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The Best Birth Control In The World Is For Men (techcitement.com)
629 points by d2vid on March 29, 2012 | hide | past | favorite | 196 comments



I do see a market with this, but it's got a lot of problems you'd need to navigate. Nothing a smart team couldn't figure out.

Most of the time, men trust women when they say they're on birth control. Women get pregnant--a big deal. It's less likely (but not unheard of) that a woman wants to get pregnant and then lies about birth control.

Men, on the other hand, would love to not use a condom. And men don't get pregnant. So saying "yeah baby, I've had my shots" would probably be a lot more common.

You'd need to market this to couples. Relationships with trust--not teenagers. Or, as an "and-1", extra step prevention. Not as a first line of defense. Then, the low cost would be more of an extra procedure that would get them thinking more about being safer. You wouldn't hang your business model on it but could actually do more business by offering it.

Lastly, being a man, the idea of someone putting forceps in my scrotum gives me the willies. Just sayin'.


The way I see it, contraceptive is for the person using it.

So if the guy doesn't want the girl to get pregnant, or wants to avoid STIs - he should use the appropriate protection.

If the girl doesn't want to get pregnant, or wants to avoid STIs - she should use the appropriate protection.

(Both people want to avoid pregnancy/disease? Then both should use protection!)

That way you don't need to worry about what the other person is doing - you manage your own expectations.

If you're in a stable long-term relationship and have talked about it, then sure, you can rely on one person, but otherwise each person should, imho, manage their own contraceptives.


Isn't most non-condom birth control primarily intended for couples?

All the other types prevent pregnancy only. Condoms prevent disease as well.


If I remember right the doctor who came up with this was trying to prevent the immediate problem of unplanned pregnancies in rural India - they're among the primary causes of our population explosion.

Most of the men and women in his (initial) target audience are illiterate and do not understand / care for methods of contraception that require any kind of anticipatory action - like taking regular pills, putting drunken desire on hold to find a condom, or even paying for either of these. (On $2 a day, all existing contraceptives are luxuries).

That said, I think is a perfect fit for his target demographic. Looks like the characteristics of that demographic are a lot more universal than he thought :D


Hormone based birth control for women has ancillary health benefits outside of family planning.


Of course, it also lowers sex drive[1], while causing weight gain, cancer[3], and heart problems[4].

For historical reasons IUDs are uncommon in the US. This is unfortunate. They aren't perfect, but they are relatively cheap, extremely reliable, and remarkably safe. Depending on the type, they also have few or no side effects. Worth considering...

[1]: This one arguably isn't a health benefit, but in many ways it's huge. With a few exceptions, humans are sexual beings, and frequency of sexual encounters correlates highly to a range of positive health outcomes, happiness, avoidance of depression, and strong long-lasting relationships.

[2]: This one confuses people, because it also prevents cancer. Best evidence is that it has a fairly strong protective effect on ovarian cancer, but causes breast and cervical cancer. The net effect on total cancer rates is still unknown; it's certainly not a clear cut benefit though, and it may be a clear net negative. (As always, these sort of epidemiology numbers are a real headache to parse. Comparing a big effect on a rare event to a small effect on a common event is very tricky. Still, anything that boosts breast cancer rates is kind of scary.)

[3]: This one is clearcut. Hormone based birth control causes a range of heart issues, from heart attacks via clots, to cardiovascular diease. We're still trying to figure out how big this factor is, but it's already clear that if you have any risk factors (ie, you're overweight, or have a family history of heart disease) you should NOT be on combined oral contraceptives, and any hormone based birth control is very iffy.


I have known several women with non-hormonal IUDs, and they all have reported the side-effect of mild-to-extreme aggravation of menstrual cramping. When the body is trying to clear out, it just doesn't like having a foreign agent that won't budge.

No silver bullet.


From personal experience with both hormonal and non-hormonal contraception (Pill vs. copper IUD), I suspect the reported aggravation is due to the fact that the Pill reduces said "aggravation", and once you are off the hormones, you feel like it's worse but it's really just back to normal.

In general, when the IUD is installed correctly, the body does not perceive it as a foreign object or try to reject it or move about and puncture holes or increase the levels of copper in the blood or [insert another myth that seems to make intuitive sense but has no scientific or observed basis].

(There is one myth that has near truth to it. The common misconception that you have to have been pregnant to get it. This is not true either - the uterus just has to be big enough to house the IUD comfortably and and it's virtually guaranteed that a post-pregnancy uterus is. However for most pre-pregnancy women this not a problem either, and a size check is the first step during the installation process).

The benefits on the other hand are real, and huge. Reduced risk of hormone-associated cancers, noticeably increased sex-drive, better hair, nails, and skin, not having to take a pill every day, less money, statistically better protection from pregnancy, the list goes on.


>No silver bullet.

My partner and I use Implanon, which has no associated cancer or heart risk. See my post: http://news.ycombinator.com/item?id=3774010

It's not perfect, but the side-effects are small and it's the most effective form of birth control besides true abstinence (as opposed to "virginity pledges," et al). Works for three years, nothing to remember, no risk of uterine perforation like IUDs, and none of the nasty estrogen side-effects.


Implanon is hormonal birth control, how does it avoid the general problems of hormonal birth control?


Looks like schiffern answered that an hour ago: http://news.ycombinator.com/item?id=3774010


In a very uninformative, and only regarding cancer.

Most issues with hormones is that they do all sort of stuff on yourbody. not only one controlled thing


I also mentioned heart problems, but I limited my response to only those side-effects Lazare mentioned in order to stay on-topic.

Side effects of Oestrogen-containing contraceptives that don't seem to be caused by Progestin-only contraceptives include:

Increased risk of cancer

Increased risk of heart disease

Bone density reduction

Blood clots / Stroke

Increased sensitivity to UV (and associated skin cancers)

Reduced breast-milk production. This isn't very detrimental to one's own health, but does effect the health of the child.

The only down-side of Progestin-only pills versus Oestrogen-containing pills is that it is extra important that it be taken at the same time every day for full efficacy. Obviously the implant doesn't suffer from this drawback.


I know every geek here research the hell out of everything... and so i don't trust even my doctor when he/she can't show (or i can't find later) pertinent and well controlled studies before messing something in my body. i'm pretty sure you did your research, but those articles and discussion here shouldn't be taken as 'proof' of anything as the comment i replied to sounded to imply.

also, i have a paranoia that no hormone/protein/enzyme does less then a few things in your body. if they list only one or two effects, it's because they have no clue what else they do.

prolactin was believed to only affect the milk production in mamals for a long time (and water-salt control in fishes). now there's some other dozen effects on the body including neuron fiber formation.


And those would be…


well, non-hormonal IUDs function by stimulating the uterus to produce hormones (prostaglandins) - So they can actually have more significant side-effects than hormonal IUDs.


All hormonal contraceptives are not created equal.

Cancer and heart problems are side-effects of estrogen or combination (estrogen + progestin) hormonal contraceptives. Progestin-only contraceptives (which include Implanon, Jadelle, and Mirena) have never been shown to cause cancer or heart problems.

As always, don't look for medical advice from HN.

(dfc was obviously referring to contraceptive treatments for debilitating menstrual pain and irregularity)


It should be noted that estrogen doesn't cause the cancer. The cancer exists and actually feeds on estrogen.

A woman's body is likely to find and destroy the defective cells before it's too late, but when you're taking hormones to overpower your body, you also have the risk of feeding the cancerous cells.


This is news to me. I have never heard/read anything that casts hormonal birth control in such a negative light. Do you have any pointers to more information? It has always been my understanding that hormone based birth control was a huge win for women's health...


Which bits?

The impact on sex drive is fairly well known, I think. Google turns up a bunch of references[1][2]. The impact on weight is apparently cloudy; birth control pills almost universally list that as a side effect on the packaging, but studies have failed to turn up a reliable link. (Silly me; never trust drug company materials, even if they seem to be casting the drug in a negative light.)

I understand there's some evidence that birth control may cause depression, but I don't know that there's a definitive answer. (Google mostly just turns up anecdotes from people convinced that their depression is caused by their birth control; not really helpful.)

The argument over which way the cancer risk goes on balance is all over the net; there's a decent roundup on Wikipedia[3]. If you dig into it a bit, it's still pretty unclear, mostly because there haven't been a lot of studies.

The heart stuff is, compared to cancer, much more solid. Again, the internet is full of stuff about this. I don't know of any comprehensive roundups, but google will turn up a TON of stuff.

[1]: http://www.medicinenet.com/script/main/art.asp?articlekey=11...

[2]: http://www.epigee.org/guide/pill_sex.html

[3]: http://en.wikipedia.org/wiki/Hormonal_contraception#Effects_...


Anecdotally the hormonal IUD's seem to have more of an effect on sex drive than the old fashioned pill. Me and the wife found that out after a clinic doctor gave her a prescription for it saying it reduces the risk of cancer (true, but unanimously agreed that it isn't worth it).

It must be noted that the anecdotal 'warnings' IE weight gain, depression, etc. may be a result of the well known drop in sex drive. Because, you know, sex has this mystical property that releases pleasure chemicals that reduce depression. Depression having the obvious side effect of weight gain. Also the impact on the hormone cycle anecdotally causes cravings.

The pill itself might not have side effects of weight gain, but I'd bet it's side effects do.


There are thousands of forums with women discussing all the negative side effects of birth control. Off the top of my head, you can visit http://iud-divas.livejournal.com/, which is women who are considering/have IUDs, and many of them report the negative (often severely so) effects of previous hormonal birth control usage. Otherwise you can visit bedsider.org, which talks about side effects for all birth control methods.

The pill is an incredible win for women's health. Unfortunately, not all women can use it effectively, safely, or comfortably.


I was looking for clinical data, peer reviewed research. But thank you I will look at these...


Read Sex, Lies, and Menopause: http://www.amazon.com/Sex-Lies-Menopause-Shocking-Replacemen...

The book references tons of studies.


As well as a lot of drawbacks and side-effects.


In theory, maybe. In practice, no. Condoms are way out of fashion these days among the young sexually active crowd.


"In 2009, the percentage of sexually active high school students who reported using a condom the most recent time they had sexual intercourse was 61%, up from 46% in 1991. In 2009, 69% of high school boys and 54% of high school girls used a condom at last sexual intercourse."

http://www.cdc.gov/nchs/data/hus/hus10.pdf#073


I was thinking more about 20-somethings than high schoolers. I'm far too removed from high school to know what they do, but I'd guess it's not as easy for them to get birth control due to their parents. But if you pick up a 25 year old girl from a bar and bring her home, she's probably on the pill and she won't want to use a condom.


That's a horrifying thought. I'm planning on doing "the talk" with my children starting with a latex condom and working outwards.

"Sex is a beautiful thing shared between two people and a latex condom from a reliable brand"...


Having the talk is great, but don't forget that some people have latex allergy and latex condoms can be uncomfortable. Of course, there are a great many materials for condoms, so all is not lost.


> ... and a latex condom from a reliable brand"...

Aren't they all required by law to be reliable?


I have no idea what the current regulatory climate for condom manufacturing is.

I just know that I'm going to trust an established brand that's sold by the box in the drug store over a no-name brand sold singly from a vending machine in the bathroom of a bowling alley.


Don't knock the bowling alley machine. Condoms are like cameras. The best one is the one you have with you and actually use. :)


It is probably better than nothing.


From what I see in the younger members of the MSM community in Norway, this is true. While they use condoms at times, I know plenty of people in their 20s who admit that they don't always use condoms, even outside of committed relationships.

Granted, this procedure is only helpful for the community if it actually is shown to reduce the risk of HIV transmission, and it's not a cure, but anything that helps reduce the risk is a good thing.


Depending on what you mean by "young," I respectfully disagree. Highschool? Middleschool? College? All of the above? Speaking for myself and the people I know (early twenties, college-educated kids), condoms are pretty common place. A lot more common place, actually, than birth control. But then again, I don't have a large sample size that cuts across socio-economic backgrounds.


You would think after the aids scare of the 80s and 90s this wouldn't be the case.


It would not be the case with people that were alive and mature enough at the time to be cognizant of the situation. I think the OP is referring to people who were not around at the time...


Not to mention that HIV/AIDs is no longer the death sentence that it used to be. So even among those who are cognizant of what it was like in the 80s, they also know that it isn't like that anymore.


It's still crazy to expose yourself to the virus. The antivirals you get for HIV infection have lots of nasty side effects, and even with treatment you're still likely to die well before your uninfected peers.


Absolutely. But the image in the pop culture mind is one of Earvin Johnson and not Ryan White.


I don't know why you were downvoted for this because, at least in my town, this is completely true. The rate of single young[1] people getting pregnant is through the roof... and the attitude (from some young people I know personally) seems to be "whatever, fuck it"

[1] I mean 18 to 21 year olds.


On HN for 1310 days and you don't know why streptomycin was downvoted? Bit surprising.

It's because he or she offers no references or even any explanation of where this bold (if not just flat out wrong) claim comes from. Your supporting evidence, commonly derided as anecdata, is not much better.


I disagree completely. Sure there are guys who might lie, but a lot of guys would love to be able to not ever have to worry about the female using birth control. Males (and females) hate condoms, but the idea of having a child before you are ready is a very scary proposition. I think this would sell very well if the surgery were painless and not too invasive.


You hit the nail on the head, here. Even if you're in a committed relationship, there's still a need, as a woman, to protect yourselves at all costs from pregnancy if you aren't looking to have a child. That's why many women in relationships will use secondary birth control. (Condoms + the pill, IUD + spermacide, etc.)

Female birth control puts the power of reproduction back in the hands of the woman, which is a comfort for most women. Relying on your partner to be the one safeguarding your body is a tough choice, but is a wonderful choice for, as you said, couples.


For couples who are done having children, this is a fantastic alternative to a vasectomy.


How so? If I'm "done" I'd rather have a vasectomy than risk forgetting about this and getting my wife pregnant at 42.


Because life is long, and when man plans, God laughs.

You could divorce (or be widowed) and remarry. You could tragically lose your existing children. You could simply change your mind - it does happen.

Should this happen to you, a shot into the vas to reverse things would be far, far easier on you and more likely to succeed than a vasovasostomy or a vasoepididymostomy.


While putting forceps into my scrotum also gives me the willies I am more than willing to get the procedure done.

I think this is more a secondary defense. For me personally it wouldn't replace condoms (1, I have never had issues with them, and 2, STD's can still be transmitted) unless in a committed relationship, but also to make sure that if something goes wrong with the female birth control, that there is a second stop-gap measure.

I as a 23 year old love the idea. If it is affordable and easy to get done I wouldn't have an issue going to get it done. And from the sound of it, it will not cause pressure to build up much like getting them cut would...

There are liars the world over. I don't think that is necessarily a trait that is just for men. I've know quite a few guys in high school that had unprotected sex because their girlfriend was on the pill end up with a baby because that is the way she thought she could keep him forever.


>There are liars the world over. I don't think that is necessarily a trait that is just for men. I've know quite a few guys in high school that had unprotected sex because their girlfriend was on the pill end up with a baby because that is the way she thought she could keep him forever.

A friend's x-girlfriend got pregnant because she poked a hole in the condom without him knowing. If you are male and don't want to have kids, make sure you use your own condoms. Woman has many more options to avoid pregnancy, man has one shot with the condom (AFAIK vasectomy can be permanent).

I think this type of birth control has the potential of lowering paternity fraud since man will know the child is not his. It also reduces unwanted pregnancy when woman poke hole in condom or other condom issues.

This birth control for man is great news and I hope to see more male birth control options in the future.


I am 23 years old, I'd consider myself rational about most things, but this scares me absolutely shitless. I know that's dumb, but if someone like me is made extremely nervous about screwing with my method of reproducing, then that can indicate what other people are feeling.

Secondly, I see orgasm as a highly pressurised, highly tuned, intense thing. It feels like I'm straining every part of my balls to the limit when I'm doing this - if I had medical procedures down there, anything that could psychologically make me feel they were frail, that would utterly ruin it.


If it's of any consolation, they don't cut open the whole scrotum or anything. They make a pinhole (that's tiny!) incision, and reach for the vas deferens just enough to inject it with a syringe.

And I don't think it does anything to make you feel like your balls are "frail". So far the only side-effects I've read about are a possibility of swelling for 1 week after the operation. Then, you're back to your old non-frail-balls self!


I have to say, I love how frank this discussion is. If we weren't talking about testicles, I would say I hope this is what every HN discussion would be like.


You could also go a different route and seek endorsements from pro athletes known to have a large and expensive number of baby mamas around the country. Market it as the "Player's Club Membership Card." It could become really trendy.


It is not the business problem if some guy lies to get sex (welcome to the human world). And there is a market among men with many sexual partners to get this procedure -- every man fears that she lies about the pill.

Doesn't mean you can't market it to couples too, of course.


If your sexual activity is not with a long-term exclusive partner, you should be using barrier protection anyway.


RISUG is indeed a great contraceptive, but when talking about its benefits for HIV we should be incredibly careful.

RISUG isn't a cure-all. Transmission is still possible through microtears and directly through the skin of the glans penis and the meatus. And RISUG does nothing to prevent female->male transmission.

It's far too easy for "RISUG inactivates HIV in some components of semen" to transmute into "It's ok baby, I got a shot that protects me from HIV!"


Agreed, but spread knowledge of this in Africa where HIV is a big problem, and isn't well understood or cared about (to western standards) and not only could it be a cheap and affordable birth control, but if it reduces the risk in transmission of HIV then its still coming up double.


That policy is a bit risky. That might diminish the use of other things that reduce significantly the spread of HIV, like condoms. It's still unknown how effective the gel is: maybe 90%, maybe 5%, condoms are 90% effective AFAIK[1].

[1] http://www.advocatesforyouth.org/publications/416


I doubt that a contraceptive with 5% effectiveness would make it this far in trials. Even "pulling out" is more effective than 5%.


Also, contraceptive success is usually annualized, like with correct condom use, pregnancy happens less than 3 percent per year. I assume there is a standardized level of sexual activity for that, too.


I think he was talking about HIV.


female to male transmission rates are really low in general.


All sexual transmission rates are pretty "low," if Wikipedia's sources are accurate. Even anal intercourse is under 2%.


Per incidence; that's a 1 out of 50 chance every single time.


Meaning, you reach 50% after 35 times.


That was a fun weekend!


Depends on when your partner was infected. If it was recently then the transmission rate is very high.


It can't be that low...

How do men (heterosexuals) get infected then?


2% per event = 50% after 35 events.

Assuming 1% of partners have AIDS and someone had 10 partners and 35 events per partner.

.01 * (1 - .98)^ 35 = 0.5% per partner. And 1- (1 - .005) ^ 10 = ~5% chance of an infection in a lifetime.

Or working the other way if the average person with aids has 35 'events' per partner and 2.1 partners after infection the infection rate will increase.

PS: Real models include differing M/F infection rates, stratification by age and other vectors like transfusions and IV drug use.


IV drug use is a major vector still.

Also, HIV transmission is more likely with other STDs. If you have open syphlitic sores on your penis, you are more likely to contract HIV.


Not forgetting that HIV increases the risk of getting those other STIs too.

There's been some speculation about why rates of HIV vary so widely across Africa.

(http://www.irinnews.org/Report/91305/AFRICA-Risky-sex-does-n...)

Unsafe injection is the most efficient way to transmit the virus. It's scary that so many injections in the developing world are unsafe. (UNICEF say "16 billion injections are administered each year, of which 90 percent are for curative purposes; 50 percent of the total number of injections are unsafe.")

(http://www.irinnews.org/Report/85278/AFRICA-Poor-syringe-hyg...)

The amount of money needed to make a difference is probably (relatively) small. But changing behaviour is hard.

(http://www.path.org/our-work/safe-injection.php)


The contamination of heterosexuals man is hard. It happens, but is very hard. This information is not well spread because it can stimulate men to stop using condoms and increase the risk for women.


Without going into detail, there are sexual practices common in Africa that significantly increase the odds of transmission from woman to man.



My girlfriend told me about this because she gets blood clots from hormonal birth control and we wish this was an option today.

You should complete this survey like I did if you are interested: http://www.surveymonkey.com/s/TSKSKGM


There's a highly effectivy method called symptothermal method. It is basically a combination of temperature measuring and cervical mucus observation, as both symptoms change during the menstrual cycle and when ovulation occurs, you can tell from the symptoms. After you successfully determined that the ovulation passed, a woman is infertile until her next cycle starts.

This means that during that time, you don't need any condoms or anything.

Unfortunately, while being extremely well-researched in Germany for more than 30 years, it is quite uncommon in the US and only known as "Fertility Awareness", which is not the "pure" symptothermal method. The method is oftentimes associated (wrongly) with Christian groups.

You can check out Wikipedia:

http://en.wikipedia.org/wiki/Fertility_awareness

Edit: Perfect use application of the "pure" symptothermal method has a Pearl Index of 0.4 (99.6% effectiveness) and typical use is 1-3 (97-99%). This is quite comparable to the pill.


My fiancée cannot use hormonal birth control for the same reason. Instead, she has a copper based IUD. Your girlfriend has probably considered this already, but if not I strongly recommend looking into it. They're not perfect, but they're very good.

(There are only two real risks/side effects: Heavier bleeding, and it's important not to get Pelvic Inflammatory Disease (which is another way of saying, it's even more important than normal not to get STDs. If she can handle the first, and is in a monogamous relationship - or at least, always uses condoms with people who aren't guaranteed STD free - then neither issue is severe.)

Mind you, vasalgel sounds even better to me. :)


What happens with the survey? Are you affiliated?


No affiliation. I think they might contact you to get quotes for media about how cool it would be and to notify you of their progress.


You should talk to you doctor about progestin-only contraception.

Blood clots, heart problems, cancer, bone loss, and sun sensitivity are all associated with estrogen-containing birth controls. From my research, progestin-only methods don't have those drawbacks.

As always, IANAD and this is not medical advice, but you should talk to one.


I guess she already did, but have you tried switching pills? (after asking a gynaecologist I guess)

My girlfirend reacted very badly to a well-known and tested brand, however she seems to do much better with a local-brand product with different composition (started that one a few months ago).


Relevant HN discussion from 10 months ago - http://news.ycombinator.com/item?id=2602785


omg omg omg omg omg omg omg omg omg omg omg omg

Please let this be real.

Male birth control is one of the top things that I wish for everyday.

The really great thing is that this isn't just a first-world problem. Birth control is obviously a huge issue in developing nations. So, while I can chase the dream of male birth control for purely selfish reasons, to address my privilege problems, I'm at the same time involved in a solution for a very real problem in the world.


Did you read about what's involved in the actual procedure...?

If you read the steps necessary for the procedure and manage to maintain your enthusiasm, you have my awed and confusion admiration.


...an outpatient procedure under local anesthesia that takes 10 minutes and lasts 10 years? It's hard to imagine how it could be better unless they literally just waved a tricorder over your junk.


You know that's exactly the same thing that's involved in a vasectomy, right?

Except with a vasectomy you have the risk of chronic testicular pain.


You know that a vasectomy is at least two weeks of hell, right? Of course, in the long run it may worth it.

Should You Get a Vasectomy?

http://news.ycombinator.com/item?id=3775066


All you have demonstrated is that one person had a bad experience with a vasectomy and decided to write about it.

>The operating room is cold. The walls are busy with gruesome anatomical diagrams, cross sections that make the male genitalia resemble charcuterie. I lie back on the table, draw the paper sheet over my crotch, and seconds later the doctor and an older, hen-shaped nurse enter the room.

I know that all reporting is biased, but the signal-to-noise ratio here is abysmal.


compared to other means of male birth control, it is quite tame as I see it.


I've asked my guy friends whether they would get this procedure, and none of them will. Guys expect women to mess with their bodies, but are not willing to make the sacrifice themselves when it comes down to it, even though this is more safe and harmless than pumping your body with hormones every day.


I got a vasectomy, even though I was sad about that, when my primary was reacting poorly to birth control. I wish that this had existed six years ago or that I had known about it. You have the wrong guy friends.


This is unrelated, but I started Harry Potter and the Methods of Rationality today and I can't put it down, so thanks!


I'll publicly go on record as saying I'd do this (if it's as safe and well-tested as the article suggests). I think, like many other things, it simply takes some public examples, preferably high profile, to help instill trust in people.


Not sure why some guys have so many reservations about this, it sounds like a simple and reversible procedure with a quick recovery. I'd get it if it were available in Canada.


Uhm, it involves cutting open your scrotum.

The idea that people will casually do this is ... hilarious.


And current birth control methods for women include injections of artificial hormones, dilating their cervix and putting a piece of plastic or metal part their vagina and into their body, and surgery to open the stomach and clamp certain organs shut. Whether or not it's hilarious, those practices are accepted as normal.

Birth control that involves body modifications is anything but casual, but to draw the line of it being ridiculous at when it involves male genitalia is a bit narrow-minded.


The line is at surgery, don't act like anyone is saying otherwise.


What's so special about the scrotum versus another part of your body? People regularly punch holes through their ears and other parts of their skin, and even get their children to do the same. A lot of parents even agree to or request that skin from the end of their newborn's penis is cut off.


You must be young. Vasectomies are a perfectly normal and routine operation in later life. I'd wager a large percentage (if not a majority) of age 50+ men in the US have them done. It hurts for a weekend, and then it's over, not a big deal. This sounds like a significant improvement over the current procedure.


"I'd wager a large percentage (if not a majority) of age 50+ men in the US have them done"

In my sample group, it's not as large as you think. I'm a 43 year-old post-vasectomy father and out of a group of ten close male friends/relatives I've encountered 2 close calls and 2 oops babies. And these are intelligent responsible men. The majority of the excuses range from "I just never got around to it" to "I don't want to get cut". Seriously?


I'm in my mid-twenties, and was seriously considering it when I thought it was reliably reversible. My reading at the time indicated that this wasn't the case and there was a good chance that you'd stay sterile after reversing the operation. This struck me as a very good reason not to get a vasectomy.


The incisions are very small, made under local anesthetic, and recovery time should be quick. Doesn't that sound less frightening than hormonal birth control?


Local anaesthetic is hardly a selling point to me. I'd prefer general, even thought that has the slight risk of death. Better than the (in my experience) 100% chance of "whoops! We'll give you another shot of that and give it a few more minutes to set in."

That's happened to be with 2 back surgeries, one on my arm, and every filling I've ever had done.

Anyway, I'd get this procedure done in a heartbeat anyway.


The scrotum isn't "cut open". It's a pinhole-size incision.


I'd happily have this done, if it were available. Screw what 'guys expect', I don't want a woman to end up 'expecting'.


From:

http://www.nytimes.com/2009/04/11/health/11patient.html

> about 527,000 vasectomies were performed in this country each year.

I have a vasectomy and would have preferred this.


Psh. If I can afford this it is 100% on.


In the US, a vasectomy runs about $400-600 (often covered by health insurance if you have it), and is largely just for the doctors time. Sounds like this should be the same if not cheaper by a very insignificant margin.


I would rather pump my body full of hormones than have invasive surgery. You wouldn't?


Fuck no. Hormones (and most other injections) has way more impact / risk / effect than a tiny cut.

I cut myself several times a month, badly a few times year. (too lazy to wear gloves when doing yard work, accidents etc). I know what a cut is / does. No idea what putting crap in my body will do.


You cut yourself badly a few times a year? To each his own, but that sounds fucking crazy to me. I manage to live my life both without artificial hormones and without non-emergency invasive surgery and I haven't had as much a a paper cut in as long as I can remember, probably over 10 years. Also I am not pregnant or had any pregnancy scares.


I should have defined "badly" as many people probably think badly == stitches. badly to means means enough to leave scar, needs cleaning & covering (bandaide).


As far as invasive surgeries (and birth control) goes, it's really not that invasive if it can be performed in 15 minutes without general anesthetic by a regular doctor. Even IUDs require more time than that.

Would you still be okay with the hormones if they caused you to gain 15 lbs of fat, lose your libido and render your SO unattractive to you? It's not as simple as swallowing a pill every morning and getting on with your life -- hormonal treatments have very real and sometimes significant side effects.


What you are describing is a possible effect, but there is no way that is the median side effect of standard oral birth control.

This type of claim always comes up whenever there is any story about new birth control. The effects of the hormones cannot possibly be worse than just not having sex since you always have the option to not have sex or always use condoms. I simply cannot believe that it is so bad considering literally every girl I know, even the ones without boyfriends and who aren't having sex or planning to have sex in the immediate future. Everyone I know in person talks just as much about how it clears up their acne as the negatives that are always posted in the comments here.


[Disclaimer: anecdote]

I was on depo provera for over 3 years. It destroyed my sex drive, nearly caused the end of my relationship, gave me terrible recurring headaches and mood swings. I came off it, and after 18 months my body was still all over the place; I ended up taking different hormone-based contraceptives to try and re-jig my system.

Few months after all that I became pregnant with twins but miscarried at 8 weeks. I know that logically miscarriage is 'normal' and common, but a tiny part of me can't help but think that screwing with my body + hormones was the cause there.


Contraceptive pills aren't like headache pills - you don't pop them on demand. They require stabilisation time.

There are contraceptive pills that are just pop-on-demand - the morning-after pill - and they're really unpleasant.


This is only barely more invasive than giving blood. You clearly haven't tried the latter if you would prefer it over the former.


I would definitely get this; already considering vasectomy.


Your friends must not get laid a lot, or are very monogamous.


While this is generally fantastic, it seems like it would be a real bummer in an apocalyptic modern-medicine-eliminated need-to-repopulate type of situation (only mostly kidding).


If it really happens, you don't want to have children for the first few years anyway. And since slowly wears off, it's pretty much the ideal scenario.


It sounds great. My partner's family has a history of cancer so she doesn't want to go on any kind chemical birth control. Nor is she keen on something like the coil.

I have always wondered why there are so few contraceptive options for men. I know a lot of guys who have had the kids they want and contraception is a hassle. Something like this for couples which is inject once and forget for a decade sounds ideal.


I would be concerned about forgetting to get it redone on year 11.. then surprise!

From the sounds of it though, you'd still have the same side effects of a traditional vasectomy: sperm granuloma. So one is mostly permanent (reconnection can happen, though super rare).. and one is only good for a few years? Yeah.. I think I'd wait for the first 10 years to see the efficacy.


I believe we've already waited 10 years. That's why it's “10+”—the oldest trials are about 10 years old at this point, and the effect is still the same (as far as I've been able to read). More, as usual, at http://en.wikipedia.org/wiki/Reversible_inhibition_of_sperm_... , including critique.


I don't see how it sounds like you'd get a granuloma. It sounds like the sperm are destroyed as they pass through the vas deferens but are still washed out as they normally would be.


Ah, I did not read up apparently. I thought this was essentially gluing the vas shut with a polymer that was reversible. According to the wikipedia entry, they don't know the exact reason it works (what?!). Very interesting.. I had overlooked that.


Just schedule it along with your passport renewal! If you are in the US~


It doesn't in langur monkeys: http://www.ncbi.nlm.nih.gov/pubmed/12826690


Oooo interesting. Now if they can slap an anti-virus on it, I'll be sold.


I believe from the article that it already neutralises HIV...


That's only male to female. Although upon further research, female to male infection has a very small chance of occurrence. Nonetheless, still risky!


This would be so awesome. The world is overpopulated, largely because of recklessness. Most people don't plan on having 4 children, it just happens. I would instantly have this procedure.


First of all, it's still in trials. Second of all, what should set off an immediate alarm is the claim of "100% effectiveness" (and safety for that matter, what if the doctor screws up and cuts your tubes?).

No, thanks.


In fact, if you check the Wikipedia article for this thing you will see a large amount of controversy and problems that the article just ignores. That alone is enough for me to not consider this seriously. It would indeed be nice if this form of birth control were real, but as things stand it's just vaporware for medicine.

It's really amazing to me how many people believe anything they want to hear...


I thought it was abstinence..


I am always surprised that every discussion of vasectomy, and even this solution, hand-waves away the experience one undergoes in the process. Before doing this yourself, at least know what your getting into:

http://thebrowser.com/articles/final-cut

For example, compare "one little injection" to "I don't scream, but I clamp my jaw so tightly it clicks. I arch my back so much I end up looking behind me at the door."


That doctor was incredibly negligent about pain management.

There's a level called 'unconscionable pain' that is essentially always malpractice, and if you're clamping your jaw and arching your back reflexively, you've hit it and then some.

There's no reason not to mildly sedate a patient, and no reason why anyone should suffer undue pain. Sure, it'll hurt during recovery, but that's why they should issue with vicodin.


This is not a vasectomy. It's not even related to vasectomy. Please RTFA.


Isn't that a little much? The procedure sounds identical to a vasectomy except the very last step -- instead of cutting the vas deferens you inject this substance into them.


It's a shot vs. a surgical procedure. It's a world of difference.


As you like to say, RTFA. They are both surgical procedures and the procedures are _identical_: make a hole or cut in the scrotum, pull out the vas deferens. In a vasectomy, you now cut the vas deferens. In a RISUG, you now inject the fluid into the vas deferens. Push the vas deferens back into the scrotum, repeat on the other testicle, and cover the wound. Both procedures can be done through a very small opening that requires no stitches, in a doctor's office, in under half an hour.


Let's not trivialize birth control with a title like this.

Good birth control comes from empowering both partners, and protecting those who are unwilling partners.

For women, an IUD is a great option. For men, barrier methods have been the only reliable, reversible methods until now. This is exciting, but let's not forget about the whole scope and meaning of self-control over reproduction.


In what way does this trivialize birth control? The ideal of birth control as a technology would allow anyone to cheaply turn their ability to reproduce on or off with no side effects. It's no more concerned with unwilling partners than willing, the technologies work the same for both. Judging from this article the method in question is getting pretty darn close to that ideal.


Its not ideal if it is only verifiable by one sex.


Like the pill?


The pill is certainly not the realization of the ideal form of birth control. However in an non-perfect universe the form of birth control that is verifiable by females (the sex that is impacted the most by pregnancy) is the closes to ideal.


Is there anything other than abstinence that's verifiable by both partners? Non-visible methods could be lied about whereas visible ones such as condoms can be tampered with.


I don't see how this title trivializes birth control. Good birth control comes from controlling birth. I don't believe any other method can claim 10+ years of effectiveness, with practically no side effects and high reversibility.


Intrauterine devices (IUDs) fit exactly that bill. But one of my points is that one form of birth control, only for men or only for women, shouldn't wear the title "best."


Have you ever had sex with someone who has an IUD. Or talked to a woman with an IUD to see her opinion on it? Because it's not all you make it out to be.


I'm curious what problems you have in mind. Of my friends who I know use an IUD, 4 out of 4 say some variation of "how could you consider using anything else?" The only complaint that I heard from this admittedly small sample is a day's worth of discomfort following insertion.


As far as IUD's, let's not forget there are two types: paragaurd (copper) IUD and Mirena (levonorgestrel eg hormonal) IUD. There are different side-effects associated with both although I have anecdotally heard that paragaurd's side effects are mild compared to oral contraceptives. Should someone not wish to use hormonal BC or if they cannot for various medical reasons-->paragaurd is what you are stuck with. And its great in many ways (no babies, no babies and no babies), but many women experience periods that last over a week and spotting in between as well as extremely painful cramps. I was on it for 6 years and I'm so happy I finally got it removed. In summary, IUD's are of course a great form of BC, but that doesn't mean we shouldn't pursue more options. I don't think I'm stating anything earth shattering when I say, women wouldn't mind more non-hormonal based BC options.


I'm not sure how that would inform my awareness of the fact that IUDs provide effective birth control for women for 10 years after insertion. But I'm in medical school, so you can make a guess as to how many of the women that I know happily use IUDs (hint: many).


When you say you know these women, do you mean in the biblical sense?


> rudiger: When you say you know these women, do you mean in the biblical sense?

This crass garbage has no place on HN.


As always, it depends on the woman; I know one who swears by them, though I've never had sex with her so I wouldn't know for sure.


You only believe what women say when you've had sex with them? What?


The OP mentioned a change in sensation for men. He's suggesting that he is not qualified to comment on that.


"Have you ever had sex with someone who has an IUD. Or talked to a woman with an IUD to see her opinion on it? Because it's not all you make it out to be."

Where does the OP say anything about a change of sensation in men?


Yes; I was conceding that I've never had sex with someone who has an IUD, only talked to them. You'd have to ask nekitamo what exactly one should learn from having sex with someone who has an IUD.


As someone who has sex on a regular basis with (one) woman who has an IUD, my experience has been that it has no impact whatsoever if installed properly. The uterus (where an IUD lives, naturally) is not typically involved in the act of sex.


I figured as much. You'll have to ask nekitamo what he was on about.


I've never noticed the IUD, but I did notice the NuvaRing (it wasn't bad or obtrusive, just "uh, wtf is that?")


Um, read the comment I was replying to for context.


IUDs have side effects. Copper ones can make periods unbearable for some women. Hormonal ones come with the same risks as hormonal birth control. You also have to open the woman's cervix which is a painful procedure, especially for women who haven't given birth before.

IUDs can also make the cervix more sensitive to pain in general. IUDs also can slip out.


And I disagree with that. If it's the best at controlling birth, it's the best birth control. Since all sex acts involve two people, and I have a really hard time picturing a form of birth control which targets both parties equally, which party benefits/is responsible for it/controls it is neutral for judging which form is best.


Both parties are responsible, so there can and ought not be a single "best". "Best" is not any single method, but instead requires something from both parties.


All right, I see what you mean. I'll explain why I think there is a best method.

For a single person considering the question on their own, the best choice is limited to what's available to them. Since there are (approximately) equal numbers of men and women considering this, neither population affects the universal rankings.

But for a couple considering their birth control options, it doesn't matter on which of them the responsibility and direct benefit fall. What matters is the effectiveness and side effects. So they can agree on which is best without worrying about who holds the responsibility, etc.

So, for example, the pill is better than condoms, because it has a lower failure rate and doesn't have the side effect of severely reduced pleasure. The fact that a single woman can't depend on condoms and a single man can't take the pill cancels out, because there's one of each of them, and the couple is making the choice for both of them.


What you have described is not a "best method;" it's a compromise due to limited resources. Using multiple complementary methods will always result in a lower risk than deciding on any one of the options.


What I've described is why, in my opinion, birth control methods that target opposite genders are still mutually comparable.


By that standard, an IUD is better than this because of the battery of Stage III and postmarketing trials supporting its effectiveness. But I disagree with your standard and find it to create a false dichotomy where there need be none.


The dichotomy exists regardless of your not acknowledging it, though. I have _had_ these conversations and made these comparisons. My current girlfriend and I switched from condoms to the pill, despite the extra responsibility for her and the definite potential for side effects, because it's a better form of contraception, period. The very instant we can switch to RISUG we will, because all available data indicates that it's better in an absolute sense.


The dichotomy is still false. Adding RISUG to what you are currently using (OCP) will be more effective than merely switching from one to the other.


Reportedly, when the pill was introduced, it empowered women by giving them much more control over their reproductive options. Afaik, this is the first non-barrier method of contraception that reliably provides the same freedom for men.


Yes, this is great. It's the title that I find wrongheaded.


The best birth control in the world is one that allows women to have control (and peace of mind) over the process/efficacy.


They already have that. It's very nice that there's also something men can have, both to supplement female birth control and to provide peace of mind for the man. It's not a "one or the other" proposition.


Yeah, why not have two contraceptive methods in play - like a "Plan A" and a "Plan B"? I think you're on the right track here. Many men, including myself, feel pretty equal with their spouse in terms of family planning, but having a Plan B would definitely give me more peace of mind "just in case" haha.


Um, "best" neccesarily implies a "one or the other" proposition.


No, "best" means that one is more effective than the other, it does in no way mean that only one method should be used.


Why is the best birth control in the world so one-sided?


Because men clearly are not as invested in the possible rearing of a child.

Clearly.

(seriously: making a kid should be && not || )


This will also let us stop hearing "men's rights activists" whine about child support. Didn't want to pay child support? Should have gotten the shot!


Tell that to the guys who are provably not the biological father, but are still forced by the courts to pay child support.


Thank you. I was a little surprised that my comment got downvoted so much. Maybe this is due to the low percentage of female HNers?

Its as if most people think that the pill would have been as revolutionary if it were for men instead of women.


Erm, I think there may have been a bit of a misunderstanding in my attempt at some dry humor. :(

I intended to imply disagreement with your claim, mostly due to the one-sided nature of it (as my parent reply suggested). I imagine the downvotes are due to the fact that your phrasing seems to imply that the male should have no say in the matter.

It's not that women should not have control over the process (perhaps even most of it), but that both parties need to have the ability to say, finally and without being overruled, "no this will not result in a child."

That was the purpose of my comment, it should be a

  (she->wantsChild() && he->wantsChild()) makeChild();
not

  (she->wantsChild() || he->wantsChild()) makeChild();
sort of deal.

EDIT: "Its as if most people think that the pill would have been as revolutionary if it were for men instead of women."

I think you've hit it right on the head here, though. The advent of the pill allowed for equality of sexes in the manner suggested above. Had it been for men, I don't think it would've changed much at all.

However, now that that is the case, we've kind of got a situation where women can choose to have relations without getting pregnant regardless of what their partner is doing, whereas for men the options are both limited and uncomfortable. A woman on the pill can have sex without protection (though there are obvious caveats, of course, know/trust your partner, etc. etc.) and still be assured of results, whereas for a man he pretty much has to either be wearing a condom (uncomfortable) or have had a vasectomy.

This would be another round of equalization, better for everyone.


Thank you for the clarification and taking the time to respond. I did not mean to imply that men should not have a say in the matter. I think I might have placed too much emphasis and an overly broad definition of "best."

My point was that given the biological constraints females ultimately are the most impacted by pregnancy. As a male I definitely value improvements for male birth control. However from a societal point of view I think the best birth control is one that is either controlled by women or is verifiable by women.

Since you are being so helpful and I seem to be so hard-headed/clueless on this one. What do you think the general disagreement is with my "best neccesarily implies one or the other comment."?


With no reasoning given it's not a particularly valuable post in terms of contribution to the conversation, and it forces people to speculate about why you're declaring it to be "the best". There are any number of unflattering possibilities, which probably accounts for no small measure of the downvotes.


I think you are confused about the post I was referring to:

"Um, "best" neccesarily implies a "one or the other" proposition."

How can best be interpreted to mean anything other than a one or the other proposition.


> I think you are confused about the post I was referring to:

Whoops.

> How can best be interpreted to mean anything other than a one or the other proposition.

(Simplified)

You said: I think the best thing is X (vs Y).

He said: I disagree that this is an either-or proposition.

You said: Um, "best" neccesarily implies a "one or the other" proposition

He was never confused about the meaning of "best", he just disagreed that it applied.

You missed his point by a country mile, and got downvoted accordingly.


I reread your comment in light of the dry humor. But I am a little confused. A dry sarcastic reading of:

"Because men clearly are not as invested in the possible rearing of a child. Clearly."

Does not seem to mesh with this:

"It's not that women should not have control over the process (perhaps even most of it)"

I think men (especially "honorable/good" men) are invested in the possibility of a pregnancy/child, but they are definitely not equally invested/impacted by a pregnancy/child.


How does this change anything for the female? If she doesn't trust the partner, but still wants to have sex with him, she can be on the pill, use a condom or use something else.

This simply gives men additional choices and allows couples where the female isn't able to use birth control to have sex without producing a baby.

The only 'choice' this takes away is the females choice (properly rare, but still feared) to claim she is on the pill and really that has never been reliable.


Good point, but I'd argue for both people. The best birth control in the world is one that both parties know has actually been administered.


I think in this case they are using "best" to mean "effective" as in "will work as advertised". Rather than the more subjective "best" overall.


I can't explain the downvotes, but you brought up a very good point, any guy can just say he's good to go, and be lying just to get a piece. A girls best to bet is to look out for herself.




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