Male Birth Control: Present and Possible Future

Perhaps you and your partner are finished having children. Or you just know you don’t want children in the future and want to make sure no unplanned pregnancies happen. If this is the case, you might be looking for permanent methods of birth control.

Is a vasectomy the answer? For many men the answer is “yes.” Since vasectomy became common in the 1970’s it has provided men and families a safe, effective, minimally-invasive form of birth control with a fast recovery period. A vasectomy involves cutting two tubes called the vas deferens - the pathways that sperm travel through. The cut ends are then tied or sealed together with heat, blocking the path of sperm. (Note: A vasectomy doesn’t take effect immediately, as some sperm cells remain in the vas deferens and will need clear out. You and your partner will still need to use contraception until there are no more sperm cells in the pipeline.)

Vasectomies are usually considered permanent. A vasectomy reversal is an option if a man changes his mind, but the procedure can be expensive, and reversals are not effective 100% of the time. This may give some men reason to consider alternatives to vasectomy. Nowadays viable sperm can also be surgically retrieved for use with IVF (in vitro fertilization) procedures, even years after a vasectomy.

Vasectomy Alternatives

Are there alternatives? Yes.

Condoms

Male condoms can be an effective form of birth control – 98% effective, in fact – as long as you use them the right way. Condoms can reduce the risk of sexually transmitted infections (STIs), too – again, when used correctly. Many men unknowingly use condoms incorrectly, often because they learned how to use a condom informally or casually when they were younger and perhaps sexually inexperienced. (If you’re not sure you’re using condoms correctly, we can provide you with accurate educational material.)

Options for Women

Your partner has temporary contraceptive options, too. Female condoms, hormonal contraceptives, birth control pills, intrauterine devices (IUDs), and diaphragms are all possibilities for temporary birth control. Her gynecologist can help her choose which methods are best for her.

Women may also consider tubal ligation (sometimes called “getting your tubes tied”), a surgical procedure that cuts and seals the fallopian tubes, preventing sperm cells from reaching an egg. This method is permanent, however. It’s also more complex than a vasectomy, and it may have more complications, a longer recovery period, and a higher cost.

What about withdrawal?

Some men wonder whether withdrawal (coitus interruptus or “pulling out” before ejaculation) is a viable contraceptive method. This approach is not considered reliable, as sperm cells can be present in pre-ejaculate (precum) and find their way into the vagina before the man withdraws his penis. The method also requires determination and perfect timing on the part of the man, which can be hard to control in the midst of intercourse. (One more point to consider – withdrawal alone provides no protection against STIs.)

Male Birth Control Under Investigation

In the meantime, scientists are looking into other temporary, reversible male contraceptive options.

• Birth control pills. Scientists are studying hormonal oral contraceptives for men. While these pills have generally passed safety tests in humans, more research is needed to determine how effective they are.
• Hormonal gel. Scientists are also investigating a hormonal contraceptive gel that can be applied to the skin once a day.
• Reversible Inhibition of Sperm Under Guidance (RISUG). Like vasectomy, RISUG blocks the path of sperm cells. But instead of undergoing surgery, men receive an injection of a special gel that attaches to the walls of the vas deferens, forming a barrier that sperm cells can’t swim past. Clinical trials have shown RISUG to be effective, and the effects could last up to 10 years. It can also be reversed by injecting another substance that breaks down the gel and flushes it out.
• “Clean Sheets Pill.” How about a pill that allows men to feel the pleasure of orgasm without actually ejaculating? That’s the aim of the “clean sheets pill,” which men can take a few hours before sex. Much more research is needed, however, and some experts question whether men will be open to semen-free ejaculation.

Talk with Your Partner(s)

We encourage you and your partner to discuss your birth control options thoroughly. This is a decision you should make together, considering your feelings about family planning and your comfort with different contraceptive methods. If you’re single and/or having sex with multiple partners, we urge you to have the vital contraception/STI conversations with everyone you have sex with, including oral sex and anal sex.

Resources

Basic and Clinical Andrology
Khilwani, Barkha, et al.
“RISUG^® as a male contraceptive: journey from bench to bedside”
(Published online: February 13, 2020)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7017607/ 


BBC.com
Campo-Engelstein, Lisa
“Are we ready for men to take the pill?”
(October 22, 2019)
https://www.bbc.com/news/health-49879667

Birth Control Pharmacist
Gonzalez, Steven
“Updates In Male Contraceptive Agents”
(June 22, 2020)
https://birthcontrolpharmacist.com/2020/06/22/updates-in-male-contraceptive-agents/

Endocrine Society
“Dimethandrolone undecanoate shows promise as a male birth control pill”
(March 18, 2018)
https://www.endocrine.org/news-and-advocacy/news-room/2018/dimethandrolone-undecanoate-shows-promise-as-a-male-birth-control-pill

“Second potential male birth control pill passes human safety tests”
(March 25, 2019)
https://www.endocrine.org/news-and-advocacy/news-room/2019/endo-2019--second-potential-male-birth-control-pill-passes-human-safety-tests

LiveScience
Rettner, Rachael
“World's First Injectable Male Birth Control May Soon Arrive in India”
(November 20, 2019)
https://www.livescience.com/male-birth-control-risug.html

Mayo Clinic
“Withdrawal method (coitus interruptus)”
(April 8, 2020)
https://www.mayoclinic.org/tests-procedures/withdrawal-method/about/pac-20395283

MedlinePlus.gov
“Tubal Ligation”
(Page last updated: August 10, 2020)
https://medlineplus.gov/tuballigation.html

National Health Service (UK)
“Condoms: Your Contraception Guide”
(Page last reviewed: September 19, 2017)
https://www.nhs.uk/conditions/contraception/male-condoms/

Urology Care Foundation
“Quick Snip: Should You Get a Vasectomy?”
(Fall 2014)
https://www.urologyhealth.org/patient-magazine/magazine-archives/2014/fall-2014/quick-snip-should-you-get-a-vasectomy

Vasectomy.com
Radcliffe, Shawn
“Birth Control for Men: ‘Clean Sheets’ Pill”
(November 28, 2018)
https://www.vasectomy.com/article/vasectomy/alternatives/birth-control-for-men-clean-sheets-pill

Verywellhealth.com
Stacey, Dawn, PhD, LMHC
“Male Birth Control Options”
(April 29, 2020)
https://www.verywellhealth.com/male-birth-control-injections-3970355