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					      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
           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

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
          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
        Sexual Side Effects


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

 Hormonal Methods

•  Testosterone levels should be
  within physiological limits
•  Little sexual side effects in clinical
•  Lack of data
        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
        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