Acceptability of contraception for men: a review

doi:10.1016/j.contraception.2010.03.016

Contraception

Volume 82, Issue 5, November 2010, Pages 453-456

https://doi.org/10.1016/j.contraception.2010.03.016 Get rights and content

Abstract

Methods of contraception for use by men include condoms, withdrawal and vasectomy. Prevalence of use of a method and continuation rates are indirect measures of acceptability. Worldwide, none of these “male methods” accounts for more than 7% of contraceptive use although uptake varies considerably between countries. Acceptability can be assessed directly by asking about intended (hypothetical) use and assessing satisfaction during/after use. Since they have been around for a very long time, there are very few data of this nature on condoms (as contraceptives rather than for prevention of infection), withdrawal or vasectomy. There are direct data on the acceptability of hormonal methods for men but from relatively small clinical trials which undoubtedly do not represent the real world. Surveys undertaken among the male general public demonstrate that, whatever the setting, at least 25% of men — and in most countries substantially more — would consider using hormonal contraception. Although probably an overestimate of the number of potential users when such a method becomes available, it would appear that hormonal contraceptives for men may have an important place on the contraceptive menu. Despite commonly expressed views to the contrary, most women would trust their male partner to use a hormonal method.

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Cited by (67)

Acceptability of innovative male contraceptive methods among major of age heterosexual adult men in France in 2021
2023, Progres en Urologie
De nouvelles méthodes de contraception masculine sont à l’étude : la contraception hormonale masculine, l’occlusion réversible des canaux déférents et la contraception thermique. Cette étude avait pour objectif d’évaluer l’acceptabilité de ces méthodes auprès des hommes.
Nous avons réalisé une enquête d’opinion de juillet à novembre 2021, au travers d’un questionnaire anonyme diffusé en France sur internet. Les sujets étaient des hommes majeurs et hétérosexuels.
Sur les 1545 connexions au questionnaire, nous avons analysé les 905 questionnaires complets. Soixante-treize pour cent des hommes se déclarent favorables à l’adoption d’une méthode de contraception masculine innovante en tant que contraception principale : 64 % en faveur de l’occlusion réversible des canaux déférents, 22 % en faveur de la contraception hormonale masculine et 13 % en faveur de la contraception thermique.
Malgré ses limites, cette étude montre qu’une part importante de la population masculine est intéressée par les modes de contraception innovants la concernant. Ceci devrait inciter à poursuivre les recherches dans ce domaine.
4
New methods of male contraception are being studied: male hormonal contraception, reversible occlusion of the vas deferens and thermal contraception. This study aimed to evaluate the acceptability of these methods among men.
We carried out an opinion survey from July to November 2021, through an anonymous questionnaire distributed in France on the internet. The subjects were adult, heterosexual men.
Of the 1545 connections to the questionnaire, we analyzed the 905 complete questionnaires. Seventy three percent of men say they are in favor of adopting an innovative male contraceptive method as their primary contraception: 64% in favor of reversible occlusion of the vas deferens, 22% in favor of male hormonal contraception and 13% in favor of thermal contraception.
Despite its limitations, this study shows that a significant part of the male population is interested in innovative methods of contraception that concern them. This should encourage continued research in this area.
4
Male contraceptive development: A medicinal chemistry perspective
2022, European Journal of Medicinal Chemistry
There is a need for non-hormonal contraceptives. One area that needs further investigation is the development of male contraceptives. Comparatively little is understood about potential drug targets in men to achieve a reversible contraceptive effect. In this article, we review the need for male contraceptives and some thoughts around the characteristics of a male contraceptive and the potential development pathway. We then discuss different potential approaches to discovering male contraceptives and then highlight potential targets that have been discussed in the literature.
Androgens in male contraception
2022, Best Practice and Research: Clinical Endocrinology and Metabolism
Rates of unplanned pregnancies are high globally, burdening women and families. Efforts to develop male contraceptive agents have been thwarted by unacceptable failure rates, side effects and a dearth of pharmaceutical industry involvement. Hormonal male contraception consists of exogenous androgens which exert negative feedback on the hypothalamic–pituitary–gonadal axis and suppress gonadotropin production. This in turn suppresses testicular testosterone production and sperm maturation. Addition of a progestin suppresses spermatogenesis more effectively in men. Contraceptive efficacy studies in couples have shown male hormonal methods are effective and reversible, but also may come with side effects related to sexual desire, acne and serum cholesterol and inconvenient methods of dosing and delivery. Recently, novel androgens as potential contraceptive agents are being evaluated in early clinical trials and look to overcome these drawbacks. Here we summarize landmark studies of prototype male hormonal contraceptives, showcasing recent advances and future prospects in this important area of public health.
Male contraception: What do women think?
2022, Progres en Urologie
Women currently bear the most responsibility in contraception, with a wide choice of methods, while only a few existing male contraceptives are available. However, it has been shown that men are willing to get involved in birth control and to control their own fertility. Our research was focused on female population and a survey was carried out to explore women's perceptions of male contraception.
An observational quantitative cross-sectional study using a self-administered-questionnaire was carried out between November 2019 and February 2020. All women aged from 16-years-old to menopause completing the questionnaire were included. Descriptive statistical analyses were conducted, qualitative variables were expressed as counts and frequency.
In total, 379 interpretable completed questionnaires were included. Among the women, 69.7% were in favour of letting men deal with contraception, without referring to a specific method. After having been made aware of the medical information concerning existing male contraceptives and those in development, the proportion of women in favour dropped to 46.7%. The most acceptable method for a majority of women was the male pill, which is still being developed. The majority (78.4%) of the women in our survey felt insufficiently informed about male contraception.
In our study, women seemed to want to share contraceptive responsibility with men, but the lack of information and of acceptable contraception methods available remained an obstacle. Although larger-scale studies are needed to confirm these results, the development of a wider range of male contraception methods seems to be what both men and women have long been expecting.
La responsabilité contraceptive repose aujourd’hui presque exclusivement sur les femmes, avec un large panel de méthodes de contraception disponibles. Bien qu’il ait été démontré que les hommes souhaitent être impliqués dans le contrôle des naissances et de leur propre fertilité, les méthodes de contraception masculines restent anecdotiques. L’acceptabilité de la contraception masculine pour les femmes n’a jamais été étudiée. Le but de ce travail était d’étudier la perception féminine de la contraception masculine.
Une étude observationnelle transversale quantitative à travers des auto-questionnaires auprès de femmes âgées de 16 ans jusqu’à la ménopause a été menée entre novembre 2019 et février 2020. Une analyse statistique descriptive a été conduite, les variables sont exprimées en moyennes et pourcentages.
Au total, 379 questionnaires interprétables ont été inclus. Dans notre cohorte, 69,7 % des femmes interrogées étaient favorables à laisser les hommes gérer la contraception du couple, sans faire référence à une méthode en particulier. Après avoir pris connaissance d’une information médicale exposant les méthodes contraceptives masculines disponibles et en cours d’évaluation, la proportion de femmes favorables chutait à 46,7 %. La méthode la plus acceptable pour la majorité des femmes de la cohorte était une pilule hormonale masculine, toujours en cours de recherche. La majorité (78,4 %) des femmes interrogées ne se sentait pas suffisamment informée en ce qui concerne la contraception masculine.
Dans notre étude, les femmes semblaient vouloir partager la responsabilité contraceptive avec les hommes, mais le manque d’information et de méthode acceptable restent des obstacles. Bien que des études à plus larges échelles soient nécessaire pour confirmer ces résultats, le développement d’une méthode contraceptive masculine fiable et efficace semble être attendu aussi bien par les hommes que par les femmes.
Still no pill for men? Double standards & demarcating values in biomedical research
2022, Studies in History and Philosophy of Science
Citation Excerpt :
However, economists estimate that a 99% effective method would have at least 11 million potential users in the United States alone (Dorman & Bishai, 2012). Furthermore, some significant portion of men have expressed interest in using new hormonal contraception and sharing responsibility (van Wersch et al., 2012), with estimates of interested men worldwide ranging from 25% (Glasier, 2010) to 55% overall and varying by nation from 28.5% in Indonesia to 48.3% in USA and 71.4% in Spain (Heinemann et al., 2005). Men's willingness correlates positively with beliefs about men's shared responsibility for reproduction (Marsiglio & Menaghan, 1987; Weinstein & Goebel, 1979) and with descriptions by others as being more “introspective, labile, and prosocial” rather than “more assertive, conventional, and self-seeking” (Gough, 1979, p. 27).
Double standards are widespread throughout biomedicine, especially in research on reproductive health. One of the clearest cases of double standards involves the feminine gendering of reproductive responsibility for contraception and the continued lack of highly effective, reversible methods for cisgender men. While the biomedical establishment accepts diversity and inclusion as important social values for clinical trials, their continued use of inequitable standards undermines their ability to challenge unfair social hierarchies by developing male contraception. Thus, the gender/sex bias present in contraceptive research raises the “New Demarcation Problem”: If we accept that values can and will play important roles in science, how can we nevertheless distinguish positive influences of values from more corrosive bias? I argue that biomedical researchers ought to aim their clinical trials at equity and utilize methodologies that actually achieve that aim. More specifically, I contend that we can avoid the problem of double standards by gender/sex in contraceptive research by utilizing more equitable standards. My demarcation strategy captures dynamic interplay between values and their effects, with direct policy implications for institutions conducting, funding, and evaluating clinical trials. For male contraceptive trials, this involves shifting risk assessment from an individual model to a shared model for sexual partners.
“I'm not going to be a guinea pig:” Medical mistrust as a barrier to male contraception for Black American men in Los Angeles, CA
2021, Contraception
Racial disparities in unintended pregnancy and contraceptive use in the United States are not mediated by access to family planning services alone. Rather, a history of medical mistrust underlies Black Americans’ adoption of new medical technologies, inclusive of contraception. Efforts to develop hormonal male contraceptives need to incorporate Black Americans’ experiences and perspectives so that new contraceptives enable their reproductive goals and promote gender equity.
Working with our community-based partner, Healthy African American Families in Los Angeles, California, we conducted six 60-minute focus group discussions with 39 Black men over age 18, in ongoing heterosexual relationships, to explore attitudes towards and willingness to use hormonal male contraceptives.
Just over one-third (35%) of respondents reported willingness to use or rely on hormonal male contraceptives. The majority held negative attitudes about hormonal male contraceptives, citing concerns about side effects and safety. Several respondents expressed mistrust of the medical community and medical research, noting that hormonal male contraceptives could be used against Black communities; several expressed unwillingness to trial hormonal male contraceptives without years of testing. However, all groups described scenarios where they would use them despite stated concerns.
Black men's hypothetical willingness to use hormonal male contraceptives is limited by medical mistrust, which may be overcome by their concerns about the unreliability of current options or the contraceptive behaviors of female partners. Nevertheless, addressing Black Americans’ history of medical mistreatment and exploitation will be essential for hormonal male contraceptives to positively contribute to Black men's reproductive options and agency.
While the development of reversible, hormonal male contraception intends to fulfill unmet global needs for contraception, the utility of these hormonal male contraceptive methods among Black men living on low incomes in Los Angeles, California cannot be fully realized until developers address and overcome historical and ongoing medical mistrust.

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Review articleAcceptability of contraception for men: a review

Abstract

Contraception

Contraception

Reprod Health Matters

United Nations, Department of Economic and Social Affairs, Population Division (2009). World Contraceptive Use 2009 (POP/DB/CP/Rev2009)

Barrier contraceptive method acceptability and choice are not reliable indicators of use

Sex Transm Dis

Omnibus Survey Report No 30. Contraception and sexual health 2005/06

Expert consultation on vasectomy: meeting report, Washington, D.C.

Review article
Acceptability of contraception for men: a review