Lakeview Health System
Male Contraceptive
Thomas J. Stormont, MD

Women have the pill, but men don't have this option - yet. There is a lot of interest in finding a better male contraceptive, with most areas of development and research focusing on condoms, vasectomies and medications.

Condoms
There are three types of condoms - lambskin, latex and polyurethane. Lambskin is thought to have the best sensation and can prevent pregnancy, but not sexually transmitted diseases (STDs). Latex is the most common, and is effective for pregnancy and STD prevention. However, they have a short 'shelf life', are broken down with petroleum based lubricants and may cause allergic reactions. Polyurethane is the thinnest with the best heat transfer. They are also the strongest, have a long 'shelf life', are hypoallergic and can be used with petroleum based lubricants. However, they have the worst fit and are the least elastic, causing the most slippage and breakage. Novelty condoms are not FDA approved for pregnancy or STD prevention.

Nonoxynol-9 is a spermicidal used in some condoms. It has not been shown to decrease the pregnancy or STD rate, it may be associated with a higher risk of female urinary tract infection, and it decreases the shelf life of the condom. For these reasons, Planned Parenthood and the FDA do not recommend using condoms with this spermicidal and most manufacturers have discontinued their production.

With 'perfect use' condoms have a 98% pregnancy free rate/year. However, with 'typical use' there is only an 85% pregnancy free rate/year. Condom failures can be caused by incorrect use (wrong size, wrong application, intermittent use), slippage or rupture, or using expired or damaged condoms.

Newer forms of condoms are being developed. A "spray on" condom is being manufactured in Germany. It is not yet commercially available.

Vasal Occlusion
Vasectomy is the safest and most reliable method of male contraception (99% pregnancy free rate/year). About 500,000 vasectomies are done in the United States each year, and about 10% of couples choose this method of birth control. In 1974, the No Scalpel Vasectomy (NSV) was developed in China. Compared to a standard (incision) vasectomy, NSV is quicker, less pain, faster recovery, and eight times fewer complications. It is as successful as a standard vasectomy. The No Needle Vasectomy (NNV) is a newer technique which uses a high pressure jet injector to spray xylocaine through the skin. It is painless and has been associated with less bleeding. While vasectomy can be associated with bleeding, infection and spermatoceles or sperm granulomas rarely, there are very few long term problems. Chronic testis pain or discomfort that lasts more than three months occurs in .1-3% of vasectomies. It generally resolves on its own but may be treated with a vasectomy reversal or epididymectomy. Failure of a vasectomy is also rare, and it is why a sperm count should be done about two months following a vasectomy, to ensure there is a zero or near zero sperm count. Late failure, or the reappearance of sperm after a zero count, is very rare and is estimated to occur in 1 in 6,000 vasectomies (vs. 1 in 100 tubal ligations in women).

Vas Clip is a plastic clip that occludes the vas. It is applied during a routine vasectomy. It has some drawbacks, such as a high failure rate and a large size that can be easily felt. Implied claims of easier vas reversibility are unproven. For this reason, its use is generally not recommended.

Intra Vas is occluding steel plugs that are removable and placed within the vas with a small incision. While it seems to be equal to vasectomy with sperm reduction, it is unclear how reversible it is. It is still being developed and is not yet FDA approved or available.

Medications
A lot of research is being done to develop a male 'pill.' One medication, Adjudin, prevents maturation of sperm. Other medications are being developed to cause a 'dry orgasm'. These have yet to be tested in humans. Most promising seems to be a hormonal medication, usually a combination of testosterone and progestin. These medications seem to reliably suppress sperm production, but have side effects (weight gain, acne), are only 95% effective, with reversibility unproven. Also, it may only be available by injection or implant. There are male 'pill' issues that will prove a challenge before FDA approval. The main concern of men is side effects and reversibility, while women are mainly concerned about effectiveness. Also, the cost, delivery method (pill, injection, etc.) is also uncertain. When can an effective medication for male birth control be expected to be available? Probably ten or more years, the delay mainly occuring because men, regulatory agencies and drug companies all want a safer and more effective medication than the current female pill.