Modern Day Male Contraceptives: Why we may never have anything more than condoms.

Have you or your partner fumbled trying to put on a condom? Has the condom ever broken? Or worse: things are getting spicy and neither of you has one on hand—did the male partner forget to buy some this time? These are all common events when trying to have sexual intercourse, some of them potentially resulting in unplanned pregnancy. Of course, the female partner could have been using some form of contraception, which decreases the chances of unplanned pregnancy. She could have used The Pill, a Depo-Provera injection, female condom, intrauterine device (IUD), Levonorgestrel intrauterine system, a diaphragm, cervical cap, the sponge, spermicide, the vaginal ring, or a contraceptive patch. However, the silly male forgot the condom! They were left with the option of the withdrawal method, which has a failure rate of 22% (Sutton & Chalmers, 2017). Who is to blame here? Should someone have been more prepared? Is it fair to think the female should have been taking a hormonal contraceptive, or should they both be expected to carry around condoms? Many people would say that the female should have been more prepared (after all, it is easier to stop one egg from being released than it is to stop millions of sperm [is it really??]), but why must the burden of pregnancy prevention be borne by females all of the time?

 An increase in the number of male contraceptives may ease this socially constructed responsibility off females. To date, though, males have been provided with, at most, three methods of contraception. These methods include condoms, withdrawal, and vasectomy. The typical failure rates of these methods are, 15%, 19%, and 0.05% respectively (Sutton & Chalmers, 2017). At first glance, the latter rate seems wonderful. However, a vasectomy is invasive and pretty much irreversible. With these limited options in mind, researchers have been working hard to find a way to provide another form of male contraceptive.

 A popular idea is male hormonal contraception. There are many possible options, such as injections or pills. These hormonal methods are derived from exogenous testosterone or, much like the pill, include a combination of hormones, testosterone and progestin, or even androgen and progestin (Wang et al., 2016). These methods decrease testosterone production and, in turn, decrease sperm production. These methods have been shown to be effective and have few side effects, with the combination contraceptives being more effective (Wang et al., 2016). So, this is one form of a male contraceptive hormone that is in the works, but why is it taking so long? In addition to lengthy clinical trials, it is likely that researchers are looking for the next male contraceptive to be 100% effective. Yet apparently, such a contraceptive already exists. Created by Dr. Sujoy K. Guha in India, reversible inhibition of sperm under guidance, or RISUG, could be the biggest form of contraception since The Pill. The easily reversible “vasectomy” works by injection of a polymer, styrene maleic anhydride (SMA), into the vas deferens (Gifford, 2011). The sperm can still pass through, but in doing so, they become functionally inactive; the membranes are ruptured and motility is removed (Gifford, 2011). Proven to be close to 100% effective by Dr. Guha since 1979, the RISUG method of contraception has yet to hit the market. But why? There doesn’t seem the be a solid reason: A single injection could be effective for 10 years, unexpected pregnancies would decrease, family sizes would be limited, and males would be provided with a reliable and less frustrating contraceptive than what exists currently. This method has also been around for decades… one begs to know why such a revolutionary male contraceptive hasn’t been introduced to the public. Surely clinical trials don’t take that long!

So, what is the hold up? If we think about commonly available contraceptives, such as a birth control pill or condoms, they are in high demand. They are a one-use product that has to be repeatedly purchased, at a troubling price for some. At the end of the day, the companies who mass produce these products are multinational businesses. Their first priority is sales. With a technique like RISUG, people won’t have to pay continuously. To put it in perspective, if someone used one $0.50 condom and had sexual intercourse every day for a year, it would cost the individual $182.50. RISUG costs approximately $10 and would be effective for 10 years (Dayal, 2017). In 10 years, assuming one could keep the rate of 1 sexual interaction per day; with condoms, the cost comes to $1,825 but with RISUG it is still just $10.

 With unexpected pregnancies accounting for a large portion of total pregnancies, it seems like it’s time for a more reliable contraceptive. A male contraceptive like RISUG is not only effective and affordable, it takes the pressure off females to bear the burden of contraception. It puts the worry of contraception on the back burner and lets people enjoy sexual activities. It seems as though we have this contraceptive but foreign governments and businesses haven’t let it hit the market. Let’s place the right to birth control ahead of the bottom line. Let’s put Dr. Sujoy K. Guha’s lifework to use. Stop fumbling with the condom and just enjoy.

Joshua Wilson, BScH, Queen’s University

References

Anthes, E. (2017). Why We Can't Have the Male Pill. Retrieved from   https://www.bloomberg.com/news/features/2017-08-03/why-we-can-t-have-the-male-pill

Dayal, S. (2017). New male contraceptive is safe, effective, inexpensive - and can't find a company to sell it. Retrieved from https://nationalpost.com/news/world/new-male-contraceptive-is-safe-effective-inexpensive-and-cant-find-a-company-to-sell-it

Gifford, B. (2011). The Revolutionary New Birth Control Method for Men. Retrieved  from https://www.wired.com/2011/04/ff_vasectomy/all/1/

Sutton, S. S., & Chalmers, B. (2017). Contraception and Pregnancy Options. In C. F. Pukall, (Ed.), Human Sexuality: A Contemporary Introduction (second edition, pp. 153-177Don Mills, Ontario: Oxford University Press.

Wang, C., Festin, M. P. R., & Swerdloff, R. S. (2016). Male Hormonal Contraception:       Where Are We Now? Current Obstetrics and Gynecology Reports, 5, 38–47. http://doi.org/10.1007/s13669-016-0140-

September 2018 SexLab Update

SexLab has been very busy during the 2017-18 academic year. Our blog is celebrating its third anniversary and with that we have some exciting news to share.

Our research associate, Shannon Coyle, spent the summer revamping our website and blog. Check out sexlab.ca for our fully redesigned lab page!

Over the last year, our Lab Director, Dr. Caroline Pukall—with invaluable input from her fantastic team and wonderful collaborators—has been incredibly productive, with over 20 new publications. She and her team members have attended numerous conferences in order to get the word out on their cutting-edge research via many well-received presentations. In addition, Caroline, along with co-editors Drs. Andrew Goldstein and Irwin Goldstein, are working on the second edition of their successful book, Female Sexual Pain Disorders: Evaluation and Management. They have lined up authors with unique expertise in order to provide healthcare professionals with state-of-the-art content related to all aspects of genitopelvic pain (expected publication date: 2020).

In terms of teaching, Caroline completely overhauled her online human sexuality course, and taught it in the Winter term 2018. It was popular and highly rated by students. The on campus course has also seen significant changes and enrolment continues to be at its maximum. Caroline is using the second edition of her Human Sexuality: A Contemporary Introduction (Oxford University Press, 2017) textbook for these courses, and she is grateful to all the contributors to this successful text.

Caroline has also been involved in successful grant applications from CIHR (with Dr. Linda McLean from the University of Ottawa), SSHRC (with Dr. Jordan Poppenk from Queen’s University), the Catherine Oxenberg Foundation (with Dr. Meredith Chivers from Queen’s University) and ISSWSH (with her student, Robyn Jackowich). Currently, she is working on numerous projects with students and collaborators on different topics, including: persistent genital arousal disorder (PGAD), diverse relationships, prostate cancer, penile pain, a vulvar pain questionnaire, and a clitoral MRI study! In addition, she is co-chair of the Consensus Meeting on PGAD (with Drs. Irwin Goldstein and Barry Komisaruk) to be held in March 2019 prior to the ISSWSH meeting. This academic year is sure to be another busy, yet productive, one!

We also have a new (and familiar!) recruit who recently (re)joined the SexLab team, Dr. Stéphanie Boyer. Stéphanie completed her Master’s and Doctoral degrees in SexLab, after which she spent several years practicing psychology in Boston, with appointments at McLean Hospital and Harvard Medical School. She has returned to us after 5 years to lend her expertise to a number of projects in the lab related to women’s sexual health, ranging from sexual psychophysiological research to healthcare experiences in women with sexual dysfunction and genital pain. We are VERY excited to have her back!

This past year, our senior PhD students, Jackie Cappell and Katrina Bouchard, have been busy applying for internship and wrapping up their dissertations.

Over the past year, Katrina applied for a pre-doctoral internship in clinical psychology and worked on her dissertation on women's sexual arousal. She successfully matched to St. Joseph’s Healthcare in Hamilton and started a year-long psychology residency in September 2018. This academic year, Katrina will finalize her dissertation and submit the associated manuscripts for publication. She plans to defend her dissertation in the coming months. 

Jackie also applied for a clinical psychology doctoral residency position last year. She successfully matched to Eastern Health in St. John’s, Newfoundland and just started this year-long position in September 2018. Jackie’s first study from her dissertation—which focuses on postpartum sexuality—was published in Birth, and several media outlets covered the novel findings. Data collection and analyses are complete for her two in-lab studies and she has presented her findings at national and international conferences, including the Society for Sex Therapy and Research (SSTAR) and the International Academy of Sex Research (IASR). Jackie is currently in the process of writing her dissertation and submitting the manuscripts for publication. She plans to defend her dissertation in the coming months. 

Our two 2nd year PhD students had a full summer with successfully completing their comprehensive exams while still managing to contribute a wealth of knowledge to the field of sexuality research via conferences and publications

This fall, Robyn Jackowich is entering the third year of her PhD in clinical psychology. The focus of her doctoral research is on a biopsychosocial investigation of persistent genital arousal disorder (PGAD) in women, examining psychosocial, sensory, and vascular factors. She was awarded a 2018 ISSWSH Scholars in Women’s Sexual Health Research Grant to support this research. During the past academic year, she published articles on PGAD in the Journal of Sexual Medicine and Sexual Medicine Reviews.

This past summer, Robyn completed her comprehensive exam and project (Developing a Self-Report Measure of Genital Arousal Sensations and Perceptions), and looks forward to sharing the results of this project at the upcoming 2018 Canadian Sex Research Forum in Toronto, ON.

Robyn also received the 2017 Routledge Young Investigator Award in Human Sexuality from the Journal of Sex and Marital Therapy, for her article titled Symptom Characteristics and Medical History of an Online Sample of Women Who Experience Symptoms of Persistent Genital Arousal. She accepted the award and presented these findings at the 2018 SSTAR meeting in Philadelphia, PA.

Stéphanie Gauvin received an Ontario Women’s Health Scholar Award and Ontario Graduate Scholarship for her doctoral dissertation which explores how chemically-induced menopause affects sexual and relationship functioning in women who have undergone cancer treatments for breast cancer.

She was recently awarded a Canadian Institutes of Health Research (Institute of Gender and Health) Hacking the Knowledge Gap: Trainee Award for Innovative Thinking to Support LGBTQI2S Health and Wellness. Part of this award funded a trip to Vancouver to attend the two-day Design Jam event. At the design jam, she worked with team members Philip Joy and Matthew Lee from Dalhousie University to create a pitch for a comic book anthology created in collaboration with queer artists, called Queer Bodies in Confidence, that highlights the challenges that queer men experience in relation to their body image. Her team was awarded with having the best pitch at the event.

Stéphanie also published the SexFlex Scale from her master’s thesis in the Journal of Sex & Marital therapy and the Handbook of Sexuality-Related Measures. In addition, she published a review paper on sexual problems and sexual scripts of individuals who self-identify as bisexual and co-authored a textbook chapter with Drs. Pukall and Eccles.

She attended the Canadian Sex Research Forum’s 2017 conference and won an award for the best data blitz for her presentation on measurement invariance. Stephanie is working on a paper with labmate Lindsey on how discrepancies in vibrator usage relates to sexual well-being, and they are working on a project examining biopsychosocial factors of idiopathic anal pain.

Our Masters students have been writing this past year in preparation for defending their theses and a thesis proposal.

Meghan McInnis has spent the last several months wrapping up her Master’s thesis study, which is an investigation of prostate cancer patient experiences. Over the summer, she has been writing up her thesis, which she will be defending later in September.

Along with Stéphanie G., Meghan was awarded a Canadian Institutes of Health Research (Institute of Gender and Health) Hacking the Knowledge Gap: Trainee Award for Innovative Thinking to Support LGBTQI2S Health and Wellness. Part of this award funded Meghan’s attendance at the Design Jam event in Vancouver this past February. For two days, she worked with other cancer researchers (Amanda Bolderston from the University of Alberta and Evan Taylor from the University of British Columbia) to develop an initiative to support LGBTQ+ cancer patients. Meghan and the rest of her team will be working with Bird Communications to develop a web site that will include video testimonials from patients and survivors and other targeted resources.

Meghan attended the annual meeting of the Society for Sex Therapy and Research in Philadelphia in April. She presented a poster on Canadian healthcare professional students’ self-reported competence and confidence with working with transgender patients and clients. Currently, Meghan is co-authoring a paper with Stéphanie G. based on these data.

Lindsey Yessick has spent her summer analyzing data and writing her Master’s thesis, which uses functional magnetic resonance imaging to examining pain processing in the spinal cord/brain of women with provoked vestibulodynia. She will defend her thesis on September 24th.

Many of her studies have been ongoing while her thesis was in preparation, including a collaboration with Stéphanie G. to examine biopsychosocial factors of idiopathic anal pain. Lindsey also launched a study validating a new fMRI paradigm to assess clitoral arousal (finded by the Catherine Oxenberg Foundation).

Lindsey attended the SSTAR meeting in Philadelphia as well. Her poster was on the impact of a discrepancy between solitary and partnered vibrator use on sexual well-being. In addition, she will also be presenting the results of her thesis at the 2018 International Association for the Study of Pain conference in Boston this week.

Our newest student, Kayla Mooney, completed the majority of her required coursework for her Master’s degree. During the winter, she also assisted with an 8-week online educational program for women with persistent genital arousal disorder (PGAD). She will be presenting a poster at the upcoming Canadian Sex Research Forum in Toronto on some data collected from this program.

In the spring, Caroline, Robyn, and Kayla co-authored a review paper that proposed a model of “genitopelvic dysesthesias” to conceptualize conditions characterized by unpleasant genitopelvic sensations, which will appear in the next edition of Sexual Medicine Reviews. Kayla and Caroline are also co-authoring a paper with collaborators at Dalhousie University on experiences of pain during intercourse during pregnancy.

Kayla has spent the last several months preparing her Master’s proposal, which she defended at the end of August. Her Master’s thesis will be an investigation of how PGAD affects the relational, sexual, and psychological well-being of couples, and how intimate partners respond to their significant others’ PGAD symptoms. She is hoping to begin data collection for her thesis in October.

So as you have read, SexLab has been incredibly productive this past year! In 2018-19, we look forward to wrapping up several important research projects, publishing new findings, and continuing our research in the field of human sexuality.

Shannon Coyle, Research Associate