Contraception for Men
Many guys would rather poke a needle in his eye than make an appointment to see their doctor about choices of contraception. Guys have all heard of Vasectomy. However, a study of 119 young males in NSW was published in 2015 by public health Australia & discovered that most of them didn’t know basic facts about the different methods available.
The choices can be overwhelming & what was learnt in grades 7 to 9 was a long time ago. Put simply, it comes down to whether the combined pill is too risky for medical reasons or the woman is forgetful, and what the other options are.
Female Contraception
Some contraceptive methods are more reliable than others. The stats are simple to understand but couldn’t be more important.
Contraceptive methods are evaluated based on rate of pregnancy over 12 months: both with regular use and perfect use. Regular & perfect use are very different for The Pill. We’ll look at regular (normal) use because “perfect” is very hard to achieve outside of pharmaceutical trials.
The Pill. First approved for use in Australia in 1961, this oral contraceptive quickly became popular. In order to be effective, it must be taken every day. It contains female hormones and works by preventing ovulation. 9% failure rate (over 12 months) with typical use. The trade off for effectiveness is an increased risk of certain diseases and conditions.
The Patch. Like oral contraceptives, the patch is hormone based. Instead of taking a pill each day, a patch is applied every 7 days. You don’t have to remember a pill, but you do have to remember to change the patch. Also 9% pregnancy rate in regular use
Now we’re onto the progestogen-only hormones. These tend to stop periods altogether unliked the combined pill, and are taken in one of 3 forms: injection, implant under the skin, or intra-uterine device.
Depo-Provera. This is also a hormone-based method of contraception. Instead of pills or patches, an injection of a progestogen is given in a medical clinic every 3 months. Because it doesn’t contain estrogen, it doesn’t carry the same cardiovascular risks as estrogen-containing contraceptives. It does require a visit to the GP every 3 months and a pregnancy test must be performed if the visit is scheduled any later than 12 weeks from the last visit. Pregnancy rate of around 0.3%.
Implant. Implanon is also a progestogen hormone-based method of contraception. The implant is inserted by the GP in the inner part of the left upper arm & it can be felt afterwards. The implanon is replaced every 3 years. Pregnancy rate of only 0.05%.
Mirena IUD. This is a progestogen hormonal contraceptive device that is placed in the uterus & stays for 5 years. The mirena is inserted by the women’s health GP or Gynaecologist & is replaced every 5 years. It is the longest acting reversible method of contraception for women. Pregnancy rate of 0.2%.
Female Sterilisation. Female sterilisation, like male sterilisation, is not reversible. It involves closing off the Fallopian tubes with clips or rings (tubal ligation) or insertion of a wire coil in the Fallopian tubes (Essure). Failure rate 0.5%. These procedures involve the use of general anesthetic so the risks are higher than for vasectomy.
Male Contraception
For years, men’s choices in contraception were limited to vasectomy and condoms.
Male condoms are one of the earliest forms of contraception. At some time in their life, most men will have direct experience with a male condom. Did you know female condoms are available as well? Both are barrier devices and may include spermicidal agents. While the perfect use effectiveness rates are pretty high for both male and female condoms, the regular use failure rate is pretty high as well. The pregnancy rate for female condom regular use is 21% and for males it is only slightly lower at 18%.
While many guys are fearless on the field and in the office, many get queasy at the thought of cutting and stitching down there. That’s why the no scalpel Vasectomy was a great advance in contraception for men when it was pioneered in the 1970’s.
Traditional vasectomy involves making an incision on both sides of the scrotum and then closing the incision with stitches. With no scalpel vasectomy, a small puncture is made in the midline of the scrotum. The puncture is so small that no stitches are needed.
A no scalpel vasectomy can be performed in a clinic with only local anesthetic. The entire procedure is quick, painless, and safe. A post procedure test is done about 12 to 14 weeks afterwards to ensure that the sterilization is complete. The rate of pregnancy after a vasectomy is around 0.15%.