Rik HW van Lunsen MD, PhD Head Dept. Sexology Academic Medical Centre University of Amsterdam 7th ESC congress Genua 2002 Psychosexual Aspects of Male Contraception WHAT ABOUT BOYS?

Male Methods Condoms Vasectomy Hormonal methods NFP

Hormonal Methods An agent that results in universal azoöspermia without significant side effects remains illusive (Brody & Anderson, expert opin investig drugs 2002) T+ progestogens T+ anti-androgens T+ 5  -reductase inhibitors T+ GnRH antagonists

Factors Influencing Male Contraceptive Use User characteristics Method characteristics Situational context Male responsibility Sexual side effects Compliance

What about women? Dear ladies in the audience, Let us presume that you are in a stable heterosexual relationship,that you are fed up with daily taking of your OC and that there is a bi-weekly injectable male contraceptive that is safe and reliable as long as the injections are given in time (within 72h)

Would you rely on this method used by your male partner?

Male Responsibility Men are more interested in avoiding unintended pregnancy than often assumed but lack information, communication skills and services (population reports ICPD 1998) The assumption that contraception, pregnancy, childbirth and prevention of STD are exclusively women’s concern reinforce men’s lack of involvement in safeguarding reproductive health (the state of world population, UNFPA 2000

Male Responsibilty Compared to sexually active girls boys are significantly more likely to believe that contraception in general: -interferes with sexual pleasure -is bothersome -involves too much planning -is difficult to obtain -makes others think they are seeking sex (Pesa,Turner et al, J Pediatr 2001)

Sexual Side Effects Interruption of foreplay Sensory loss Lack of experience Rationalisation Condom

Sexual Side Effects Health beliefs about negative effects on sexual functioning explain huge differences in vasectomy rates Vasectomy

Sexual Side Effects  Testosterone levels should be within physiological limits  Little sexual side effects in clinical trials  Lack of data Hormonal Methods

Compliance factors influencing condom use Sex education Communication skills Female autonomy Male responsibility Social image Accessability of services and supply

Compliance - vasectomy In western countries vasectomy rates vary from 0-35% in men > 40 years (female 170 million vs male 43 million) * Health beliefs * Shared responsibility 34% of men never show up for post- vasectomy screening (Maatman et. al, fertil. steril 1997)

Compliance - hormonal methods Route of administration Male pharmacotherapy use High continuation rates in clinical trials (e.g. WHO 1996)

Hormonal Methods Will women trust their partners? > 50% Dutch women in stable relationships say YES No data on compliance

Male Contraception A Matter of Attitudes

Rik HW van Lunsen MD, PhD Head Dept. Sexology Academic Medical Centre University of Amsterdam 7th ESC congress Genua 2002 Psychosexual Aspects of Male Contraception