During our bimonthly sex-ed classes, Miss Parker would dedicate five long minutes to the virtues of abstinence and the other 55 to safe sex--different methods of birth control, how to pick and use a condom. She would also dwell on the consequences of unsafe sex--unplanned pregnancies, sexually transmitted diseases. Miss Parker urged the young women in her classes to seize control of their sexuality. Because of her, I can still correctly identify the clap out of a disease lineup. And I've been very careful about what I put into my body ever since.
However, much has changed concerning contraceptives since my pubescence. Although the female condom was approved by the Food and Drug Administration in 1993, the concept of fucking a woman with a Hefty bag inside her didn't catch on until I was nearly 20, making sex safer for women and creepier for their partners. Today over 86 percent of employer-provided health plans cover contraceptive costs, according to the Alan Guttmacher Institute. And 43 years after birth control pills became available to women, scientists are predicting that men will have access to their own hormonal birth control within the next decade.
Whether it is possible to completely suppress the 20 million to 200 million sperm found per milliliter of ejaculate is no longer a question. It can be done. What's up in the air, however, is what form this birth control will ultimately take. It may wind up being a pill, a shot, or an adhesive patch. Regardless, whether or not men, who have long regarded birth control as the woman's responsibility, will take responsibility for keeping their partners out of America's maternity wards and abortion clinics is a question that heterosexuals will have to consider with growing seriousness.
Currently, condoms and vasectomy are the only reliable contraceptive methods available to men. Vasectomies require a simple outpatient surgery that entails severing both the vas deferens, the tubes that transport sperm from the nuts to the ejaculatory duct. The Associated Urologists of Orange County estimates that 500,000 vasectomies are performed in the United States annually. However, roughly one-third of men experience chronic testicular discomfort after their operation. Vasectomies are also considered irreversible, which makes them an unattractive option for many men.
And then there are condoms--which actually haven't changed all that much since my pubescence. They have a 98 percent effectiveness rate when used correctly and consistently. Plus, they are the only form of birth control that offers protection against a host of STDs (HIV, chlamydia, fruit flies, etc.). But despite the protection they provide, condoms don't seem to hold much appeal for men. When I asked 13 male friends to rate having sex with a condom, 10 complained of reduced sexual pleasure with condoms; half bitched about inconvenience or awkwardness of putting a condom on during sex.
Dr. John Amory, the assistant professor of medicine at UW's Center for Research in Reproduction and Contraception, believes men deserve better. "If you look at the current breakdown of contraceptive use by couples, roughly one-third is male-directed, with 14 percent using condoms and 17 percent relying on vasectomy," said Dr. Amory. "Men are more interested in having sex than in being parents. They need more options."
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I lost my virginity at the age of 16 to a soccer player named Aaron. Our courtship was brief and endearingly trashy. He took me out for hot wings at Red Robin. He had a cute butt. He didn't want to be a father, but he argued that condoms didn't "feel good." Aaron suggested the pullout method. I suggested no sex at all. We compromised on a condom. When he climaxed, he'd shout, "Eye of the tiger!" He did this every time we had sex. It was like his own team cheer. Climax. "Eye of the tiger!" Our relationship didn't last long: He had no concept of foreplay so I had no climaxes, no team cheer of my own.
In that relationship, and in all subsequent relationships, I have been in charge of contraception--be it buying condoms, taking birth control pills, or running to the pharmacy for emergency contraception. While none of my boyfriends wanted me getting pregnant, not one was proactive about ensuring that I wouldn't wind up pregnant--and many objected to condoms on the grounds of diminished sensations and pleasure. Mike liked pulling out, Chris wouldn't use condoms, and Brandon only liked novelty condoms--say, condoms featuring images of KISS members.
I don't limit my dating pool to irresponsible freaks, though these examples suggest otherwise. All three were nice men who exhibited maturity and good judgment in many aspects of their lives--just not in the bedroom. That may be because men have historically been able to avoid the consequences that come with being sexually active. While straight men and women may be at roughly equal risk for STDs, men don't get pregnant. Roughly half of all pregnancies in the U.S. are unplanned, according to the Guttmacher Institute, and until child support became nationally scrutinized and enforced in the 1980s, unmarried and divorced men could easily avoid taking financial responsibility for their children. It's not so easy for men to walk away today. Nevertheless, I am more than willing to shoulder a greater share of the responsibility in the bedroom to protect my safety and health. I will take the pill, I will buy the dreaded condoms.
Given the objections raised by the men I've had sex with about condoms, it seems to me that any hormonal contraceptive designed for males would fail if it provided them with anything less than a pleasant experience. Bearing that it mind, the contraceptives being explored by researchers don't seem very promising.
Most of the male contraceptives being developed today involve the hormone testosterone. When the brain senses an increase in testosterone levels, it discontinues the secretion of luteinizing hormones (LH), which control testosterone synthesis in the testes, and follicle stimulating hormones (FSH), which contribute to sperm cell maturation. Without these hormones, the testes stop manufacturing sperm. A contraceptive that convinced the body to stop producing sperm would not affect existing sperm; it would simply disrupt the production of new sperm, making for a delay of two to three months before sterilization occurred. Because testosterone is rapidly metabolized in the liver when ingested, it must be injected into the body every two weeks, according to Dr. Amory. And if twice-a-month injections and a three-month wait aren't big enough disincentives, potential side effects include oily skin, acne, and shrunken testicles.
Making matters worse, testosterone isn't completely reliable at suppressing sperm production in all men. In a recent study conducted by the World Health Organization in Asia, Europe, and Australia, only 60 percent of European and Australian men reached azoospermia, or a complete absence of sperm in their ejaculate, after receiving testosterone injections for six months. Ninety percent of Asian men, however, reached azoospermia.
Why some men fail to respond to testosterone injections remains a mystery. However, Dr. Amory hypothesizes that a diet rich in soy could cause Asian men to be more responsive to testosterone as a contraceptive. While he is interested in pursuing this theory and exploring how diet could affect sperm production and contraception, Dr. Amory's secret fantasy is to become a God among men: "My dream would be to create a safe, effective male contraceptive that would impact rates of testicular and prostate cancer among men, while alleviating male pattern baldness." And I dream of battery-free orgasms, doctor.
Since testosterone is not a reliable contraceptive, researchers have turned to variations of the hormone to reduce sperm count. One such variation, 7a-methyl-19-nortestosterone (MENT), takes the form of two small rods implanted in the upper arm. While this synthetic hormone acts like testosterone, MENT may also reduce the risk of long-term prostate enlargement and block hormones most closely associated with causing acne and male pattern baldness, bringing Dr. Amory one step closer to realizing his dream. However, the real beauty of MENT is that it allows females to check out a man's biceps and birth control rod simultaneously.
"Apparently, they've been a hit at cocktail parties," said Dr. Amory of a current European study. "Men like showing them off." But like hormone injections, there's a long wait for MENT to take effect, so the presence of a rod doesn't mean a man is sterile. A female at a cocktail party who desires a man with a rod in his biceps still has to find out how long it's been there.
While testosterone derivatives have proven themselves to be strong candidates for a male contraceptive, they are not the only hormones being studied. Gonadotropin-releasing hormone (GnRH) is also being tested on 20 men in Chile. GnRH secretions trigger sexual development at the onset of puberty. Preliminary studies being conducted by the Population Council show that when used as a contraceptive, GnRH injections repress the body's natural supply of GnRH (similar to testosterone injections), which in turn arrests sperm development. One drawback of GnRH is that it also suppresses testosterone in patients, which could negatively affect libido and reduce secondary sexual characteristics, such as facial hair growth. Meanwhile, scientists at the University of California, Davis, are experimenting with proteins which facilitate movement in the tail of the sperm. Using antibodies to attack these proteins, scientists hope to cause sperm to lose their mobility and render them unable to fertilize an egg.
It is important to note that none of the male contraceptives currently being developed would offer instantaneous infertility or protection against STDs. That is to say, none are as effective as condoms. Subsequently, it's only men in long-term relationships who are being targeted for these products. Researchers, including Dr. Amory, believe that men in committed relationships are eager to assume responsibility in the bedroom for their peace of mind as well as their partner's. And their statistics seem to back them up. Out of 148 men polled in 2002 by the Monash Medical Centre in Australia, 75.4 percent of men stated that they would "maybe," "probably," or "definitely" be willing to try a form of male hormonal contraception. While this might be heartwarming news to scientists, it does little to reassure the women who would be fucking these men. The participants were asked if they would consider taking daily tablets, a weekly injection, or a monthly injection. However, whether they would continue with hormonal birth control once the testicle shrinkage and acne set in remains yet to be seen. Considering the selection, none of the men I know are that eager to take control of their own fertility.
Oh, and about those side effects, boys: irregular menstrual bleeding, nausea, weight gain, headaches, dizziness, breast tenderness, bloating, increased vaginal infections, mood changes, with rare cases of chloasma (darkening of skin pigment in the face), and increased blood pressure--these are the side effects women deal with today. When oral birth control was first introduced, women experienced blurred vision, depression, blood clots, strokes, heart attack, gall bladder disease, and liver tumors. Shake your shriveled testicles at that.
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It is true that I cannot fairly predict the actions of millions of men, based solely on the male delinquency I've experienced in my own life. However, I am not a fair person, and when it comes to sex, I, like any rational woman, would rather be safe than polite. While I don't resent men for wanting to take control of their fertility, I wouldn't trust any man I know, including my father, not to get me pregnant.
Both sexes agree that they'd like more options when it comes to contraceptives; the trouble is that men and women don't trust each other, according to Laurie Dils, a counselor and educator for Planned Parenthood. Women (like myself) currently manage the birth control in their relationships, and many wouldn't relinquish that responsibility to their significant others. Meanwhile, men in Dils' classes are eager to learn about contraception--because they don't entirely trust their partners.
"I talk to women who say they can't imagine letting a man have that control over their bodies," said Dils, "and men who wish there were more options available to them because they don't always trust women when they say they're sterile, or on the pill."
Many men get vasectomies because they want control in the bedroom, according to Dils, who has worked in this field for seven years.
"Ideally, couples would make a joint decision before exploring any type of birth control," Dils said. She believes that male birth control should be offered. Combined with effective communication, it could strengthen relationships in which intimacy is abundant, but trust is not.
Kari Kesler, a health educator with King County's public health department, agreed with Dils on the issue of trust.
"When young men are involved in the birth control process, the effectiveness of the method goes up. Partners are able to support each other, and ensure that the contraception is being used correctly," said Kesler. "I would highly encourage partner participation."
Kesler noted, however, that she rarely sees young men supporting their partners in the family planning center where she works. But when Kesler gives birth control presentations to young men in detention centers, her students are "overwhelmingly inquisitive. They are grateful to have someone answer their questions and explain their options." While not all men are mature enough to handle birth control (with the surprising exception of delinquents), Kesler thinks it should be offered.
"Even if not all men are ready to handle birth control, having the option available will mean that at least some men will be utilizing it," said Kesler.
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Speaking of my father: His name is Chuck, and he's in his early 40s. He and his third wife--after the recent birth of my baby half-sister--are looking for a reliable form of birth control. His wife, Chris, is unable to take hormonal contraceptives for health reasons. Like most men I interviewed, Chuck finds that condoms diminish sensitivity and pleasure during sex. After summarizing several of the male contraceptives in-the-making, I asked him which he would prefer.
"Blowjobs. I would be perfectly happy with the oral-sex method of birth control, but your stepmom says no," my dad replied. Shudder.
Chuck said that while he will most likely get a vasectomy, the idea of taking such permanent steps to prevent contraception still bothers him.
"I wouldn't have considered a vasectomy even five years ago, but now I've got three decent kids, which is plenty, and basically no alternatives that satisfy Chris and me."
Chuck readily acknowledged that more choices for male contraceptives would be nice, while also conceding that he probably wasn't responsible enough to handle half of them.
"If it involved shots or trips to the doctor's office, I wouldn't have stuck with it--especially as a younger lad," Chuck said, "but I'd be okay with a daily pill."
"I think I could do it," said John, a 25 year-old baristaa to whom I put the same questions. "I wouldn't be down with getting shots in the ass, but I think I could swallow a daily pill."
John's girlfriend currently takes care of the birth control. "I feel like it's kinda her job. I wouldn't feel comfortable telling her what to do with her body," he added. While John would be willing to go on birth control, he would want his girlfriend to stay on the pill too, "just in case mine didn't work or I forgot a day or something."
"It wouldn't work for me," said 23-year-old Matt, whose girlfriend has miraculously stuck around for two years. He contended that he wouldn't trust a drug to keep his girlfriend unfertilized.
"I've got Rambo sperm," Matt boasted. "They'd find a way."
He had a point. Deterring millions of sperm versus one egg has kept pharmaceutical companies from investing in male contraceptives for decades. Currently, researchers consider it a success if sperm are suppressed from 200 million to 1 million sperm cells per milliliter of ejaculate--a victory, surely, but not one that will inspire confidence in many women.
"Plus, getting a shot every three weeks or a rod implanted in my arm isn't a very good alternative to my current method, which is having my girlfriend take care of it," Matt added. "I don't see why she can't still be on the pill."
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It all comes down to trust. Currently, men trust women to take care of the birth control. If male birth control becomes available, should women trust men?
The trust that men like my dad, John, and Matt place in their female partners is almost as endearing as it is reckless. Since the introduction of the birth control pill in 1960, men have allowed women to manage the contraceptives. A lot of women are fine, even gleeful about the power over reproduction that so many men are willing to surrender. However, there's little to stop women from abusing this power by not taking birth control pills, or by poking holes in condoms. There are plenty of fathers who were assured by their children's mothers that they were on the pill. Men and women can be equally untrustworthy.
It's easy to distrust men in the abstract--or my father, John, and Matt in specific--with women's sexual health. The more relevant question for me, though, is would I trust my boyfriend, Blake? We've been dating for seven months. He has huge hazel eyes and a high-wattage smile. After highlighting the virtues of men taking responsibility for birth control, I asked Blake if he'd be willing to take a male contraceptive. He responded with an enthusiastic "sure," as if I'd just suggested an afternoon of ice cream and oral sex. Amazingly, this was our very first discussion about contraceptives; my stockpile of condoms and birth control pills made the issue moot.
"Are you at all resentful that I haven't been more proactive about birth control?" Blake inquired.
I told him about the kiwis. I was trained to protect my health, and consequently my partner's health; it makes me anal, not resentful. I can't imagine relinquishing that control to anyone. In this regard, I empathize with any man's desire to have command over his own fertility. If anything, I'm surprised that my partners have trusted me to take care of contraceptives without question or comment. Blake said that he always trusted me to know what I was doing.
"Would you trust me to use some type of male contraceptive?" Blake asked.
Considering that the FDA hasn't approved any male contraceptive for testing in the U.S., it could be 10 years before a product will be made available to Americans. Meanwhile, Europe could potentially have a hormonal contraceptive on the market in five years or less if current testing is successful, estimates Dr. Amory. Either way, I doubt that Blake and I will still be together by then.
"Sure," I said, to spare his feelings.
