Sexuality does not only equate to vaginal penetration and/or ejaculation. Engaging in physical love is penetrating a space made of a whole array of gestures that are as wide as the Universe.
Overview
- General information
- A better understanding
- The Pearl Index and the contraceptive threshold
- A presentation of the 15 natural or low-medicalisation methods
- A presentation of the 12 artificial of high-medicalisation methods acing on men’s fertility
We invite you to download the article entitled Another view on contraception, which contains different tools to help you decide than those offered here :
- A spider web graph with comparative studies regarding low-medicalisation natural methods
- Overview of the natural methods available
- Overview of the artificial methods available
General information
A fair contraception is a contraception that results from a free and informed choice.
The choice of any method is at the crossroads between the health and experience of the woman and/or the couple, their sexuality, their desire to have children, the religious and sociocultural representations and norms. This choice can vary depending on the age and the stage of life, the health condition and the lifestyle of the person.
Each contraception method comes with its own set of advantages and downsides that need to be known in advance.
The efficiency of the method depends greatly on its correct use. It is therefore essential to know how to react when faced with a problem while using it.
Here are a few of the criteria that can help making a choice : efficiency, reversibility, no side effects, acceptability, cost.
Diversifying and adapting the methods throughout the contraceptive journey is an interesting topic to reflect upon.
Each of the two partners is responsible for their own fertility and their own contraception. An inclusive and mutual model in which each partner uses the method that best suits them at the same time is a perfectly viable solution.
Coupling two natural contraception methods, one female and one male, would obviously result in a greater theoretical and practical efficiency than each method would achieve on its own. It is time we started normalising combined or hybrid methods in our current contraceptive models.
What is the first contraception visit? “Since contraceptives are medicines, this first visit is designed to make sure the person can safely use the method they wish to use.” (extract from ChoisirSaContraception ). This visit with a specialist is prescribed by your general practitioner.
Since natural contraception methods are not medicines, we could offer to create the first natural pre-contraception visit, with or without specific tools for the couple, which would include the following aspects:
- Reminding about the concept of free and informed decision-making and of the non-judgemental nature of individual or couple choices;
- Explaining the eligibility criteria for contraception methods, their adaptability to the life and experience of the person, as well as the importance of using a variety of methods in order to limit secondary pathologies and long-term risks;
- Presenting the natural methods available;
- Presenting the hybrid or inclusive contraceptive model for greater theoretical and practical efficiency;
- Providing anatomical and physiological information;
- Evaluating the individual or mutual choice with a benefits/risk approach (done by a professional);
- Taking the individual and the couple into account, with some time devoted to each person as well as a discussion with the couple;
- Offering a health check (STI screening, for instance)
Here is a new categorisation of the types of contraception methods we could envision in terms of intrinsic medicalisation:
- Low: with natural methods, with or without tools, often ancestral and collaborative, requiring the user to get in touch with their body. The mental, physical and emotional loads may be heavier here, since the efficiency indices are usually lower than that of medical methods. This is combined with a high level of responsibility and with skills that need to be acquired.
- High: with artificial methods, often invasive, occlusive, requiring the use of medicines or surgery, associated with significant risks. These methods are chemical, modern, individual and require no or minimal relationship between the user and their body. The mental, physical and emotional loads are high as well, but in a different way, just like the degree of responsibility.
This approach, which does not place the focus on gender – male or female – but on how medicalised the method is – low-medicalisation for so-called natural methods, with or without a device ; high-medicalisation for so-called artificial methods – is said to have a substantial social impact on the various practices, on the risks/benefits balance and on the social and financial cost of the contraceptive experience of the users. It also leads to better fertility management, to better health for women and for men and to rediscovering our intimate relationship to ourselves and our partners.
Contraception is not an illness. According to the principles of bodily autonomy and of freedom of choice regarding one’s contraception, and to the definition of freedom which is “being able to do anything that doesn’t cause harm to others”, it would be interesting to question the requirement for every contraceptive device to be considered a medical device and, as such, to go through the same costly and lengthy circuit than a medicine, i. e. the CE marking as well as an MA (Marketing Authorisation).
A new approach, at least for natural contraception methods, could be considered, taking past successes and failures into account, and offering a simplified circuit while maintaining a quality and safety guarantee, with regard to the purpose of the said methods, and to the choice of eligible methods in this new contraceptive era.
“It takes time to market a new drug
The first step is the discovery with a phase of optimisation: some twenty products are tested, some thirty universities and research centres across the world work on it.
The second step is about developing the product, with a preclinical development phase:
- Phase 1 (4 years): human trials (injectable DMAU for instance);
- Phase 2 (6 years): security & efficiency (nestorone & testosterone gel with the Population Council & oral DMAU for instance);
- Phase 3 (4 years): fine-tuning, pre-marketing;
Phase 4 (2 years) : MA (Marketing Authorisation).
As a result, there is little hope to see marketing authorisations before 2030, which makes the two “French” alternatives – that can be used with doctors applying the protocols of Dr. Soufir and Dr. Mieusset – very attractive.
Excerpt from the AFC newsletter (in French): Un sujet d'actualité : la contraception masculine” (Male contraception: a trending topic), October 2018.
Couldn't natural and low-medicalisation methods benefit from a different circuit than that of drugs?
A better understanding
“Male contraception includes contraceptives and sterilisation.
The definition of contraception is: ‘A method used to mute one’s fertility.’ Sterilisation is a more general term meaning: ‘A method that destroys microorganisms.’ Sterilisation can thus have a contraceptive purpose. Female or male sterilisation is a surgical act practised by a doctor in a private or public healthcare facility (hospital or clinic). This contraception method is completely different than all other available methods because its purpose is to permanently prevent procreation. As such, it should be considered irreversible.
Spermatogenesis takes place in the testicles from spermatogonial cells (stem cells) that then become primary spermatocytes. Primary spermatocytes go through the reductional division phase (meiosis) to become secondary spermatocytes. These secondary spermatocytes become spermatids after they undergo mitosis or equational division. Spermatids, which are actually immature spermatozoa, go through a maturing phase called spermiogenesis in order to produce spermatozoa. So when they come out of the testicle, the spermatozoa, even though they are morphologically differentiated, are immature and not fertile yet. They will become fertile while going through the epididymis (a long, coiled tube). The spermatozoa then transit into the vas deferens towards the prostate gland.
A contraception method aims at avoiding the fertilisation of an egg by a spermatozoon. It must present four key criteria:
- efficient;
- reversible;
- acceptable;
- affordable.”
Excerpt from Association Française d'Urologie - Référentiel du Collège - Contraception masculine
The Pearl Index, a statistic that only measures effectiveness
This statistical index dates back to 1933 and was formulated by the American scientist Raymond Pearl. It is the percentage of unwanted pregnancies per 100 women who used the same contraceptive method for a full year.
"The effectiveness of a contraceptive method is assessed by the Pearl Index (PI) calculated using the following formula: PI (%) = [(number of unplanned pregnancies/number of months a contraception method has been used) × 1200]/100."
Excerpt from Association Française d'Urologie - Référentiel du Collège - Contraception masculine
“The theoretical effectiveness of a contraceptive method is measured with the Pearl Index, a theoretical index that equals the percentage of ‘accidental’ pregnancies over the course of one year of optimum use of the method.
For example, a Pearl Index of 2 means that 2 women out of 100 using the examined method for one year were pregnant during that year.
This theoretical effectiveness that implies correct use of the method is then compared to the practical effectiveness, calculated on the basis of the whole sample, including the couples who have not respected the method (i.e. who forgot to take the pill, who wrongly used a condom, and so on). This method allows us to assess the risk of a pregnancy specific to the contraceptive method itself as well as the risk specific to its use in everyday life.
A significant gap between the theoretical and the practical effectiveness usually means that the contraceptive method is difficult or constraining to use. The gap between the theoretical and the practical effectiveness is particularly large for the pill (due to oversights), for condoms (due to tears or wrong positioning), and for natural methods (due to the constraints of self-observation).”
Excerpt from the HAS - High Sanitary Authority - The effectiveness of contraceptive methods
The Pearl Index accounts for failures. With a more positive approach, we will reverse the counting and suggest the number of unwanted pregnancies that, indeed, did not occur. Just like the World Health Organisation, instead of saying the Index is 1 for instance, we will state that the method is 99% effective.
As a reminder, if you do not use any method, you have 85% chances – both theoretical and practical – to fulfil your desire to have a child.
The decision process could be eased with the creation of a new statistical index based not only on the risk of an unwanted pregnancy, but also on the acceptability of the method, on its ecologic impact, its practicality in everyday life and its safeness with regard to its reversibility and its potential side or adverse effects.
The contraceptive threshold:
It is the concentration of spermatozoa expressed in million per ml on an ejaculate, below which the risk of an unwanted pregnancy leans towards 0.
It is difficult to determine it precisely, because to do so would require couples to get pregnant with very low sperm concentrations. That is why the chosen value of 1 million/ml is extremely low to take as many precautions as possible. It is important to remember that no method of contraception is 100% safe. Even vasectomy has a Pearl Index of only 99.9%/
Here are some figures to understand how the value of 1 million/ml guarantees minimum risk:
- 1 unintended pregnancy out of over 1331 exposure cycles in clinical trials, due to misuse of the method.
- The infertility threshold is 15 million/ml with a progressive motility higher than 32%. This means that below that threshold, it is hard to conceive a child.
- A WHO study on infertility that followed 4500 men accross14 countries who had had a child within the 12 previous months shows that below 5 to 6 million/ml, the chances of conceiving is close to 0. The study concludes by providing a limitation, which is that a paternity test could have been carried out for the small amount of men who had had children despite a sperm count that was below 5 million/ml.
- For many years, the official WHO infertility threshold was 3 million/ml with a progressive motility inferior to 10%.
- Several years ago, this threshold was lowered for all contraceptive practices to 1 million/ml with a progressive motility inferior to 10%.
A presentation of the 15 natural or low-medicalisation methods:
Sorted alphabetically
Anejaculation or retrograde ejaculation
- Practical/theoretical effectiveness (%): 78/96
- How to: Block the urethral lumen at the level of the perineum with your fingers, by contracting the pelvic floor or with an external accessory. The sperm is redirected into the bladder.
- Contraindications / not advised to / constraints: Requires good self-awareness. Ejaculation can sometimes be uncontrollable. What’s more, the first drops of sperm, which may contain many spermatozoa, sometimes come out without the man feeling them: the pre-ejaculatory fluid (or pre-cum) contains enough spermatozoa to fertilize the oocyte and thus cause a pregnancy.
- Reversibility: yes
- Side or adverse effects: no
- Individual or couple acceptability: good
- Cost: free
- Reimbursed by the social security system: no
To explore this technique, read this article (in French) about orgasms and tantra.
Hot bath
- Practical/theoretical effectiveness (%): unknown/unknown
- How to: the man sits in a bath heated to 41.7°C for 45 minutes every day for 25 days. He is then sterile for 4 to 7 months.
- Contraindications / not advised to / constraints: unknown
- Reversibility: unknown
- Side or adverse effects: unknown
- Individual or couple acceptability: unknown
- Cost: free
- Reimbursed by the social security system: no
Cervical cap
- Practical/theoretical effectiveness (%): 84/91
- How to: (made from silicon) slip it into the vagina, in contact with the cervix, to prevent spermatozoa to get into the uterus.
- Contraindications / not advised to / constraints: Multipara, women for whom a pregnancy would represent a serious risk, suffering from recurrent urinary tract infections or from a prolapse.
- Reversibility: yes
- Side or adverse effects: no
- Individual or couple acceptability: good
- Cost: €60 / product
- Reimbursed by the social security system: no
Diaphragm + spermicides
- Practical/theoretical effectiveness (%): 88/94
- How to: Rubber half-sphere placed in the vagina. Prevents sperm from entering the cervix. It should be left in place for 8 hours after an intercourse (and removed no later than 24 hours after it).
- Contraindications / not advised to / constraints: Women who are uncomfortable with the idea of putting their fingers inside their vagina to place their contraception device. Women for whom pregnancy would represent a serious risk (heart disease, for example), as the protection against pregnancy offered by the cervical cap is not sufficient. Women suffering from recurrent urinary tract infections or from a prolapse (pelvic organ prolapse). Women who have already had several children because the physical changes associated with pregnancy can reduce the effectiveness of this method of contraception. Requires some training.
- Reversibility: yes
- Side or adverse effects: no
- Individual or couple acceptability: good
- Cost: €60 / product
- Reimbursed by the social security system: yes (65%)
To dig deeper:
Contraception with a diaphragm
Gendarussa
- Practical/theoretical effectiveness (%): 99.96/99.96
- How to: Gendarussa has the characteristic of inhibiting hyaluronidase, an enzyme secreted by spermatozoa, which can no longer penetrate the ovum. Drink the leaf juice daily.
- Contraindications / not advised to / constraints: unknown
- Reversibility: unknown
- Side or adverse effects: unknown
- Individual or couple acceptability: unknown
- Cost: unknown
- Reimbursed by the social security system: no
To dig deeper:
Male contraception newsletter (in Frenc), 2018
"Bambang's mission is to transform traditional knowledge into modern knowledge. His contraceptive pill has brought him to several international congresses, including one in Lausanne, Switzerland, where he defended the right to alternative contraceptive methods for men, based on tropical plants.” Read the article (in French). Courrier International
Billings Method
- Practical/theoretical effectiveness (%): 75/95
- How to: Based on the observation of the appearance of the cervical mucus, which varies according to the period of the cycle.
- Contraindications / not advised to / constraints: Requires cooperation and motivation from both partners. This method is for people who can do without penetrative sex for several days. Learning time is 4 cycles. Harder to apply to certain types of lifestyles. Management of the fertile window (you will need to find a suitable barrier method during the fertile period). Difficult to apply during puberty, post-partum, pre-menopause and in cases of irregular cycles and amenorrhoea.
- Reversibility: yes
- Side or adverse effects: no
- Individual or couple acceptability: good
- Cost: free
- Reimbursed by the social security system: no
Knaus-Ogino Method
- Practical/theoretical effectiveness (%): 75/95
- How to: Avoid sexual intercourse during the fertile window for women with regular cycles.
- Contraindications / not advised to / constraints: Requires cooperation and motivation from both partners. This method is for people who can do without penetrative sex for several days. Learning time is 4 cycles. Harder to apply to certain types of lifestyles. Management of the fertile window (you will need to find a suitable barrier method during the fertile period). Difficult to apply during puberty, post-partum, pre-menopause and in cases of irregular cycles and amenorrhoea.
- Reversibility: yes
- Side or adverse effects: no
- Individual or couple acceptability: good
- Cost: free
- Reimbursed by the social security system: no
Temperature Method
- Practical/theoretical effectiveness (%): 75/95
- How to: Requires the woman to check her body temperature every morning upon waking up in order to identify the slight rise in temperature that takes place from the moment of ovulation.
- Contraindications / not advised to / constraints: Requires cooperation and motivation from both partners. This method is for people who can do without penetrative sex for several days. Learning time is 4 cycles. Harder to apply to certain types of lifestyles. Management of the fertile window (you will need to find a suitable barrier method during the fertile period). Difficult to apply during puberty, post-partum, pre-menopause and in cases of irregular cycles and amenorrhoea.
- Reversibility: yes
- Side or adverse effects: no
- Individual or couple acceptability: good
- Cost: free
- Reimbursed by the social security system: no
External condom
- Practical/theoretical effectiveness (%): 79/95
- How to: Keeps the sperm from entering the vagina.
- Contraindications / not advised to / constraints: Allergies to the material.
- Reversibility: yes
- Side or adverse effects: no
- Individual or couple acceptability: good
- Cost: €0.5 / product
- Reimbursed by the social security system: no
Internal condom
- Practical/theoretical effectiveness (%): 85/98
- How to: Keeps the sperm from entering the vagina.
- Contraindications / not advised to / constraints: Allergies to the material.
- Reversibility: yes
- Side or adverse effects: no
- Individual or couple acceptability: good
- Cost: €8.3 for a pack of 3
- Reimbursed by the social security system: no
Testicle lifting
- Practical/theoretical effectiveness (%): 99/99, caution: 3-month delay for it to be effective
- How to: Exposing the testes to body temperature (37°C) by holding them in the inguinal canals for 15 hours a day, 7 days a week. Clinically tested for 4 years. Precautionary principle: use this method for a maximum of 4 consecutive years. Nothing prevents you from using the testicle-lifting method again after a period without it, with your general practitioner's approval. 100% of users respond to this method and reach the 1 million/ml threshold, except in cases of non-compliance.
- Contraindications / not advised to / constraints: Treated or untreated anomaly disrupting normal testicular descent (cryptorchidism, ectopia); treated or untreated inguinal hernia; testicular cancer; varicocele of the spermatic cord; obesity.
- Reversibility: yes. Caution: with a 3-month delay.
- Side or adverse effects: Side effects: Decrease in testicular volume (about 10%) only during the contraceptive period. No adverse effects.
- Individual or couple acceptability: good
- Cost: Andro-switch: 37€ - Briefs: unknown - Jock-strap: unknown - Bra: unknown - Other DIY models: unknown.
- Reimbursed by the social security system: no
Unlike other methods, all contraceptive approaches acting upstream of the sperm discharge are regularly monitored with seminograms. The effectiveness and reversibility of such techniques are therefore closely monitored, which increases the degree of trust that can be placed in these official, but often silenced, alternatives.
For more information, here is a video of andrologist R. Mieusset presenting the male thermal contraception method with testicle lifting as practiced today.
Spermicides
- Practical/theoretical effectiveness (%): 71/82
- How to: A product that destroys spermatozoa. They come in the form of gel or suppositories inserted deep into the vagina.
- Contraindications / not advised to / constraints: Women suffering from a sexually transmitted infection (STI), from a vaginal yeast infection, from recurrent urinary tract infections, or who have vaginal lesions. Women using vaginal medications (e.g., suppositories or creams used to treat yeast infections may render spermicides inactive).
- Reversibility: yes
- Side or adverse effects: no
- Individual or couple acceptability: good
- Cost: €7 to €19 for several doses.
- Reimbursed by the social security system: no
Symptothermal Method or Fertility Awareness
The symptothermal method has several names depending on the training institutions: Sensiplan (Germany, Belgium, the Netherlands, etc.), SymptoTherm (Switzerland), MAO (France, taught by CLER), Séréna (Quebec). They all use the same principle but the training methods vary a little from one to the other.
- Practical/theoretical effectiveness (%): 98.8% / 99.6%
- How to: When using this method, the woman observes her cycle, which allows her to identify her fertile and infertile days (to avoid or promote pregnancy) because unlike a man, she is fertile only one week a month, while he is fertile 24/7.
- 2 parameters are taken into account: temperature (taken upon waking up) AND cervical mucus or cervical position (depending on the woman's preference). Cervical mucus is a secretion that varies according to the moment in the cycle to ensure or not fertility (not to be confused vaginal discharge, as these are two different things: the discharge is the "waste" evacuated by the self-cleaning of the vagina). “When I was a teenager, I always thought it was dirty, but when I learned about this method, I discovered that it was perfectly normal and that thanks to it, I could know at which point I was in my cycle.”
- These 2 factors (temperature and mucus) make it possible to accurately identify the time of ovulation. This double control makes the method much more effective (compared to the temperature method alone, or to the Ogino or Billings methods).
- Contraindications / not advised to / constraints: Requires cooperation and motivation from both partners. This method is for people who can do without penetrative sex for several days. Learning time is 4 cycles. Harder to apply to certain types of lifestyles. Management of the fertile window (you will need to find a suitable barrier method during the fertile period). Difficult to apply during puberty, post-partum, pre-menopause and in cases of irregular cycles and amenorrhoea.
- Reversibility: yes
- Side or adverse effects: no
- Individual or couple acceptability: good
- Cost: €150 for the training, applicable for life.
- Reimbursed by the social security system: no
Excerpt of an article by Chloé De Bon, "Does it work without hormones?", FEMMESProd, March 2019
If you’d like to dig deeper, you can go to this explanatory page by Sexual Health Info.
Removal
- Practical/theoretical effectiveness (%): 78/96
- How to: The penis comes out of the vagina before ejaculation.
- Contraindications / not advised to / constraints: Requires good self-awareness. Ejaculation can sometimes be uncontrollable. What’s more, the first drops of sperm, which may contain many spermatozoa, sometimes come out without the man feeling them: the pre-ejaculatory fluid (or pre-cum) contains enough spermatozoa to fertilize the oocyte and thus cause a pregnancy.
- Reversibility: yes
- Side or adverse effects: no
- Individual or couple acceptability: good
- Cost: free
- Reimbursed by the social security system: no
A presentation of the 12 artificial of high-medicalisation methods acting on men’s fertility:
You can find all 10 other medical or high-medicalisation methods for girls and women on the High Sanitary Authority website.
Sorted alphabetically
Bimek
Preclinical trials are currently carried out.
- Practical/theoretical effectiveness (%): unknown/unknown
- How to: "A saline solution heated to 37°C connected the testicles to the ultrasound transmitter to ensure conductivity. After two fifteen-minute sessions within forty-eight hours, the researchers were able to reduce the sperm count to zero."
- Excerpt from an article published in Le Monde newspaper: Les ultrasons pourraient être utilisés comme contraceptifs masculins (Ultrasounds could be used as contraceptives), 2012
- Contraindications / not advised to / constraints: unknown
- Reversibility: unknown
- Side or adverse effects: unknown
- Individual or couple acceptability: unknown
- Reversibility: unknown
- Reimbursed by the social security system: no
“In fact, scientists identified ultrasound as a potential tool almost 40 years ago after finding that prostate cancer patients treated with ultrasound showed a serious decrease in sperm production.”
Excerpt from an article published in Maxisciences in 2012.
Reproductive Biology and Endocrinology: Therapeutic ultrasound as a potential male contraceptive: power, frequency and temperature required to deplete rat testes of meiotic cells and epididymides of sperm determined using a commercially available system.
Epididymal approach (Drevet)
- Practical/theoretical effectiveness (%): unknown/unknown
- How to: unknown
- Contraindications / not advised to / constraints: unknown
- Reversibility: unknown
- Side or adverse effects: unknown
- Individual or couple acceptability: unknown
- Reversibility: unknown
- Reimbursed by the social security system: no
Several studies are currently being conducted, here are some links about it:
- Male contraception newsletter (in French), 2018
- Urofrance
Here is another alternative tested on animals that relies on epididymal action, with gossypol:
- Epididymal effects of gossypol.Soufir JC, Dantec MC, Jegou B, Folliot R, Garnier DH, Andre J, Stelly N.Lancet. 198414;2(8394):107
- Early effects of gossypol on the testis and epidiymis in the ratRadigue C, Soufir JC, Couvillers ML, Dantec MC, Folliot R.Reprod Nutr Dev. 198828(5):1329
- Effect of gossypol on the morphology, motility and metabolism of a flagellated protist, Dunaliella bioculata.Druez D, Marano F, Calvayrac R, Volochine B, Soufir JC. J Submicrosc Cytol Pathol. 198921(2):367-74.
- Gossypol-induced modifications in the microenvironment of rat epididymal spermatozoa.Soufir JC, Radigue C, Dantec MC, Garnier D, Jegou B.J Reprod Fertil. 198986(2):427-34.
Hormonal gel
- Practical/theoretical effectiveness (%): unknown/unknown
- How to: unknown
- Contraindications / not advised to / constraints: unknown
- Reversibility: unknown
- Side or adverse effects: unknown
- Individual or couple acceptability: unknown
- Reversibility: unknown
- Reimbursed by the social security system: no
Hormonal implant
- Practical/theoretical effectiveness (%): unknown/unknown
- Instructions: unknown
- Contraindications / not advised to / constraints: unknown
- Reversibility: unknown
- Side or adverse effects: unknown
- Individual or couple acceptability: unknown
- Reversibility: unknown
- Reimbursed by the social security system: no
Intramuscular hormone injection
- Practical/theoretical effectiveness (%): 99/99, 3-month delay for it to be effective
- How to: Weekly intramuscular injection. For 18 months according to wide-scale WHO protocols. For unidentified biological reasons, 20% of users do not reach the contraceptive threshold of 1 million/ml.
- Contraindications / not advised to / constraints: >45 years old; single; history of phlebitis or coagulation disorder; cardiac, hepatic, renal, psychiatric, respiratory, dermatological, prostatic pathologies ; family history of prostate cancer; no tobacco or alcohol intoxication; not being treated with drugs that modify androgen transport or that counter peripheral action; BMI>30; no hypertension; no acne; biological check-up must be normal as well as spermatic values.
- Reversibility: yes, with a 1-to-3-month delay.
- Side or adverse effects:
Acne / detectable gynecomastia;
changes in mood (aggressiveness/depression/asthenia);
excessive libido;
weight gain;
changes in lipids or haematocrit;
hypertension;
aphthous ulcers;
acute prostatitis;
- Individual or couple acceptability: good
- Cost: Information not available - ask your general practitioner
- Reimbursed by the social security system: Information not available - ask your general practitioner
For more information, here is a video of Professor and endocrinologist JC Soufir presenting the male hormonal contraception method as practiced today.
Hormonal per os (the pill)
- Practical/theoretical effectiveness (%): unknown/unknown
- How to: unknown
- Contraindications / not advised to / constraints: unknown
- Reversibility: unknown
- Side or adverse effects: unknown
- Individual or couple acceptability: unknown
- Reversibility: unknown
- Reimbursed by the social security system: no
Several studies are currently being conducted, here are some links about it:
Here are some of the studies carried out in France on the hormonal approach in animals:
- Protective effect of medroxyprogesterone acetate plus testosterone against radiation-induced damage to the reproductivefunction of male rats and their offspring.Jégou B, Velez de la Calle JF, Bauché F. PNAS 19911;88(19):8710-4
- Protection by steroid contraceptives against procarbazine-induced sterility and genotoxicity in male rats.Velez de la Calle JF, Jégou B. Cancer Res 199015;50(4):1308-15
Here are some of the studies carried out in France on the hormonal approach for men:
- MPA-TestostéroneReversible inhibition of sperm production and gonadotrophin secretion in men following combined oral medroxyprogesteroneacetate and percutaneous testosterone treatment.Soufir JC, Jouannet P, Marson J, Soumah A. Acta Endocrinol 1983102(4):625-32
- Male contraception: effect on sperm production and gonadotrophin secretion of percutaneous testosterone alone or combined with oral medroxyprogesterone acetate.Soufir JC, Jouannet P, Soumah A. Society for Study of Fertility, Manchester 1983
- Androgenisation of female partners of men on medroxyprogesterone acetate/percutaneous testosterone contraception.Delanoe D, Fougeyrollas B, Meyer L, Thonneau P. Lancet. 19844;1(8371):276
- Inhibition of spermatogenesis in men using various combinations of oral progestagens and percutaneous or oral androgens.Guerin JF, Rollet J. Int J Androl 198811(3):187-99
- Efficiency of a male contraceptive association-oral medroxyprogesteroneacetate-percutaneous testosterone.Soufir JC, Laporte A. IVth International Congrress of Andrology, Florence 1989Contraception in men: efficacy and immediate toxicity. A study of 18 cases.Lobel B, Olivo JF, Guille F, Le Lannou D. Acta Urol Belg. 198957(1):117-24
- Spermatogenetic inhibition in men taking a combination of oral medroxyprogesterone acetate and percutaneoustestosterone as a male contraceptive method.Soufir JC, Meduri G, Ziyyat A. Hum Reprod. 201126(7):1708-14
- Enanthate de TestostéroneContraceptive efficacy of testosterone-induced azoospermia in normal men.WHO Task Force on Methods for the Regulation of Male FertilityLancet 1990336:955-9
- Contraceptive efficacy of testosterone induced oligozoospermia in normal men.WHO Task Force on Methods for the Regulation of Male FertilityFertil Steril 199765:821-9
Obturation of the vas deferens
- Practical/theoretical effectiveness (%): unknown/unknown
- How to: “Studied in China as early as 1988 with simple silk threads. The current device is made of a polyurethane and barium sulphate envelope filled with medical nylon threads (1 mm in diameter and 17 mm long) blocking the spermatozoids but not the epididymal and deferential liquid, therefore there is no dilatation of the canal and no increase in pressure, and less granulomas. Study carried out on 1500 men but none of them asked for reversibility although it seems to be easy. This intra-deferential method seems very promising, close to vasectomy but theoretically reversible.”
Excerpt from a male contraception newsletter (in French), 2018
- Contraindications / not advised to / constraints: unknown
- Reversibility: unknown
- Side or adverse effects: unknown
- Individual or couple acceptability: unknown
- Reversibility: unknown
- Reimbursed by the social security system: no
Ultrasounds
- Practical/theoretical effectiveness (%): unknown/unknown
- How to: "A saline solution heated to 37°C connected the testicles to the ultrasound transmitter to ensure conductivity. After two fifteen-minute sessions within forty-eight hours, the researchers were able to reduce the sperm count to zero."
Excerpt from an article published in Le Monde newspaper: Les ultrasons pourraient être utilisés comme contraceptifs masculins (Ultrasounds could be used as contraceptives), 2012
- Contraindications / not advised to / constraints: unknown
- Reversibility: unknown
- Side or adverse effects: unknown
- Individual or couple acceptability: unknown
- Reversibility: unknown
- Reimbursed by the social security system: no
Several studies are currently being conducted, here are some links about it:
- Parsemus
- Reproductive Biology and Endocrinology: Therapeutic ultrasound as a potential male contraceptive: power, frequency and temperature required to deplete rat testes of meiotic cells and epididymides of sperm determined using a commercially available system.
- “In fact, scientists identified ultrasound as a potential tool almost 40 years ago after finding that prostate cancer patients treated with ultrasound showed a serious decrease in sperm production.”
Excerpt from an article published in Maxisciences in 2012.
RISUG: Reversible Inhibition of Sperm Under Guidance
- Practical/theoretical effectiveness (%): 98% / 97.3% with a 1-to-6-month delay
- How to: inject a gel into a canal through which sperm cells pass after they have been produced, rendering them unable to fulfil their fertilising role. This method is reversible, as the subsequent administration of a chemical agent dissolving the gel is sufficient to remove it from the canal. The procedure takes between 10 and 15 minutes, and is said to provide reliable contraception for 13 years.
- Contraindications / not advised to / constraints: unknown
- Reversibility: delayed from 1 to 3 months, little data on the long term. The 2019 study notes that reversibility is total on about 100 people after one year. Excerpt from wikipédia The contraceptive action appears to be reversible by flushing the vas deferens with another solution, either dimethyl sulphoxide or sodium bicarbonate, although this reversal procedure has only been successfully tested on primates. Unlike vasectomy, the vas deferens is not completely blocked, the body does not have to absorb the blocked sperm, and antibodies are not produced in large numbers.
- Side or adverse effects: Classic after-effects of an operation and anaesthesia; Rare: haematoma or infection at the level of the scars; Failure at a distance from the operation due to repermeation of the vas deferens.
- Individual or couple acceptability: unknown
- Cost: €300 to €600
- Reimbursed by the social security system: no
Several studies are currently being conducted, here are some links about it:
- SALF (French-speaking Andrology society): 2020 Summary available on this page: RISUG as a male contraceptive: journey from bench to bedside
- Vice.com : la longue et pénible histoire de la contraception masculine non-hormonale (The long and arduous history of non-hormonal male contraception)
- NCBI: 1993 Guha Phase I clinical trial of an injectable contraceptive for the male
- NCBI: 1997 Guha Phase II clinical trial of a vas deferens injectable contraceptive for the male
- NCBI: 2014 Lohyia RISUG: An intravasal injectable male contraceptive
- NCBI: 2017 Ansari Safety evaluation through genotoxicity and apoptotic markers following RISUG® induced contraception and its reversal in male rabbits
- NCBI: 2018 Ansari Toxicity and Mutagenicity Evaluation Following RISUG Contraception Reversal in Rats
- NCBI: 2019 Sharma Phase III Safety & efficacy of an intravasal, one-time injectable & non-hormonal male contraceptive (RISUG): A clinical experience
- Futura sciences
SILODOSINE 8mg UROREC: Blocks the contraction of the seminal vesicles so no ejaculation occurs, or so-called dry ejaculation.
- Practical/theoretical effectiveness (%): 99.9% / 99.9%, 3-hour delay
- How to: 3 hours before vaginal intercourse, ingest one SILODOSINE 8 mg pill. No ejaculations for 8 to 13 hours.
- Contraindications / not advised to / constraints: unknown
- Reversibility: Total in 48 hours, total evacuation of the molecule from the body. Ejaculation gest back to normal.
- Side or adverse effects: Stuffy nose 35%; Dizziness 20%; Orthostatic hypotension 20%; Ejaculation difficulties (Uncomfortably delayed ejaculation 18%; Painful ejaculation 3%; Thin ejaculate 5%); Allergic reaction; Swelling of the face; Swelling of the tongue; Pharyngeal edema; Decreased libido; Dizziness; Syncope; Loss of consciousness; Decreased tone of the irisof the eye in case of cataracte surgery.
- Caution : Due to the dilation of the blood vessels, orthostatic hypotensionmay occur within hours of taking the drug. This discomfort, often preceded by dizziness and sweating, is favoured by a sudden change to an upright position (when getting up from a chair or bed). The risks are especially high in the first few days of treatment, during which dangerous activities should be avoided. Then the body adapts to the drug. If you feel dizzy, lie down for a few minutes and stand up gradually.
- Caution for drivers: this drug may cause dizziness.
- Individual or couple acceptability: Good
- Cost: €8 for a box of 30 tablets
- Reimbursed by the social security system: yes (30%)
- Accessibility: only with a prescription from your general practitionner.
A pilot study has been conducted in India for one year on 70 people and a large-scale study is planned for 2021.
This drug has been used for 10 years in urology for the treatment of benign prostatic hypertrophy. To date, no long-term pathology has occurred as a result of taking this drug. Here is how it works:
Silodosin is highly selective for alpha1A adrenergic receptors located primarily in the human prostate, close to the base of the bladder, the bladder neck, the prostate capsule and the prostatic urethra.
When these alpha 1A adrenergic receptors are blocked, the smooth muscles in these tissues relax, which reduces resistance to evacuation from the bladder without affecting the contractility of the detrusor smooth muscle. This helps alleviate both the irritative symptoms due to the filling of the bladder and the obstructive symptoms due to urination (lower urinary tract symptoms, LUTS) associated with benign prostatic hypertrophy.
Silodosin has a significantly lower affinity for alpha 1B adrenergic receptors located mainly in the cardiovascular system. It has been shown in vitro that the alpha 1A/alpha 1B binding ratio of silodosin is extremely high (162/1).
Vasalgel
- Practical/theoretical effectiveness (%): unknown/unknown
- How to: Injecting vasalgel, a polymer, into the vas deferens prevents the passage of spermatozoa. Requires surgery.
- Contraindications / not advised to / constraints: unknown
- Reversibility: "Proven reversibility in rabbits. But progressive decrease in motility and loss of acrosome: functional alteration of spermatozoa?”
Excerpt from a male contraception newsletter (in French), 2018
- Side or adverse effects: Classic after-effects of surgery and anaesthesia; Rare: haematoma or infection of the scars;
- Individual or couple acceptability: unknown
- Reversibility: unknown
- Reimbursed by the social security system: no
For more information, we invite you to visit the following pages (in French):
Vasectomy
- Practical/theoretical effectiveness (%): 99.8/99.9, 3-month delay for it to be effective
- How to: Ligation of the vas deferens under local anesthetic. You will always be asked if you’d like some sperm to be preserved before the vasectomy is performed.
- Contraindications / not advised to / constraints: The surgery can only be performed:
- after an initial informative medical consultation;
- after a reflection period of 4 months following this first consultation;
- and on the condition that the person provides written confirmation of his willingness to undergo this surgery.
- Reversibility: no
- Side or adverse effects: Classic after-effects of an operation and anaesthesia; Rare: haematoma or infection at the level of the scars; Failure at a distance from the operation due to repermeation of the vas deferens.
- Individual or couple acceptability: good
- Cost: €54.89
- Reimbursed by the social security system: yes (70%)
For more information, we invite you to visit the following pages (in French):
- Planning familial & vasectomie (Family planning and vasectomy)
- Urofrance - prise en charge de la vasectomie (Urofrance - reimbursment of vasectomies)