Heterosexual sexuality cannot be reduced to the act of vaginal penetration and/or ejaculation. To enter into physical love is to enter a space of a multitude of gestures and movements as vast as the universe. This is what we learn from Tantric sexual practices. While penetration has long been synonymous with true and authentic sexual intercourse in the official cultural imagination, more and more men and women today are questioning this sexual diktat and exploring other forms of sexuality.
Nevertheless, for all heterosexual couples of childbearing age, the question of contraception, desire and timing of pregnancy, remains a central issue of sexuality. For many men, contraception used to be a woman's business, but with advances in research into male and female anatomy, researchers are discovering that it may no longer be the sole responsibility of women.
Why, at a time when men are preparing to conquer Mars, isn't male contraception normalized and customary?
What is contraception today? What's the current state of male contraception? What criteria characterize a good contraceptive system?
Here's a comprehensive, well-documented dossier that reviews a huge amount of basic information on contraception in
general and male contraception in particular. Our aim is to provide you with all the information you need to make an informed decision about contraception for women, men or couples. Contraceptive choice is fundamental to building a more egalitarian and freer sexuality, for all.
How do I choose a contraceptive method?
Contraceptive choice lies at the crossroads of a woman's and/or couple's health and experience, sexuality, desire for children, and socio-cultural and religious representations and norms. This choice may vary according to age and stage of life, state of health and lifestyle. Although this concept is rarely emphasized, the right contraception is one that is chosen freely and in an informed manner.
Criteria for choosing contraception with a clear conscience:
Every contraceptive method has its advantages and disadvantages, and it's important to be aware of them. To choose a contraceptive method conscientiously, it's useful to know the criteria that help you make your choice:
- efficacy: this criterion largely depends on proper use of the method, so it's important to fully understand all the uses associated with a contraceptive method;
- reversibility: sterilization is a radical and irremediable choice; for a choice to remain open, it must be possible to reverse it, hence the notion of reversibility;
- no undesirable effects: health must not be affected by a contraceptive choice, and it is better to choose a contraceptive method that is the least intrusive possible, based on one's own metabolism;
- acceptability: a method that is freely chosen and consented to will be better experienced and accepted;
- cost: it is important that a contraceptive method is financially accessible or reimbursed by a health organization.
Is it possible to combine several contraceptive methods?
Varying and adapting methods during one's contraceptive journey is a fertile reflection. Both partners are responsible for their own fertility and contraception, and being able to question their usual type of contraception allows them to revisit the foundations of their relational and sexual balance: is it fair and equitable? An inclusive, mutual model where everyone uses the method that suits them at the same time is
entirely feasible. Clearly, coupling two natural contraceptive methods, one for women and the other for men, would be theoretically and practically more effective than either method on its own. When will we see the introduction of combined or hybrid methods in current contraceptive models?
What is the first contraception consultation?
"As contraceptives are medicines, this medical check-up should make it possible to verify that the person can safely take the contraceptive they want." (excerpt from ChoisirSaContraception ) This visit is prescribed by the general practitioner and carried out with a specialist, usually a gynecologist.
While attitudes are changing, it is important to know that many doctors are not in favor of, or well-trained in, natural contraception. It's not uncommon for people wishing to take control of their contraception to be faced with an unsympathetic doctor who won't sincerely support you in your contraceptive project. So, if you feel you've made a firm decision to use alternative contraception, it's important to be well-prepared for your appointment with your doctor. Hence the importance of a natural pre-contraception consultation, to help you get to grips with the tools and different options available.
How do I arrange a consultation for natural contraception?
As natural contraceptives are not drugs, we could propose the creation of the first natural pre-contraception consultation with or without a couple's tool, including :
- Reminder of the concepts of free and informed decision-making and the non-judgmental nature of individual or couple choices;
- Explanation of the eligibility criteria for contraceptive methods, adaptation to the life course, and the variability of methods to limit secondary pathologies and long-term risks;
- Presentation of natural methods;
- Presentation of the hybridized or inclusive model of contraception for improved theoretical and practical effectiveness;
- Provision of anato-physiological knowledge;
- Evaluation of individual or mutual choice, made by a professional, with regard to benefits/risks;
- Consideration of the individual and the couple, with dedicated time for individuals and couples;
- Proposal of a health check-up (STI screening, for example).
A new categorization of contraception:
Here's how we might envisage a new categorization of contraception in terms of its intrinsic degree of medicalization:
- Low degree of medicalization: with natural methods with or without tools, often ancestral, collaborative and requiring the user to make a significant connection with his or her body. Here, the mental, physical and emotional burdens can be heavy (as the effectiveness indices are generally lower than with medicalized methods), and are combined with a high degree of responsibility and a necessary skill to acquire.
- High degree of medicalization: with artificial methods, often invasive, occlusive, medicated, surgical,
with significant associated risks. These methods are chemical, modern and individual, requiring little or no connection between the user and his or her body. The mental, physical and emotional burdens are also significant, but in different ways, as is the degree of empowerment.
This approach, centered no longer on gender (male or female), but on the degree of medicalization, which is low for so-called natural methods with or without tools, and high for so-called artificial methods, would have a significant social impact on :
- practices,
- the benefits/risks balance,
- the social and financial cost of contraceptive paths,
- better fertility management,
- improved health for women and men,
- a rediscovery of intimate knowledge, of oneself and of others.
Contraception is not a disease
In line with the freedom to dispose of one's own body, to freely choose contraception and the definition of freedom as "the freedom to do whatever is not harmful to others", it would be interesting to question the obligation for any contraceptive device to be considered as a medical product, and therefore to follow the same lengthy and costly route as that of a drug, i.e. CE standardization and AMM (Autorisation de Mise sur le Marché).
A new approach, at the very least for natural contraceptive methods, could be envisaged, taking into account past successes and failures, and proposing a simplified route or pathway, while maintaining a quality and safety approach, in view of the
purpose of these methods, as regards the choice of eligible methods in this new contraceptive era.
The timing for bringing a drug to market is long
The first stage of a protocol for bringing a drug or contraceptive device to market is that of discovery, with an
optimization phase: some twenty products are tested; some thirty universities and research centers worldwide
work on it;
The second stage : development with preclinical development:
- phase 1 (4 years): human trials (e.g. DMAU injectable),
- Phase 2 (6 years): safety & efficacy (e.g. nestorone & testosterone gel with Population council & dMAU oral),
- Phase 3 (4 years): development, pre-marketing,
The third stage (2 years) : AMM (Autorisation de mise sur le marché);
So we can't expect to have any products on the market before 2030, which makes the two "French" methods very attractive for use with doctors referring to Dr Soufir's and Dr Mieusset's protocols." From the AFC Newsletter "A hot topic: male contraception", Oct 2018.
Couldn't natural, low-medication methods benefit from a different route to that of drugs?
The 4 essential criteria for a contraceptive method
To better understand where male contraception stands today, it's instructive to read this excerpt from the Association Française d'Urologie - Référentiel du Collège - Contraception masculine: "Male contraception includes contraceptive means and sterilization. The definition of contraception is: "a method of achieving zero fertility". Sterilization is a more general term meaning "a method that destroys micro-organisms". Thus, there is sterilization for contraceptive purposes. Female or male sterilization is a surgical procedure performed by a doctor in a public or private health establishment (hospital or clinic). It is a contraceptive method that differs profoundly from other existing methods, since its aim is to prevent procreation for good. It should be considered irreversible.
Spermatogenesis takes place in the testicles from spermatogonia (stem cells), which then transform into spermatocytes I, which undergo the reduction mitosis of meiosis to give spermatocytes II. These spermatocytes II then undergo equational mitosis to produce spermatids. The spermatids, which are actually immature spermatozoa, undergo a maturation phase, called spermiogenesis, to give rise to spermatozoa. On leaving the testicle, spermatozoa, although morphologically differentiated, are immature and non-fertile, and will become so as they pass through the epididymis (which corresponds to the epididymal duct, a long tube wrapped around itself). Sperm then travel through the vas deferens to the prostate.
A contraceptive method aims to prevent the fertilization of an ovum by a spermatozoon. It must meet four essential criteria:
- efficient
- reversible
- acceptable
- low cost
Pearl index and contraceptive threshold :
definitions
How do you measure the effectiveness of a contraceptive method? An American researcher, Raymond Pearl, has proposed a statistical index to determine the number of unwanted pregnancies in relation to the number of pregnancies avoided over the course of a year. This index expresses the failure rate of a contraceptive method. We propose an alternative way of quantifying the efficacy of contraceptive methods, as well as a reassessment of the contraceptive threshold in the count of sperm present in an ejaculate.
Pearl Index: a statistic that measures the effectiveness of contraception.
This statistical index dates back to 1933, and was formulated by the American scientist Raymond Pearl. It corresponds to the percentage of unwanted pregnancies per hundred women using the same method of contraception for a full year.
"The effectiveness of a contraceptive method is evaluated by the Pearl Index (PI) calculated by the following formula: PI (%) = [(number of unplanned pregnancies/number of months using a contraceptive method) × 1,200]/100."
Extract from Association Française d'Urologie - Référentiel du Collège - Male contraception
"The theoretical effectiveness of a contraceptive method is measured by the Pearl index, a theoretical index equal to the percentage of "accidental" pregnancies over one year of optimal use of the method.
For example, a Pearl index = 2 means that 2 out of every 100 women using the contraceptive method analyzed for one year were
pregnant within the year.
This theoretical efficacy, resulting from correct use of the method, is compared with the practical efficacy, calculated on the whole sample, including couples who have not used the method correctly (forgotten to take the pill, incorrect use of condoms, etc.). This enables
us to assess the risk of pregnancy specific to the contraceptive method itself, and the risk specific to its use in everyday life. A significant discrepancy between theoretical and practical efficacy is generally due to complex or restrictive use of the contraceptive method. Thus, the gap between theoretical and practical effectiveness is particularly wide for the pill (due to forgetfulness), for condoms (due to breakage or incorrect insertion) and for natural methods (due to difficulties associated with
self-observation constraints)."
Extract from HAS - Haute Autorité de Santé - Efficacité des moyens contraceptifs
Why do we propose a different counting method?
The Pearl index therefore counts failures. For a more positive approach, we'll reverse the counting and propose the number of successful unwanted pregnancies. Like the World Health Organization, instead of saying that, for example, the index is 1, we'll say that
the effectiveness is 99%. As a reminder, if you don't use any method, you have an 85% theoretical and practical probability of realizing your desire for a child.
The creation of a new statistical index based not only on the risk of unwanted pregnancy, but also on the acceptability of the method, its ecological impact, its practicality in everyday life, and its safety in terms of reversibility and potential side effects and adverse reactions, could help in the decision-making process.
The contraceptive threshold: 1 million sperm per ml guarantees a minimal risk of pregnancy
This is the concentration of sperm per million ml of ejaculate, below which the risk of an unwanted pregnancy tends towards 0.
It's tricky to determine precisely, as to do so would require couples to achieve pregnancies with very low sperm concentrations. This is why the announced threshold of 1 million/ml is extremely low, to take maximum precaution.
It's worth remembering that no method of contraception is 100% safe. Even vasectomy only has a Pearl index of 99.9%.
A few figures to help you understand how the 1 million/ml value guarantees minimal risk:
- 1 unwanted pregnancy out of over 1,331 exposure cycles in clinical trials, due to incorrect use of the method.
- The infertility threshold is 15 million/ml and progressive mobility over 32%. This means that below this threshold, it is difficult to have a child.
- A WHO study on infertility involving 4,500 boys from 14 countries who had had a child in the previous 12 months, shows that below 5 to 6 million/ml, the probability of having a child is close to 0. The study concludes with a limitation, which is that
paternity testing could have been considered for the small number of children born to boys with concentrations below 5 million/ml.
- The official WHO threshold for many years was 3 million/ml and progressive mobility below 10%.
- In recent years, this threshold has been lowered for all contraceptive practices to 1 million/ml and progressive mobility below 10%.
Labrit Maxime 06-15-2019