Sex column: Men should be able to control their fertility

With the exception of condoms, the responsibility for avoiding pregnancy has generally fallen on women. But men are entitled to control their own fertility too. The question is: how?

When I first started taking the contraceptive pill, I experienced depression, mood swings and low libido. Any one of these would have been bad; together they were unbearable. It’s little wonder that particular pill was rated 99.9% effective – I didn’t feel much like having sex with my partner, and the mood swings ensured he didn’t fancy having sex with me either!

My doctor told me to give it a few months to see if things settled. They didn’t. They got worse. He suggested waiting another three months before changing prescriptions. Instead I changed doctors – and pills. This time the side-effects included acne outbreaks, nausea and tender breasts. Fun indeed! At least I no longer wanted to kill either myself or my boyfriend, so that was a plus. Still I persisted, through hormonal trial and error, until my new doctor suggested the mini-pill. It doesn’t work for every woman, but it worked for me.

For those who are affected, the side-effects of hormonal contraception can range from unpleasant, such as acne or weight gain, to fatal – there is an increased risk of deep vein thrombosis, breast cancer and, for women over 35 who smoke, heart attacks. Long-acting reversible contraceptives have side-effects too. These can include depression, blood clots, serious pain from intrauterine devices, increased bleeding – sometimes every day of the damn month – or no bleeding at all. The reason very many women are willing to put up with side-effects, and potentially take risks with their long-term health, is because contraception (generally) prevents the more immediate risk of an unplanned pregnancy. Then again, as a Trinity College survey this week confirmed, in Ireland, one in six pregnant women suffers from pre-natal depression. And 15% experience post-natal depression.

The importance of being able to control your own fertility can’t be overstated – which is why it is a real pity that trials of hormonal contraceptives for men have been halted.

The trial had been running for a number of years. In total, 350 men took part. They were given injections of long-acting progestogen to switch off sperm production. To counteract this, the study participants were also given testosterone. Combined, the injections were 96% effective.

That’s better than many commonly used contraceptives. The pill, patch and UDIs are over 99% effective if used perfectly. Human error, however, means they are typically only about 91% effective. The same goes for condoms. In real world conditions, their effectiveness drops from an impressive 98 to a worrying 82%.

Like hormonal contraceptives for women, the male injection had side-effects. These included depression and acne, both common with the pill, plus – fortunately or otherwise – an increased libido.

Again like the pill, these side-effects were not uniform. Only 20 men dropped out because of them – just over 6%. The vast majority – 75% – were happy with the results and wanted to continue. The scientists, however, have cancelled the trials until they find a way around the side-effects.

What’s going on here? Why are depression and acne acceptable side-effects for female contraceptions, but not for male ones?

In fairness, testing standards have changed and become more stringent since the pill was first introduced. But that doesn’t mean that drug manufacturers won’t get approval for a product with fairly serious contra-indications. Addyi, the so-called “female Viagra” has plenty – dizziness, sleepiness, nausea, fatigue, insomnia, anxiety, constipation, abdominal pain, menstrual spotting and vertigo have all been cited. Some commentators have argued that the trial was cancelled because the scientific community is still largely sexist – the theory being that scientists are happy for women to experience significant side-effects but regard similar ones as unacceptable for men. I don’t think this is necessarily the case, or not the whole case.

The more telling issue is that the researchers abandoned the trial against the wishes of three-quarters of the men who wanted to continue using the contraception. These men either did not experience side-effects or were not particularly troubled by them.

There is a long history of doctors not listening to women when they complain about the side-effects of the pill, including pain and depression. Depression is one of the more serious side-effects – which doctors tend to ignore or downplay.

A recently published study from the University of Copenhagen confirmed just how common. Researchers tracked one million Danish women for 13 years. They found that women taking the pill were 23% more likely to be diagnosed with depression. Those using the mini-pill were 34% more likely. Teens were at the greatest risk. They had an 80% increase in risk of depression taking the pill. Hormonal contraceptives, such as UDIs and the coil, were also shown to increase depression at a rate much higher than either kind of pill.

As depression is a side-effect of the male contraceptive injection, I am glad researchers are taking it seriously. What I don’t understand is why trials have been halted when the majority of men did not experience it. If doctors are sometimes unwilling to listen to women when contraception affects them negatively, it seems that they are equally unwilling to listen to men when it affects them positively.

Heterosexual couples in long-term, monogamous relationships rarely choose condoms as their primary method of contraception. They only do so if there is a good reason the woman can’t use the pill, a UDI or other hormonal contraceptives. The burden of contraception certainly lies heavier on women, but on the flipside it also means that for decades women have been controlling their own – and their partner’s – fertility. That’s not really fair.

Being in control of your own fertility means you largely control your reproductive destiny. It would be great to give men that option too.

 

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