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Birth Control pills
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Female and Male Contraceptive Techniques: How We Got Here

Outside of the 16% of male-directed contraceptive techniques [1], contraception seems to primarily rely on the cooperation of females. As discussed by Medical Anthropologist Emily Martin in her rhetorical analysis, “The Egg and the Sperm”, an apparent history of gender stereotypes has been hidden and unaddressed in scientific research. At first glance, such stereotypes may not seem obvious; however, the disparity of gendered-contraception reveals a clear disproportion of social perspective on sex and responsibility. Both men and women are limited by the options of contraception in different ways, which may be fueled by societal biases in marketing and research. To displace the pressure of gender-roles in safe-sex practice, research and marketing could work towards promoting gender inclusive methods and provide more accessibility to reliable contraception.

The Clear Disparity

There is a difference between the perceived roles of women and men in the context of intercourse and contraceptive responsibility. When analyzing the cognitive roles in relationships, women are reported to have more sex education, feel a greater vulnerability to pregnancy, and feel a greater commitment to their relationships than men [13]. Females have also reported to take on a greater responsibility when it comes to pregnancy  [5]. On the other hand, men tend to feel a greater sense of power in their relationships [13], which may have a hand in the disparity of contraceptive responsibilities between men and women. Furthermore, though it has also been cited that males are less knowledgeable, they are still significant influences, confidants, and financial supporters when it comes to contraception and abortion among women [5]. With male partners primarily being the decision makers for abortion [5], combined with the over-abundant contraceptive techniques for females, the possibility of a power imbalance can manifest in gender roles.

Martin’s analysis of views on ovaries and sperm may provide insight into the influence of gender stereotypes in scientific research. Females are born with all of their available eggs in their lifetime, while males continuously produce sperm throughout their lives. With this information, there is a history of studies describing the female reproductive system as “degenerative”, “scarred and battered”, “wasteful”, and as a “damsel in distress” [2]. On the contrary, the male reproductive system has been described as a “feat”, “strong”, “efficiently powered”, and that sperm overcomes a “perilous journey” to fertilize an egg [2]. Moreover, even after new research has revealed alternative information about the female reproductive system, stereotypes were instead adapted to accommodate the new findings [2]. Martin argues that the evident projection of personalities onto scientific research can risk influencing societal stereotypes if inappropriately used. Her main conclusion is that gender stereotypes in reproductive research can stem from something as simple as the rhetorical language used to describe female and male sexual counterparts. Martin explains that researchers must recognize the importance of cultural content in scientific communication and think critically about language that may lead to varied public interpretations.

Comparably, the history of contraceptive research primarily focuses on women, which allows these stereotypes to continue to have implications on research today [13]. A 2021 study analyzes the effects of gender stereotypes on the pharmaceutical industry [15]. Pharmaceutical companies have marketed female contraception as an option that may make “women feel more like women,” coining the idea of hormonal contraception as a “life-style drug” [15]. Additionally, it has been noted that clinicians disproportionately discuss the challenges of current contraceptive techniques with men by devaluing their effectiveness, such as by emphasizing the negatives over the positives [16]. Such a disparity has caused contraception to be viewed as “feminized,” further contributing to the gender inequality that stalls new development [16]. Additionally, a 2024 analysis promoting new contraceptive alternatives indicates that the development of male contraception is linked to gender-equitable attitudes, but that new methods can increase gender equality in relationships [14].  It is clear that gender stereotypes are evident in contraceptive marketing and in guiding research efforts.

Female Contraception Today

Figure 1
Figure 1: A visual image of the common contraceptive techniques used today.

As of now, female contraception is most diversified and accessible between gendered-products. 88% of sexually active women not desiring pregnancy have used at least one contraceptive technique in their lives [3]. The hormonal methods are very popular—over 150 million women worldwide have chosen these methods [6], which each vary in concentration of the natural hormones progesterone and estrogen. In an analysis of hormonal methods among females in Sweden, the most common hormonal method is oral with an 86.5% combined use of hormonal pills [3]. The easy-to-take progestin (synthetic progesterone) pill effectively prevents ovulation by interacting with neural signaling pathways [6]. It can also restrict fertilized eggs from reaching the womb, while also increasing the thickness of mucus in the cervix to make it difficult for sperm to pass [7]. However, hormonal female contraception may also have negative effects on the health of the cervix and risks blood clotting [3]. The pill must also be taken daily—one missed day can result in pregnancy [7].

Aside from the physical effects, there is a strong link between emotional processing and cognitive signaling in hormone manipulation [6]. In some cases, the hormonal pill can cause sexual dysfunction, leading to low arousal, pleasure, and orgasm satisfaction [6]. Additionally, increased progesterone and estrogen levels may contribute to the higher rate of depression in women [6]. This behavior is primarily present in females aged 16-25 who have taken an oral pill for over six months [8]. The added hormones of the daily medication have been associated with more depressive symptoms than in non-pill users, including increased fatigue and eating problems [6]. Though depressive symptoms also increase in older aged pill users (Figure 2), symptoms decrease when the pill is taken continuously for longer periods of time, suggesting that hormonal contraception may still be well-received and could be promising in marketing new products.

Figure 2
Figure 2: A graph of female Oral Contraceptive Pill (OCP) users vs. OCP non-users and their relation to depressive symptoms [8].

Non-hormonal female methods typically include the copper IUD [3] and sterilization. The copper IUD is associated with a reliable 99% success rate, preventing pregnancy via the spermicidal effects of copper salts [3]. The sperm has a toxic reaction to copper salts which restricts their ability to reach the ovaries; however, the salts can also cause inflammation in the uterus [3]. This has been especially effective in the use of emergency contraception, reducing the risk of pregnancy down to 0.1% up to five days after unprotected intercourse [3]. The health issue with the copper IUD is that it can be uncomfortable for the first three to six months of use [3] and can be associated with higher menstrual bleeding [9]. Though the increased popularity of implants has proved a failure rate of less than 1% per year [3], there is still a global population of 44% with unwanted pregnancies, with half ending in abortions [4]. Moreover, the IUD method is generally more expensive and can be difficult to access in more rural areas [10], so most of these effective contraceptive techniques are only accessible in higher-income countries [3]. In low-income areas of Africa, 57% of pregnant females aged 15-24 were succumbing to unsafe practices—some methods as desperate as using crushed bottles and battery acid [5]. The need for effective contraception and education of alternative possibilities [5] is necessary for the universal practice of safe sex.

Sterilization, on the other hand, is a process that includes either the closure or the complete removal of the fallopian tubes, which also provides controversy around its reversibility [11]. Females have stated that their reason for sterilization was predominantly dictated by discontinuation of previous contraceptives, medical advice, or a partner's views [11]. Despite the high success rate, an estimated 5-20% of females report feeling regretful of this choice, citing pain, complications, and a longing for now-absent menstrual symptoms [11]. Moreover, despite researchers stating that male sterilization is more safe and secure, the wide use of female sterilization has been stated to reflect the cultural and socioeconomic views of female responsibility when it comes to contraception [11].

The New Market for Male Contraception

In contrast to the abundance of female contraceptive techniques and their complications, research has shown that men struggle with the sparse options for safe-sex practice, sparking new research for male contraceptive techniques. 50% of sexually active US males aged 18–49, who also do not wish to father a pregnancy, have expressed strong interest in male contraception [1]. 50–85% also cited that they would be willing to pay out of pocket if contraception were commercially available [1]. Another study also found that the majority of men believe that partners should share equal responsibility for family planning [4]. The development of male contraception could not only satisfy the desires of men, but also reduce the harm and stressors of female contraception.

The limited methods of male contraception include condoms, spermicidal cream, or sterilization (vasectomy). Condoms are accessible, but have an unreliable failure rate of 13% [4]. Spermicide has been shown to cause severe toxic effects on the vagina by disrupting the microbiota, leading to an increase in sexually transmitted diseases, and current research endeavors have proven to still cause mild genital irritation [12]. Male vasectomy is common due to an easy procedure, in which the vas deferens, the sperm-carrying tube, is sealed off or cut [11]. It has been cited to also have fewer complications, a shorter recovery time, and to be more cost-effective compared to female sterilization [11]. Despite these findings, there is still a 6% estimated rate of sterilized men who regret the procedure [11].

However, A highly accepted method of hormonal male birth control is in development [1]. Willingness can be as high as 83% among men, with 98% of women stating they would trust their male partner to take an oral hormonal contraceptive [14]. The method suppressing the presence of sperm in male semen, working similarly to the way female hormonal contraceptives function [1]. The feedback loop in Figure 3 displays the pathway of sperm production. The hypothalamus sends gonadotropin-releasing hormones (GnRH), which releases luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Both LH and FSH produce sperm and testosterone and are necessary for normal sperm counts to be produced (Figure 3). Once the correct level of testosterone has been reached in the testicles, excess testosterone is released to tell the brain that the sperm count has been satisfied and that it may stop releasing the GnRH, FSH, and LH hormones.

Hormonal male contraception adds exogenous testosterone, along with progestin, to provide a negative signal for suppressed sex hormone release [4]. These methods reduce sperm count while also maintaining normal body functions such as muscle mass and sex drive, and have also shown signs of being fully reversible [4]. This could be important in promoting oral contraception to males who are interested, but may be skeptical of the effects. The method of delivery ranges from injection to topical gels, but the most preferred is the pill, which requires 2–3 doses per day [17]. There are some side effects—mild weight gain, acne, and some mood changes have been observed [1]. Yet, male hormonal contraception has been associated with high satisfaction between both male and female partners, so these side effects are not alarming [1]. Additionally, if the similar types of hormonal methods are made for both men and women, this could lead to a more fair dispersion of contraceptive responsibilities between partners. 

The major issue with this method is that the reversibility takes time—up to two years—and can sometimes result in lower-than-normal recovered sperm counts [18]. Nevertheless, these drawbacks have only been associated with older participants [18]. Fortunately, there is a home sperm count test in development, which could allow male patients to check their fertility status to qualify for hormonal contraception [4]. This could provide more security not only for a broad range of males, but also for intersex and transgender individuals who may differ on the hormonal spectrum.

Figure 3
Figure 3: The brain to testicle pathway, indicating how exogenous testosterone functions to provide contraception. Excess testosterone and progestin both work to reduce sperm production [17].

The methods of nonhormonal male contraception are limited to the use of styrene maleic anhydride (SMA), a method proven to be successful through an injection that lasts one year for participants [4]. SMA works by disrupting the sperm environment, such as by changing pH, which prevents sperm transport and fusion with an egg [17]. Though it has proven reversibility in animal models, SMA has not shown reversibility in human participants which would severely reduce acceptability among males [4]. There is also discussion of a similar chemical called Vasalgel, which may also allow fertile reversibility, though research on this method is sparse [17]. Most efforts in non hormonal contraception have gone into developing reversible methods that inhibit sperm function, which may be promising due to the abundance of sperm production in healthy males. A variety of compounds have proven potential, including the sperm-targeting protein EPPIN, Vitamin A, Adjudin, and Indenopyridines [17]. However, all of the trials for these methods have produced short-lasting successes, inefficiencies, or severe side effects [17]. Regardless, the effort in developing male contraception has revealed new possibilities. It is important that these results are further developed to minimize the issue of the disproportionately gendered-responsibilities in safe-sex practices. 

The new focus on male contraception is merely a step forward in reversing the history of gender stereotypes in scientific research. It has still been argued that because men produce so much sperm, it is easier to regulate pregnancy by instead limiting the female reproductive system [19]. However, with how much sperm is produced in men (1,000 cells per second according to the NIH), compared to the limited eggs that females produce (400 mature eggs in a lifetime according to Martin), we still primarily place limitations on the more confined contributor to fertilization. A shift in the perspective of these numbers may fuel the development of not only more equal options, but also more effectiveness and reversibility. A recent study has revealed that there is a far greater number of contraceptive targets in males when compared to females, providing hope for the shift in equitable research [20]. The benefit in marketing newly-developed gender-inclusive contraceptive methods will fuel the possibility for more acceptable and effective safe-sex practices. The success of more universal contraception can expose how societal implications are critical when guiding research communication.

Author's Note

In Fall 2023, I took STS/ENG 164, Writing Science, with Professor Wills. One of the topics was the way rhetorical moves manifest in science research papers. This brought up the discussion of an article, written by Emily Matin in 1991, on the gender stereotypes hidden within the analysis of female and male reproductive systems. My professor asked our majority female class whether they felt if these subtle stereotypes were still present in society and continue to be detrimental. The unanimous raising of hands tied everything in perspective. I hope to further the discussion with Martin in this analysis of current contraceptive techniques.

References

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