Contrary to female contraceptives, those intended for men remain unknown due to socio-cultural factors, mentalities that are slow to change, a lack of investment in research and budget allocation problems for manufacturers.
Nevertheless, a shift seems to be taking place, according to Geoffroy Robin, university lecturer, hospital practitioner in reproductive medicine and medical gynecology at the Lille University Hospital, secretary general of the national college of French gynecologists and obstetricians.
“
As a professional, I have never spoken so much about male contraception as in the past two years.
A craze which could be explained by the increase in requests from men, realizing that women do not have to assume contraception alone.
What male alternatives are currently available in France?
The "
Figaro
" takes stock.
Methods of birth control without hormones
The
male condom
is a latex or polyurethane sheath (in case of latex allergy) which unrolls over the erect penis before penetration so as to prevent the passage of sperm into the vagina.
A single-use device, it also remains the best way to protect yourself against sexually transmitted diseases.
Overall it is a method that works well with a failure rate of 2%.
"
However, in everyday life, there are often errors of use (slippage of the condom, rupture, insertion too late at the time of intercourse) which cause the failure rate to climb to 15%
", explains Geoffroy Robin.
It can be used with lubricant for better comfort and to limit the risk of tearing.
The
thermal brief
: Using this adapted underwear, it is possible to slightly increase the temperature of the testicles thanks to the body heat trapped by the fabric.
The natural testicular environment does not exceed 32 to 35°C.
Beyond that, the spermatozoa, which are very sensitive to heat, are neutralized.
If this method is the subject of a strong enthusiasm, it nevertheless has some limits.
On the one hand, it is restrictive since you have to wear the briefs 15 hours a day, preferably during waking hours.
It can also induce pain in the testicles because of the heat.
Finally, “
several studies have shown that heat would impact the quality of sperm by altering their DNA.
“, worries Professor Robin.
The risk is then double when the man wishes to procreate: a sperm of lower quality would favor the development of malformations at birth, or even would not give rise to a birth at all if it is too altered.
This is why this device should not be used continuously for more than 4 consecutive years.
The
androswitch
: still in the test phase, this contraceptive method is attracting more and more attention.
It comes in the form of a silicone ring that is inserted at the base of the penis to hold the testicles at the entrance to the inguinal canal.
"
You have to slide it to the base of the penis by gently pulling, which causes the testicles to lift mechanically into the body.
“explains the gynecologist.
Like all thermal methods, the androswitch must be worn 15 hours a day to become effective in order to slow down the sperm maturation cycle.
Its advantage is that it is a hormone-free method, therefore more natural, inexpensive and reusable.
In addition, the elasticity of the ring does not make it painful in case of erection.
However, a medical consultation is necessary to determine if the patient is not affected by certain contraindications (abnormal descent of the testicles, inguinal hernia, testicular cancer, etc.)
Vasectomy is a
permanent
sterilization method that involves cutting and blocking the vas deferens carrying sperm from the testicles.
The operation, which lasts about a quarter of an hour, is performed under local anesthesia by a specialist.
However, it must be subject to medical supervision which imposes on the patient a long period of reflection of approximately 4 months.
"
This framework is essential: it allows time to internalize all the necessary information related to the practice, and offers the possibility of retracting in the event of doubt
".
It is one of the most reliable means of contraception with an effectiveness rate estimated at 99.8%.
A negative point to underline however: more and more young people are thinking about sterilization when they do not yet have children.
“
If it is the subject of a considered and deliberate choice, there is no reason to oppose it.
Nevertheless, very often these young people launch themselves without weighing the benefits and risks, thinking that there is always the solution of freezing their sperm.
But I don't think that's the right mentality to adopt
,” worries the doctor.
For the latter, the vasectomy must therefore be considered definitive, although there is a possibility of reconstruction of the canals (which only results in pregnancy in 40 to 50% of cases) and the use of medically assisted procreation (PMA ).
” READ ALSO –
Vasectomy: what blocks men?
Hormonal methods of contraception
Testosterone
gel
: still under development, this is a male contraceptive with hormonal action, developed by a team of American researchers from the
UCLA Medical Center
.
The so-called "
androprogestogen
" gel contains testosterone coupled with a progesterone derivative (Nestorone), the combination of which would make it possible to reduce sperm production "
by blocking the hypothalamic-pituitary axis of the brain involved in the functioning of the testicular activity
“says Geoffroy Robin.
In any case, this was shown by the preliminary results of the American study published in 2018: 89% of the participants saw their sperm concentration drop to a threshold which makes the possibility of conception extremely low.
A rather promising method, it also has the advantage of being very easy to use since it consists of the daily application of the gel to the forearm.
The injectable testosterone solution
: hormonal device validated by the WHO, it consists of an intramuscular injection of a very high dose of testosterone every two weeks.
“
As we are above the physiological threshold, this induces a blockage in the
pituitary gland
which stimulates the testicles.
After 6 months of treatment, sperm production stops, which makes it a very effective method
,” says Professor Robin.
However, it is only recommended for short periods because the long-term effects are still little known and may include the appearance of acne, mood swings, and a risk of polycythemia (an abnormal increase in number of red blood cells in the blood).
VS'
the gel seems to offer a better alternative because the testosterone it contains does not exceed the natural threshold, which reduces the occurrence of undesirable side effects
”, considers Geoffroy Robin.
The prescription of this contraceptive is often reduced to situations where the woman cannot or does not tolerate means of contraception, for example in the event of chemotherapy or after recovery from certain hormone-dependent cancers.
” READ ALSO –
Testosterone can make you aggressive… or altruistic
What reimbursement for male contraceptives in France?
The means of male contraception are to date very poorly supported by social security.
Only vasectomy is covered entirely by health insurance.
The great novelty of 2023 concerns the condom which, since January 1, has been available free of charge in pharmacies for young people under 26 years of age.
However, this only concerns the classic models of the “
Eden
” or “
Sortez Couverts! ” brand.
“, often judged not very comfortable because of a very thick latex.
The rest of the contraceptive methods are at the full expense of the patients.
Count on average 40 euros for the thermal brief, 10 euros for the injection of a dose of testosterone from the protocol of the