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Frithghiniúint hormónach, teirmeach fireann: modhanna éifeachtacha?

 

Almost 60% of men today say they are ready to use contraception. However, the spectrum of male contraceptives remains limited for the time being and some usual methods are not very effective. In fact, the prevention of a possible pregnancy still falls, in the great majority of cases, to the woman. What are the most common methods of male contraception today? What are the most reliable male contraceptives? Overview.

The male condom: an effective male contraception, but often misused

The male condom is the most widely used male contraception: 21% of couples use it worldwide.

Cad é an coiscín fireann?

The male condom is one of the so-called “barrier” reversible contraceptive methods and consists of a thin membrane, generally made of latex, to be placed on the penis before intercourse, to prevent the emission of semen into the vagina. The male condom is recommended, according to the Haute Autorité de Santé, “in the absence of a stable partner or as a replacement method to be kept available in the event of occasional inaccessibility or failure to comply with a hormonal method”.

Is the condom effective?

The male condom is considered to be an effective contraceptive. Indeed, its Pearl index, which allows to evaluate the percentage of “accidental” pregnancies over a year of optimal use, is indeed 2. But in fact, the condom is much less convincing in the prevention of pregnancies. unwanted with a failure rate of about 15% due to its conditions of use. These failures are mainly attributable to condom breaks, but also to its irregular use, or even to its withdrawal during intercourse.

What are the advantages and disadvantages of the male condom?

Still, the advantages of the male condom are numerous and its disadvantages, rather limited.

Among its advantages are :

  • Its accessibility : condoms are both inexpensive and widely available (supermarkets, pharmacies, etc.)
  • Its effectiveness against sexually transmitted infections : the condom (male or female) is the only contraceptive method effective against STIs. It is therefore recommended in risky relationships (multiple partners, casual relationships) or when there is no stable relationship.
  • Its compatibility with another contraceptive method (female hormonal or intrauterine contraception, spermicide, etc.), excluding the female condom.

On the downside, the condom can …

  • promote the onset of reactions in people with an allergy to latex. Where appropriate, polyurethane condoms, which do not present an allergy risk, should be preferred.
  • lose efficiency if misused, hence the importance of learning about good practices (put the condom completely on before the start of intercourse, hold it with your hand when removing it, etc.)
  • present risks of slipping and breaking. As such, it is in particular not recommended to use oil-based lubricants with a male latex condom, at the risk of degrading said latex and promoting the rupture of the contraceptive.
  • reduce or modify sensations during sexual intercourse in some users.
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What is the price of this male contraception?

The average price of a male condom is between 50 and 70 cents a piece. And contrary to popular belief, the condom can be covered by Health Insurance under certain conditions. Indeed, since 2018, some boxes, available in pharmacies, can be reimbursed up to 60% if they have been prescribed by a doctor or a midwife (on the basis of a sale price of $ 1,30, € 6 for the box of 2,60, € 12 for the box of 5,20 and € 24 for the box of XNUMX.). They can also be obtained free of charge at family planning centers.

The withdrawal method or coitus interruptus: a very random male contraception

Interruption of coitus, also known as the withdrawal method, is used by around 5% of men worldwide, 8% in France. This male contraception would have notably gained in popularity during the “pill crisis” and the questioning of female hormonal contraception in 2012.

What is the withdrawal method?

The removal method involves, as the name suggests, removing the penis from the vagina and the area around the vulva before ejaculation. As such, it is one of the “natural” male contraception methods, one of the few with so-called “thermal” practices.

Is interrupted coitus an effective male contraception?

In theory, with a Pearl index of 4, interrupted coitus remains classified, according to the Haute Autorité de Santé, in the category of effective male contraception… as long as it is used correctly and regularly. But in practice, the failure rate is very high (27%). The withdrawal method alone is therefore not recommended by healthcare professionals.

What are the advantages and disadvantages of the withdrawal method?

The main advantage of the withdrawal method is its “accessibility” : free, available in all circumstances, without contraindications, it is therefore generally considered “better than nothing”.

 

But its major drawback remains its limited effectiveness. Indeed, this method requires not only a perfect control of the ejaculation (which is not always it), but even if it is “apparently” the case, the pre-seminal fluid (which precedes the sperm and the ejaculation and can therefore be deposited in the vagina) contains sperm and can therefore fertilize an oocyte during ovulation. Also, interrupting coitus does not protect against sexually transmitted infections.

Vasectomy: a definitive sterilization

Vasectomy is a method of sterilization for contraceptive purposes (or definitive contraception in everyday language) used by 2% of couples in the world, less than 1% in France. Very effective, it is however considered irreversible. It is therefore only recommended for men wishing a permanent method of contraception and should be the subject of extensive information and reflection.

What is a vasectomy?

Vasectomy is surgery to block the vas deferens, which allows sperm to flow from the testes. After a vasectomy, the semen therefore no longer contains spermatozoa (azoospermia), fertilization of the oocyte after ejaculation (and therefore pregnancy) is no longer possible.

 

Is vasectomy effective?

Vasectomy is very effective. Its theoretical Pearl index is 0,1% in theory and 0,15% in current practice. Unintended pregnancies are therefore very rare.

What are the advantages and disadvantages of vasectomy?

The greatest benefit of vasectomy is above all its effectiveness. Its other positive points?

  • It does not affect erectile function, in particular because it does not affect, as one can often believe, the production of male hormones. The quality of the erection, the volume of the ejaculate, the sensations remain the same.
  • It is without daily constraint and of (very) long duration.
  • The surgery is generally very well tolerated.

Among its negative points, it is important to keep in mind that the vasectomy …

 
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  • is irreversible: current techniques aimed at making the vas deferens permeable again have very uncertain results. For this reason, the vasectomy is considered final, not allowing a subsequent child project. This is why a cooling off period of 4 months is imposed. In addition, the practitioner can propose to carry out a cryopreservation of sperm (freezing of gametes) in a dedicated medical center (CECOS).
  • is not effective immediately. The seminal vesicle (which produces semen) may still contain sperm between 8 and 16 weeks after the procedure or after 20 ejaculations. Complementary contraception is therefore prescribed for 3 months after the operation and extended until the absence of sperm is confirmed by a spermogram.
  • does not protect against STIs,
  • can lead to postoperative complications (bleeding, bruising, infection, pain, etc.) in 1 to 2% of cases. However, these can be supported.
  • has certain contraindications : WHO always recommends considering a vasectomy on a case-by-case basis to take into account “all conditions and circumstances which require certain precautions”. In addition, certain purely medical reasons may lead to postponing the intervention such as local infections (STIs, epididymitis, orchitis, etc.), generalized infections or gastroenteritis, the identification of a mass in the scrotum, etc.

What is the price of this male contraception?

The vasectomy costs on average 65 euros and is covered up to 80% by the Health Insurance.

Thermal methods: a still confidential male contraception

Male thermal contraception (or CMT) methods are based on the deleterious effect of heat on male fertility. If they are a priori rather convincing, they are for the moment not very accessible or must still be the subject of a scientific validation.

What does thermal male contraception consist of?

CMT is based on a simple physiological observation: for spermatogenesis to be good, the testes must be permanently at a temperature slightly lower than that of the body (between 2 and 4 ° C). It is for this reason that the scrotum is anatomically outside the body. On the contrary, when the temperature in the testes is too high, spermatogenesis can be impaired. CMT therefore aims to promote this local rise in temperature in order to make the spermatozoa less fertilizing, failing to generate azoospermia. This effect can be achieved by several methods. Traditionally, CMT has been based on repeated hot baths (above 41 ° C). More recently, two means of thermal elevation have been developed:

  • wearing underwear using thermal insulation (24 hours a day)
  • keeping the testicles in an elevated position (called supra-scrotal) for at least 15 hours a day, again thanks to specific underwear. We then speak of artificial cryptorchidism.

Is thermal male contraception effective?

Today, artificial cryptorchidism is the best evaluated thanks to the work of Dr. Mieusset. This technique is considered effective, although it still needs to be the subject of new regulatory studies to take into account a larger population. Tested on 51 couples and 536 exposure cycles, it only gave rise to one pregnancy, due to an error in the use of the method.

What are the advantages and disadvantages of thermal male contraception?

At this stage of research in this area, CMT has the merit of being both effective, when its mode of use is strictly applied, and reversible. It can also be long-term: the recommended duration can be up to 4 years.

However, thermal male contraception has certain drawbacks, namely:

  • Míchompord linked to wearing underwear specifically developed for this purpose (felt by one in two men)
  • a certain constraint: if the underwear is not worn for at least 15 hours a day or if it is not worn at all for a day, the contraceptive effect is no longer guaranteed. In addition, the performance of regular spermograms before verifying the effectiveness of the method is required (every 3 months for the first two years, then every 6 months).
  • thermal male contraception does not protect against sexually transmitted infections (STIs).
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In addition, this method is not indicated in the case of natural cryptorchidism (a disorder of the migration of the testes, which are then said to be “poorly descended”), testicular ectopia, inguinal hernia, testicular cancer, varicocele. advanced and in men with severe obesity. 

  • CMT remains very inaccessible, no industrial production for the time being making it possible to obtain said underwear on a large scale.

Hormonal male contraception (CMH): a promising avenue for the future?

Widely used in women, hormonal contraception remains confidential for the time being in men. However, this method has been the subject of studies since the 1970s and has even given rise to convincing clinical trials for several years.

What is hormonal male contraception?

It is a reversible method of contraception aimed at inhibiting spermatogenesis through hormonal treatment. Two main types of protocols have been developed in this area:

  • contraception based on testosterone alone. This monotherapy is based on the regular injection of a dose of testosterone enanthate. Subsequently, a protocol based on prolonged-release testosterone was proposed in order to space the injections, but the latter is not currently used in France.
  • a combination of progesterone and testosterone. This protocol is being studied in several forms, but the most successful today is a gel based on progesterone and testosterone: Nestorone. Its marketing in France is currently not authorized.

More recently, a contraceptive pill for men combining the action of testosterone, androgen and progesterone has successfully passed the phase of the first clinical trials in the United States. Called “11-beta-MNTDC”, it would be reversible and without side effects. Although promising, this alternative to the female pill should not be available on the American market for about ten years.

Is hormonal male contraception effective?

Monotherapy based on testosterone is today the form of CMH on which there is the most evidence. Studies establish its Pearl Index from 0,8 to 1,4 for enanthate-based contraception and between 1,1 and 2,3 for the sustained-release method. These two hormonal male contraceptives can therefore be considered effective, even very effective. In addition, men using it generally regained normal spermatogenesis between 3 and 6 months after treatment.

As for Nestorone, it seems promising: clinical trials carried out in the United States indicate an efficacy of 85% without adverse effects.

What are the advantages and disadvantages of hormonal male contraception?

The great advantage of testosterone monotherapy is above all its éifeachtacht, comparable to that of female hormonal contraception. Weekly, it would also represent, for the couple, a less important constraint than the daily intake of the pill for women.

However, this method of male contraception has a number of disadvantages:

  • It is not effective immediately : it is generally necessary to wait 3 months after the start of treatment for this to be the case.
  • It is limited to 18 months of use, for lack of scientific studies on its long-term effects.
  • It remains restrictive, particularly in terms of monitoring : Not only, male contraception based on testosterone alone requires an injection at regular intervals, but the realization of a spermogram is recommended every 3 months and a biological assessment as well as a clinical examination every 6 months.
  • It promotes the appearance of certain side effects like acne (frequent), but also sometimes aggressiveness, excessive libido or a drop in libido, weight gain …
  • It has a number of contraindications : the men who can benefit from it must be under 45 years old, not have a family or personal history of prostate cancer, not suffer from coagulation, cardiac, respiratory or psychiatric disorders, must not (or little) smoke and / or drink alcohol, not be obese …

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