Male contraception and the pleasure deficit

One of the most thought-provoking lectures of this semester so far has been from Prof. Jenny Higgins, who introduced us to the concept of the “pleasure deficit” – that research on the use of contraception for birth control and disease prevention cannot ignore the important role of sexual satisfaction. In class, we noted that the pleasure deficit may extend to better understanding other interventions to improve healthy behaviors, such as exercise or healthy eating – which involve individual perceptions of pleasure or displeasure from such activities. A PHS 795 student draws our attention to an article and YouTube video about factors underlying the lack of parity in male birth control options. They write:

Dr. Higgins’ lecture has renewed my interest in male birth control options. I’m including an article from 2011 WIRED about Vasagel. It does reinforce the pleasure deficit, discussing that it is difficult to develop hormonal birth control that doesn’t impact male libido, without discussing the sexual side effects of female birth control that has been on the market for years. Truth be told, I feel like I’ve been hearing about Vasagel-like products for over 10 years, but we haven’t gotten any closer to parity in male contraceptive options. MTV’s feminist vlogger Laci Green rightly asks why this is the case, and offers some intriguing ideas. I feel that the pleasure deficit is part of a larger issue in which women are asked to assume both the responsibility and health and sexual side effects of contraception.

https://www.wired.com/2011/04/ff_vasectomy/

https://www.youtube.com/watch?v=qUlQiELaR7M

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5 thoughts on “Male contraception and the pleasure deficit

  1. What an incredibly relevant and thought-provoking resource you found! I, too, enjoyed the lecture by Professor Higgins and am glad that you chose to follow it up with this video and article. I had never considered how much more complex female reproduction is. It now seems very foolish to me that male contraception has been under-studied in the U.S. for decades. I think it is admirable how Laci Green points out the inequality of current contraception for both women and men. First, it is unfair for men to only have two contraceptive options, especially considering one is permanent. Second, it is unfair to women to have to carry the financial burden, discomfort, and responsibility of birth control. I bet social acceptability will, consequently, play a significant role in the expansion of male contraception in the U.S.

    Although I am optimistic about the potential for Vasagel use in the U.S., I do have hesitations. The “Braless” video claims that polled men are willing to take on more contraception responsibility. However, most men I know are squeamish about having their genitals operated on. I cannot imagine men will be lining up for appointments to get their scrotum sliced open when their partners could simply take a pill and achieve the same end, especially if Vasagel is only temporary. I agree that Vasagel use would likely reduce U.S. vasectomy rates, but I do not think it will increase male contraception use. Furthermore, the article incorporates the following quote from a man in Florida: “I’d gladly put my balls on the chopping block for the benefit of mankind.” While this is a generous (if not slightly masochistic) sentiment, I would bet this is the exception, not the norm.

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  2. I hope that Vasagel actually makes its debut in the US as early as 2018!! That would be a wonderful addition to male contraceptive options. it would be a great temporary (vs permanent) male birth control. It’s essentially the male version of the female LARC (long-acting reversible contraceptive such as IUDs and Nexplanon). I think this could greatly increase the male birth control usage in the US, especially because there would be no secondary negative effects such as decreased libido, impotence, etc, as there have been with previous hormonal male birth control attempts. This is kind of the perfect solution to the pleasure deficit. Men and women would both be protected from unwanted pregnancy, but neither would have decreased pleasure as they could with condoms or female hormonal birth control options. Female partners also wouldn’t need to subject themselves to hormones that present their own risks such as increased risk of blood clots.

    There was mention that men wouldn’t volunteer to have their scrotums sliced open for this procedure. I think this is an interesting comment because, currently, women have multiple birth control options that are far more complicated than having a small injection placed into the vas deferens. IUDs are placed into the uterus through the cervix, but have the risk of perforating the uterus during placement, going into the abdominal cavity and needing to be surgically removed. The Nexplanon is placed into the arm with local anesthesia, but if that isn’t placed correctly, it may need to be removed with a more extensive surgery as well. If these are acceptable and actually, the MOST effective female contraceptives, then men should certainly be willing to have a small (<1cm) incision made in their scrotum. I perform vasectomies myself and the images shown regarding placement of this injection would be quite simple. No sutures would be needed following the procedure because scrotal skin lines up where it needs to heal and men and their partners would be protected from unwanted pregnancy for at least one year. I think this really sounds like a great option!

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  3. This is SUCH a rich topic area, and Dr. Higgins is one of my all-time favorite lecturers! I agree with previous comments that more options for male contraception are definitely needed. Everyone deserves to be able to control their own fertility, as well as enjoy expanded access to options that don’t diminish sexual pleasure.

    I met with Dr. Higgins after this talk to ask about how the pleasure deficit relates to pregnancy, and she shared this recently-published commentary, Rethinking the Pregnancy Planning Paradigm: Unintended Conceptions or Unrepresentative Concepts? (http://onlinelibrary.wiley.com/doi/10.1363/48e10316/full) that I wholeheartedly recommend checking out. It discusses the idea (and popular public health framework) of intended vs. unintended pregnancy, and how this framework fails to recognize the spectrum of feelings that people experience about getting pregnant. Dr. Higgins explained that the idea of getting pregnant may fit a similar model of “acceptability” as contraception; many people are somewhere between adamantly opposed or absolutely in favor (i.e., varying levels of ambivalence, openness, or attraction to the idea). And, probably unsurprisingly, many people’s feelings go back and forth before and during pregnancy, which is about more than just the decision “to have kids or not have kids” – it’s also about people’s levels of attraction to the idea of creating a baby with a partner, and so on. Similar to contraception, this idea of pleasure is often missing from discussions about pregnancy, intention, and outcomes. Definitely a much-needed area for further research, considering the implications for public health policy and education about teen pregnancy. I believe Dr. Higgins asked during lecture whether unplanned pregnancy was truly typically a negative outcome – or if sentiment might be dependent on who is having an “unplanned” pregnancy – and whether sentiment would be different if all individuals had access to more resources.

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  4. Vasalgel seems like a very promising (and much needed!) alternative for male contraceptive options. Some of the previous comments made some interesting points on whether or not men would be interested in the necessary incision, as well as the fact that long term contraceptive options for woman are can be more complicated than the vasalgel injection. I find myself with a more optimistic view of this treatment, considering male interest in contraceptive use and the fact that it is a relatively simple outpatient procedure. This alternative seems especially important considering the less promising news regarding a halted study on hormonal male contraceptive shots due to side effects (depression), which not surprisingly, is already one of the side effects of female hormonal birth control (http://www.cnn.com/2016/10/30/health/male-birth-control/). While this is obviously super applicable to the idea of the pleasure deficit that Jenny Higgins introduced, I just want to highlight one aspect of the article, which is that despite the side effects of the hormonal birth control shot, 75% of men in the study would be willing to use that method of contraception. It seems really clear that alternatives in male contraceptives are also desired by many men and could relieve some of the burden and responsibility women face regarding current birth control methods, so hopefully there will be more of an emphasis on studying male contraceptive options going forward.

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  5. This was a very interesting watch and read. What I find interesting is that there is survey data supporting that men want birth control; yet, there is a societal perception that they do not. I wonder about those survey methods – for example, I know that women report fewer sex partners when they perceive any lack of anonymity in a survey or study than they report when they feel completely anonymous, which contributes to the perception that women are less sexual. It may be that men are willing to accept birth control, but aren’t as willing to discuss it, contributing to the perception that they wouldn’t want it; or perhaps it’s simply the lack of options and programs that lead to less discussion (causing an unfortunate cycle).

    Also important, there’s a huge environmental impact of female hormonal birth control; as excess hormones are flushed away, they end up in rivers and streams, having effects on fish and crustaceans living in those environments. Non-hormonal forms of birth control become even more important in light of that information.

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