Taboos define social practices, behaviors or actions that are forbidden, censored or invisibilized by a human society, due to cultural, social or religious issues. The taboo concerns major prohibitions, anything that seems unnatural, that puts at risk the survival of the species, civilization or the power in place. In 2020, should we still consider male contraception to be taboo, and restrict the field of action of men who have been contracepted, confined to secrecy and privacy? In this article, we'll look at the obstacles to more shared contraception, the taboos surrounding men's and women's bodies, the resistance to change, to the margins and to innovation. And we'll look at the future of male contraception.
The limits of female contraception: the contraceptive obligation
Female contraception has been legal for 50 years. Just long enough to begin analyzing its social, health and psychological implications in the lives of women and their couples. While it's impossible to question the major contribution made by female contraception to women's access to financial independence and the choice to freely dispose of their own bodies, we seem to have missed out on a fundamental aspect of contraception: it could be thought about and practiced by two people. Once the period of sexual freedom and uninhibited pleasure had passed, condoms became essential in the fight against STIs, and the only women able to benefit from contraceptive comfort are faithful couples. No man, no contraception. Yet, over the years, women have come to carry the burden of contraception alone, experiencing it as an obligation, a matter of course. Some suffer from this, while others would prefer to rely on their partners, during transitions such as the post-partum period, for example, or at the end of their fertility, in the years leading up to menopause.
Couple contraception: greater freedom of contraceptive choice
Contraception for couples has become a social issue, where freedom of choice is opposed to compulsory contraception, for both women and men. Male contraception, managed by men, offers an alternative for couples, complementing or taking over from conventional methods. It also enables men to choose their own fertile period.
Men's bodies in sexuality and medicine
While the female body is the center of reproductive function, it has been treated by medicine in its functional aspect for centuries. It's only recently that the pleasure function has been discovered and explored. Men's bodies have therefore been completely excluded from the contraceptive field. It's only with the decline in male fertility that studies have emerged to try and understand this phenomenon. However, a male body is always fertile, from adolescence to death, and men do not experience a complete and definitive halt (apart from reproductive disorders) to their spermatogenesis. The methods available are mechanical (condoms, coitus interruptus or abstinence), but do not take into accountthe physiology of semen production and reproductive function as a whole. When it comes to STI prevention or the normal functioning of their reproductive systems, men don't have the same routine contacts as women do with their gynecologist, whom they are obliged to visit at least once a year. General practitioner, dermatologist, urologist: the care pathway for access to male sexual health is not clearly defined.
Male contraception: the missing link in the gender equity issue
In recent years, social issues concerning male-female relations have constantly called men's place into question. Male contraception provides a partial answer, but could well change roles by balancing them out.
All that's left is to create a language, a vocabulary, words for what doesn't yet exist: contracepted men, testicular contraception, slow contraception and so on. Putting words to male contraception when society is silent means raising the profile of the second major player in contraception, and bringing the male body out of silence and inaction.
Method: Action research for male contraception
Action, experimentation and intervention: these are the tools at work in male thermal contraception research over the last 40 years. One of the best ways to overcome taboos is to change habits and create a culture of male contraception, through social proof.
Overcoming social and cultural obstacles
Contraception has always been a woman's business. But the world has evolved, and despite strong resistance to change, contraceptive techniques that can be used by men are beginning to emerge. As Pr Thierry Troussier, public health physician and sexologist, reminded us at the ANCIC 2019 Congress:
- 90% of men think that contraception is as much a matter for men as it is for women;
- 61% are willing to try a male contraceptive pill;
- For Male thermal contraception (MTC), after information for users and training for professionals, 29% are ready to try it and 40% to prescribe it.
It is therefore essential to understand resistance, obstacles and barriers, in order to adapt a satisfactory response and find the tools that will enable men who so wish tohave access to suitable male contraception.
What's the latest in male thermal contraception research?
Testicular contraception has been the subject of action research for over 40 years. Developed by groups of men and convinced users, it has been the subject of several clinical studies, the validity of whose results is limited by the small number of participants. Studies and small-scale clinical trials have nevertheless produced encouraging results. This is a promising method:
- 99% reliable;
- very few side effects;
- limited contraindications;
- increasingly easy-to-use tools;
- a well-defined thermal protocol.
So what does thermal male contraception need today?
- conduct clinical trials on a larger scale;
- be approved by the Bioethics Commission for official marketing;
- integrate male methods into the medical practices of sexuality professionals.
Realities on the ground and change-makers
At the origin of the discovery of male thermal contraception, there are men, with real practical needs, for themselves, to relieve their partners and for their couples. Every day, a man discovers male contraceptive practices, and more and more men are being contracepted. Who do they talk to? Family planning centers, GPs and some university hospitals are slowly learning more. But some men find themselves isolated: how can we support them in their efforts? We still need to make Male thermal contraception (MTC) a method accessible to users accompanied by health professionals.
Innovation and results: A new start for male thermal contraception
The results of initial research and action taken by citizen groups and individuals are really just a starting point. While thermal male contraception is a functional method that has been acclaimed by its users, it has yet to gain the support and validation of the relevant medical authorities. Thermal male contraception is a concrete proposal for temporary male contraception. Non-surgical, it complements vasectomy, which remains largely inaccessible to young men who have never had children, and is therefore proposed as a permanent contraceptive solution.
A contraceptive method that escapes health scandals
Thermal male contraception, because it relies on the natural rhythm of spermatogenesis, offers the possibility of non-chemical contraception, without hormones or ingestion of products whose side effects will take decades to test. 2019 has been an important year in male contraception innovations, with the Indian RISUG or the American male pill still undergoing testing, before they can be brought to market. In France, we have a reversible and functional male contraceptive that can be used very soon, with very few side effects, which increases the contraceptive choice and allows it to be adapted to each individual case.
Ethical contraception for couples in line with the national sexual health strategy
According to the World Health Organization (WHO): "Sexual health is a state of physical, emotional, mental and social well-being related to sexuality, and not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the ability to have safe and pleasurable sexual experiences, free from coercion, discrimination and violence. To achieve and maintain good sexual health, the human and sexual rights of all people must be respected, protected and fulfilled. Male thermal contraception is a tangible response to the needs of users, men, women and couples, respecting equitable sexuality and guaranteeing contraceptive choice. It offers greater freedom of action:
- Evoking the male body's reproductive function is an ideal opportunity for young people to understand how their bodies work, so they can take care of them through contraception and improve their reproductive health (spermatogenesis, healthy living, good body practices);
- Talking about contraception for couples provides another entry point to sexually transmitted infections (STIs);
- offer women an alternative contraceptive option and provide them with a real contraceptive choice, not just one based on their own body;
- promote research, knowledge and innovation in sexual health.
Conclusion: What do we need?
The question of testicular contraception raises issues of ethics, clinical practice, research and the transmission of knowledge. The involvement of academics, practitioners, doctors, non-doctors, teachers, students, men and women is essential, in a spirit of joint action, to move this fundamental issue forward in the evolution of our society towards greater equity between men and women.
Develop an access strategy for couple contraception in general and male contraception in particular
Male contraception needs training in healthcare facilities, for professionals and those who work with the public:
- Set up online data to provide access to resources, disseminate protocols and highlight best practices;
- create publications to reassure, share and exchange;
- create and organize training courses and forums for exchanging and sharing experiences.
A practical tool for male thermal contraception
To reach the general public, male thermal contraception needs to create a tool validated by sexual health professionals (experimentation, support from GPs and some andrologists): effective, ergonomic and comfortable tools. We also need to develop and simplify access to the testicular thermal contraception protocol.
Integrating testicular contraception into professional practice
For the future of this contraceptive method, it is essential to support and facilitate societal change, so that testicular contraception becomes an integral part of the professional practices of sexual health practitioners. For shared contraception to see the light of day, the support of sexual health practitioners is essential.