), the withdrawal method (withdrawing the penis prior to ejaculation, which is notoriously ineffective due to pre-ejaculate) or sheer luck. I’ve had other friends publicly denounce hormonal contraception as a means to control women’s bodies. It’s only recently that I’ve started to understand why.

I put a call out to my friends to share with me some of their bad experiences with hormonal contraception. There were the usual contenders like issues with regulating mood, weight gain, irregular periods and bloating. Then there were more serious issues like depression, anxiety and loss of libido. And then there were the real heartbreakers: agonising and humiliating cystic acne, weight gain of ten kilograms and more, periods that went for weeks and constant pain.

I heard about a woman who had a stroke at the age of twenty-four after being on the Pill for ten years. No, you didn’t misread that—a stroke at age twenty-four, definitively caused by the Pill.

So I found myself balancing up the risks (heavy bleeding, perforated uterus, weight gain) to make an informed decision about the next step in my contraceptive journey. I decided to go with Implanon—a small plastic rod that releases the female sex hormone progesterone slowly in the blood stream over two years. It is arguably one of the most effective forms of contraception available. I figured I’d be able to feel the rod in my arm and if it all went to hell I could get it taken out. I could even tear it out myself if need be (there is no way I would be able to actually do this, I was shaking when they put it in and the doctor wouldn’t let me drive for an hour afterwards).

Implanon has been a bit of a wild ride. My periods are half as often but twice as long. I’ve put on a few kilos. I feel anxious for no reason. It reached the point where my partner was so exasperated that he raised the idea of getting a vasectomy. He did a bit of research, too, and was appalled to see that aside from condoms, there are basically no contraceptive options for men.

I was just resigned. Almost universally, the financial and physical responsibility for contraception in heterosexual penetrative sex is left to women, so most men don’t really have a clue because they don’t need to have a clue. At the end of the day, I’m the one left with having to try another invasive procedure, balancing one collection of risks and negative effects against another.

I wanted to hear more about what men were saying

Nevertheless, I have heard male friends complain about the lack of male contraceptives, and have discussed at length the reluctance of doctors to permit men in their twenties to get vasectomies. In fact, I was talking to my (male) doctor recently about how poorly Implanon has been going the last month (I’ve had my period for going on four weeks now) and I told him that my partner had raised the idea of a vasectomy. He looked me seriously in the eye and said, “Please tell me you’re joking, how old is he?” So when the news broke that not only is the Pill bad for women’s mental health (duh) but that testing on male contraceptives had been abandoned, I had to find out more.

For one, there are forms of contraception that seem to be perpetually in testing phases, such as Vasalgel, a completely reversible, non-hormonal procedure that prevents sperm cells from entering seminal fluid by injecting the gel into the vas deferens (a tube in your testicle). If you think that sounds scary, please let me take the time to talk to you about the prospects of getting an IUD injected into your cervix opening.

For another, even if the idea of Vasalgel or a Pill for men might seem worrisome to people who haven’t normalised the psychological and physical burdens of handling contraception for two, my male friends seemed open to and even desirous of such products.

Finally, most of the articles available to read about this were written by women with (understandably) little patience for men’s gaslighting and capitulation.

I wanted to hear more about what men were saying.

The thing I really wanted to know was whether men would even consider using male contraceptives, so I asked a few of my male friends what they thought.* There were some real trends that emerged from these conversations; some positive, some negative.

For one, there was a notable level of reluctance to accept that female adverse effects from contraception may be worse than those experienced by males (especially considering male contraception isn’t even available). Right from the get-go, without even looking at the study, a lot of the men I spoke to were sceptical that the side-effects of women’s hormonal contraception were comparable to those experienced by the men in the study. There were calls for side-by-side comparisons and suggestions of bias.

This kind of response is hardly surprising. The fact that women’s pain is taken less seriously than men’s has been proven. It’s so well studied, in fact, that this phenomenon has developed its own name—Yentl Syndrome has now become synonymous with women not receiving the same treatment as men with the same condition. So there is a bias, and the bias is against women’s symptoms.

There also seemed to be a basic level of concern for female adverse effects, but there was an equally significant amount of ignorance. I think the thing that surprised me, and continues to surprise me, is the pervasiveness of this ignorance when it comes to female contraception. Even in the writing of this article, I have had to go back and explain terms and concepts to do with women’s health and contraception that I thought were common knowledge.

What’s more, there is a real sense of complacency when it comes to men’s engagement with pregnancy prevention, yet just read any comments section on an article about contraception and there will inevitably be men complaining loudly about paternity fraud and being trapped in a relationship by pregnancy. An ounce of prevention is worth a pound of cure.

In previous long-term relationships with women, bisexual man Mark was surprised when partners went off hormonal contraception due to side effects. “It wasn’t something we learned about in health class,” he said. Similarly, it was not until a deep discussion with a roommate that another man, Kenjamin, learned about both his own ignorance as well as general male ignorance of contraceptives. After looking up terms such as tubal ligation, he concluded that “female hormonal contraceptives are flawed, and carry much greater risks than I had thought prior to my discussion last night”. Tim also learned about the side effects of hormonal contraception from a woman: his ex. Even John, who is “always constantly taken aback with some of the side effects my friends put up with,” learned about those side-effects from female friends.

There’s a pretty clear pattern here: it appears to be the responsibility of women to not only educate their male friends and partners about contraception generally, but to also convince them of the adverse effects they experience. Tying back into Yentl Syndrome above, that seems a pretty heavy burden, especially given the taboo nature of talking about female reproductive systems.

The third major trend, however, was in-principle support for male contraceptives. There were a telling number of caveats, though, not to mention that support tended to be based on the increased enjoyability of sex (rather than, say, the decreased discomfort of partners).

Daniel, in a long-term relationship, said he was all for equal options for men and women. He went on to distinguish between couples and single hook-ups, and highlighted the importance of communication and balancing the options available. Balancing options only really works, though, when those options address existing inequalities such as availability, affordability and burden of consequences, which the current options have yet to do.

For others who supported male contraceptives in principle, the priority was the enjoyability of the sex itself

Mark’s approach was more reparational or restitutional: “I would be happy to use hormonal birth control. It seems fair that men should bear an equal portion of the burden—which means we have decades of time to make up.”

In contrast, Callum, who is in a long-term heterosexual relationship, doesn’t buy the “men should now take equal responsibility for birth control argument” because he’s always been careful with condoms. While that is all good and well for him, it doesn’t take into account the broader inequalities associated with women bearing the brunt of the risks and costs of contraception.

However, he did say that he would absolutely consider a male contraceptive because he’d like the choice of having longer-term option. He added, “Hopefully it doesn’t come down to a choice of ‘your side effects and health implications are less severe than mine’.” Sadly, this may be exactly what it comes down to.

For others who supported male contraceptives in principle, the priority was the enjoyability of the sex itself.

Kym, a single dad, would magnanimously “consider just using condoms” if a partner were “affected by the contraceptives a fair bit.” But, he added, “it feels better not having to use one.” He would also “be open to using [male contraceptives] … so long as it doesn’t affect my ability to have kids again.”

For Tim, better sex was also a big driver behind his support for male contraceptives. “I hear people with vasectomies often feel more comfortable and less worried, which makes for even better sex.” James, who has two kids, was also on board with vasectomies. “I would rather be sterile and use condoms where needed than have to consistently remind myself to take a pill/get a jab/rub gel”.

Although Kenjamin was reluctant to consider male hormonal contraceptives due to concerns about the potential impact on his mental health and the risk of STI transmission in casual sex, he did acknowledge “society sees fit to burden women with that responsibility.” He would be willing to consider hormonal contraceptives if “1. Reasonable progress, or assurances, could be made towards reducing whatever symptoms or side effects arise, and 2. I was having way way way more sex and had somehow, I dunno, some extreme aversion to parenting.”

Three men talked to me about the desirability of a fluid-bonded relationship—one which is monogamous and entered into by two people known to be free of STIs, thereby supposedly enabling risk-free, condom-free, penetrative sex and ejaculation if the woman is taking contraceptives. This kind of relationship in a monogamous, heterosexual context is obviously dependent on reliable contraceptives.

So why aren’t there more male contraceptive options available? Two words: ignorance and disinterest. As long as men are unaware of or unwilling to hear about the burden of contraception, women will continue to pay with their health and their wallets. Among the men I spoke to, it seemed like most of their education about female hormonal contraceptives and their adverse effects came from partners and female friends. This is a huge mental and emotional burden to place on individual women who are already combating the tendency for women’s medical symptoms to be minimised and dismissed, as well as the general taboo around menstruation. If you’re grossed out right now, that’s the problem.

Then, there is a lot to be said for demand. I think Tyson, another man I spoke with, had the right idea: “I guess some other richer guy doesn’t stand to get more richer enough from some other guy’s more useful thing being the thing”. As long as women are stuck being the ones to foot the bill for something that is necessary to avoid pregnancy, nothing is going to change.

Although a lot of men who talked to me would be willing to take a male contraceptive, there aren’t very many who are actively campaigning for more options. To get true equality when it comes to availability of contraceptives, men have to be asking for it, even paying for it. Contraceptives need to be a discussion between couples—and at a broader level, within society. They are another aspect of being someone’s partner, but it can’t be a true partnership without the ability to equally share the burden.

There is nothing stopping men from taking the initiative to ask questions, perform research and listen. If you have a female partner, ask about what her contraceptive arrangements are, how they might be affecting her and have a think about who exactly is paying for them.

To get true equality when it comes to availability of contraceptives, men have to be asking for it, even paying for it

But don’t stop there. There is a male contraceptive option that has no hormones, no side-effects and is completely reversible—Vasalgel. However, as a long-term once-off procedure, Vasalgel isn’t slated to be a big money-maker for pharmaceutical companies. Despite success in animal trials in the USA, and similar human trials in India, until now there hasn’t been the funding or the interest to back human trials in the USA (or Australia, for that matter).

Vasalgel is relying solely on donations and they are hoping to run a small human trial in 2017 and a bigger trial in 2018. So if you’d like to give this technology a bit of a nudge, and do your bit for contraceptive equality, check out their website and see how you can support them.

* Some names have been changed and the type of sex we were talking about is penetrative heterosexual sex that could result in pregnancy.

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