Abstract

Contraception is critical to health, development, and quality of life. Both men and women have little self-determination unless they have control over their own fertility; yet for much of the world, this control remains elusive. The world’s poor have only two affordable contraceptive choices: sterilization, which is permanent, and the copper IUD, which can cause pain and heavy bleeding. Even in wealthy countries, women face an unappealing choice: hormonal and intrauterine methods plagued by side effects, or barrier methods with double-digit typical-use failure rates. Men have even fewer options for controlling their fertility: vasectomy (which is inappropriate for men who still want children), withdrawal (which has a high typical-use pregnancy rate), and condoms (which, though important for disease prevention, are unpopular among committed couples and can sometimes fail). A safe, reliable, reversible, nonhormonal method for men would therefore meet a critical need. Indeed, men have begun to demand such a method.

This paper describes the current state of research on more than a dozen promising contraceptives for men, including vas deferens-based approaches, heat methods, and nonhormonal oral methods. Each contraceptive has a clear advantage over current methods (male and female) in safety, effectiveness, convenience, reversibility, or avoidance of surgery.

Medical research has made enormous strides in the last few decades, and developing a new male contraceptive is well within our ability as a society. The technical challenges are not complex. No breakthrough is required: only the dedication, commitment, and money to finish what has been started. The task is small, yet the public health rewards would be huge.

Next section: Introduction