For seven nights out of every month, my boyfriend soaks his balls in a bathtub of 118-degree water for 45 minutes. He crams his six-foot-four frame into our claw-foot bathtub and sweats profusely as a constant stream of hot water slowly kills off enough sperm to render him infertile for the next few weeks.
He does this so that I don't get pregnant.
This approach may seem dramatic—it is—but there are very few options available to men who choose to take control over their fertility. Vasectomies and male-driven condom use account for about a third of current contraceptive action in the United States, but the permanent nature of a vasectomy isn't ideal for couples who, like us, would like to spawn at some point in the future. Condoms make the most sense, are super-important in the effort to stop the spread of sexually transmitted infections, and are highly useful as barricades against wily sperm on the hunt for an egg. But one of the many pleasures of being in a long-term, monogamous relationship is not having to worry about such diseases, and we really don't want to have to rely on condoms every time we have sex until I reach menopause.
So now my boyfriend shoulders the work of making sure we don't get pregnant.
I will give you more detail on how he does it, but first let me just point out that this is a huge reversal of the usual rules of contraception. Most women prefer to have absolute control over our uteruses, and rightfully so. We want to be damn sure that we don't have to deal with the physical, emotional, financial, social, and professional effects of childbearing before we're ready—if ever. Pregnancy and childbirth are freaking brutal. The World Health Organization estimates that more than 800 women die from issues related to pregnancy and childbirth every day. At this incredible point in scientific development, where we can reveal a person's DNA from an itty-bitty blood sample, transplant an organ from a dead person into a living person, and create a pill to give a man a boner without also giving him a heart attack, women have to worry about all sorts of crap—some of it life-threatening—from something as natural and necessary as pregnancy.
Besides the obvious hardship that comes with carrying a human-shaped parasite in my abdomen for nine months, I may face depression, high blood pressure, kidney problems, infections, constant puking and peeing, and hemorrhoids. And then there's labor and delivery. If I give birth naturally, I will likely tear my vagina. I could break my tailbone. If I have to undergo a cesarean section, there are added risks associated with surgery. If I'm a teenager, living in a developing country or somewhere where health care just isn't readily available, or if I don't have health insurance, these risks are greatly increased. These are the risks we take as women who breed, and the risks that we avoid by using birth control. Men, of course, breed without facing these risks. All male contraception does is keep a sperm from successfully hooking up with an egg; it does not save men from any life-threatening physical side effects.
So it makes sense that there are a bazillion methods of female birth control available on the market, and most of them are fantastically effective and easy to use. Hormonal birth control, which is very popular, tricks a woman's body into thinking it's pregnant, preventing ovulation (release of an egg) by maintaining a constant level of hormones. The problem for some women is that these artificially regulated hormones affect more than the ovulation cycle, just as fluctuating hormones during a regular menstrual cycle affect more than the reproductive organs. Hormones do a lot more than just give us the tools to make people: They affect every part of our bodies, including the chemicals in the brain responsible for telling our bodies what we feel moment to moment and how we experience every aspect of daily life.
You know those stupid cartoons that say shit like "Be careful, I have PMS and a gun"? Obnoxious, yes, but the cultural meme of the hormone-crazed woman is based on very real biological events. During a menstrual cycle, estrogen and progesterone levels fluctuate to make a woman ovulate. They also help make the uterus habitable for fertilization by building up the endometrial (innermost) tissue to allow a fertilized egg to implant and grow. At the end of the cycle, the uterus sheds the extra tissue if no egg implants. During these physical changes, the estrogen and progesterone (and progestin, the artificial form of progesterone in hormonal birth control) are abundant in the body and are usually just broken down and sent away. But sometimes they're not, and an imbalance in these hormones causes other chemicals to go nuts, like decreased serotonin (which makes us happy) and increased norepinephrine (which makes us aggro). The emotional effects from the fluctuation in birth-control hormones were, for me, much worse than the changes that happened during a regular menstrual cycle.
Hormone-based pills made me bloat, bleed, barf, and so depressed that Morrissey lyrics held no irony. The Mirena, a hormone-secreting IUD beloved by many of my lady friends—and my gynecologist—completely zapped my libido into oblivion. (While a strong aversion to penis is an excellent contraceptive, it is not ideal if you're naturally inclined toward cock.) A copper IUD got stuck somewhere in my uterus—they don't work that way, and it hurt like a bitch—and landed me in urgent care with severe hemorrhaging. And so in the interests of our relationship, our futures, and my physical and emotional health, my partner researched male contraception and discovered the ancient art of ball boiling.
He began boiling his undercarriage only a few months into our relationship, after that copper-IUD nightmare. He lived in a co-op at the time with four women, and he shared a bathroom with three of them. He's not a shy man—he's the one who suggested that I write about our birth-control history for The Stranger, for Chrissakes—and he'd commence the boiling with an open-door policy. The ladies would come in and out to pee, to brush their teeth, to argue about who'd fed the chickens that day—and it kept his mind (somewhat) off his burning man parts.
We've now been together for five years.
The baths suck, especially in the summer. One summer, he and I got tired of the rigmarole and he stopped boiling his balls for a month. Twelve weeks later, I was doubled over on the floor of my acupuncturist's office, hemorrhaging from my nether regions and blacking out from the pain. I had an ectopic pregnancy: a viable, growing fetus stuck in my fallopian tube instead of neatly tucked away in my uterus. If not caught and treated in time, these tubes can rupture, causing internal bleeding, loss of the tubes, and death. I got to the hospital just before my tube ruptured—some people don't.
Of course, even with hormonal birth control in women, there are risks: In my early 20s, in a different relationship, I failed to take an all-progestin pill at the prescribed same time every day, and in turn it failed to keep me from getting pregnant. My partner at the time and I made the decision together to have an abortion—a shitty decision for anyone who's ever had to make it, and also a profound one.
Considering all the responsibility pregnancy entails, available, affordable, healthy, and effective contraceptives should be available for both sexes. So why aren't there more options for men? Why aren't there more options for couples like us?
Dr. Stephanie Page is a medical doctor and immunologist at the University of Washington who's currently working to develop a reversible hormonal-birth-control method for men. These treatments essentially disrupt spermatogenesis, the process by which men's cells become sperm. With a surprisingly high success rate of 90 to 95 percent, Dr. Page's results are astounding, but still not as effective as female hormonal contraceptives, which are more than 99 percent effective. The effectiveness rates Dr. Page has seen on male contraceptives just aren't good enough to get the big pharmaceutical companies to kick in the bucks for clinical trials, and without that support, this research won't be survive the long, rocky, expensive road to market.
And it's not just funding. There are many other intertwined social and financial hurdles with male contraception, as Dr. Page points out. Popularizing male contraception techniques in a male-dominated society could potentially be devastating to women whose bodies and/or financial situations cannot support the number of children desired by their male partners. There is also the chance that increased availability of male contraception may decrease the use of condoms by people who use them primarily for birth control, causing—yikes!—an increase in transmission of STIs.
Men may not face the drastic physical side effects of being pregnant, but fatherhood is a life-changing event, and depending on only a condom is pretty scary for a guy who's not looking to make babies. Dr. John Amory, another male-contraception researcher at the UW, explains his interest in male-contraception development from a personal standpoint: "Parenting is a wonderful thing, but better when people are interested in being parents. As a clinician, I take care of lots of women with adverse effects from birth control or who have contraindications to the treatments" from existing medical conditions or current medications. But, says Amory, "Since male contraceptives aren't treating anything, they need to be safer than even aspirin or Tylenol if we're going to take them to market. All medicines are toxins, but giving them at the right doses is what makes them medicine, and this is tricky. I'm not despondent over where we are in the process. I wouldn't have devoted my research career to it if I were. There are a lot of unique things about how the body makes sperm, and this gives us a lot of ways to approach [the development of male contraceptives]."
The key word there is "tricky." To develop a successful male contraceptive, researchers must develop a treatment that renders men clinically infertile, meaning there must be so few viable sperm in a man's ejaculate that his chances of impregnating a woman are virtually impossible. Female hormonal contraception just has to stop a woman from ovulating once a month. That's a much easier scientific hill to climb than going after the approximately 300 million sperm that swim in every teaspoon of male ejaculate. It makes sense that so many big-time funders who pour money into research to prevent the spread of sexually transmitted infections and unwanted pregnancy are going to be way more keen to face the huge-pain-in-the-ass process of developing birth control for women than for men, even though male birth control would mean so much for women who can't take birth control and for men who desire control over their own fertility.
Take the example of Amory's current research into nonhormonal contraceptive treatments for men: Based on an observation that a lack of vitamin A in mice renders them blind and infertile—but still horny—Amory is looking for a method to block the sperm-producing enzymes created by vitamin A in the testes. His team is well on the way to success, he says. "My chemists rock, my team of biochemists is superior. All we have to do now is find a compound to block the enzyme manufactured by vitamin A that is site-specific to the testes, test it in animals and then in humans, generate the intellectual property for the UW to patent, license to a drug company to test in clinical trials, and get it to market. This is what we have to do—we don't have the billion bucks to get these medications through clinical trials to approval." Every medication available to us on the market goes through this process of development, testing, regulation, and licensing, so it's not surprising that male contraceptives are taking so damn long to hit the shelves.
There are other methods of male contraception currently being tested all over the world. In India, researchers are conducting clinical trials of a treatment known as RISUG: reversible inhibition of sperm under guidance. It's a kind of reversible vasectomy in which the mobility of sperm is hindered by a chemically produced polymer as they pass through the vas deferens (the vessel that transports sperm from the testis out through the penis). The chemical is delivered via injection to the scrotum, which sounds freaky, although possibly a lot less freaky than taking a knife to the penis to create a permanent roadblock to babydom. Information about the RISUG method is spotty—some of the best information I found about it was not in medical journals but from an article in Wired. While the relative safety and viability of RISUG is yet to be established, it theoretically sounds pretty damn cool, at least to someone without a scrotum.
The other ball-intensive approach to the war on sperm—the heat method my boyfriend and I use—is great if you can put in the time and energy, but not many people really want to do this. The water in a hot tub rarely exceeds 104 degrees (or shouldn't). Sperm-killing water must stay above 116 degrees—FOR 45 MINUTES. This means sitting in a tub (or in a sitz bath or on something really hot) for a long time while continually monitoring the temperature to make sure it's high enough to zap the little bastards. My boyfriend downs a couple of pitchers of ice water during every bath. And, again, it's incredibly time-intensive—45 minutes out of every evening for a week out of every month, not to mention the time it takes to run the water and cool down afterward.
Then the sperm must be counted, usually every few months at a clinic or at home with a microscope if you're really sciencey. Someone who chooses this method must be dedicated, disciplined, and very patient. Perhaps this is why the heat method hasn't ever been taken very seriously by the research community as a sole method of contraception. Maybe it's because getting a pharmaceutical company to test and market this is highly improbable, or maybe it's because the time and energy that a man must put into heating his balls is so high in comparison to the questionable success rate. We have to use my boyfriend's 118-degree baths as one layer of a three-part nonhormonal birth-control system that includes Toni Weschler's Fertility Awareness Method and good ol' coitus interruptus. The Fertility Awareness Method is a rather time-consuming effort as well, involving daily recording of body temperature, cervical fluid descriptions, daily activities, and life events.
It's cool, though: Years of doing this have taught me and my boyfriend some amazing things about the nature of the human body. I've always had a soft spot for chemical reactions, probably stemming from the first time I mixed baking soda with vinegar and red food coloring to make lava spew out of my papier-mâché volcano. My body is just a more complicated version of that volcano, containing the ability to set in motion a series of chemical and biological reactions that result in a freaking person. A PERSON. Only I'm a bit of a delicate volcano without the ability to handle a lot of hormonal fucking-with, so I'm unable to take the more common routes to pregnancy prevention. It's a damn good thing there are people out there like Dr. Page and Dr. Amory who will someday develop male contraceptives that help out people like me. And it's a damn good thing that I have the boyfriend that I do. He boils his balls for me. I love him.