The Vagina Burden: Part Three

The Vagina Burden: Part Three

In case you missed them; Part One and Part Two


People...I've never been pregnant. This has been due to a large amount of diligence on my part, and I guess partially also a proclivity for butt sex. But the important part is, that as a woman who never wants to become pregnant, I will be spending around 40 years or more of my life working my ass off to keep myself deliberately barren. Welcome to The Vagina Burden: Part Three 

The Contraceptive Burden

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Our bias towards contraception (and its failure) has been relatively consistent throughout history; even during times when contraception was the responsibility of men (e.g when condoms or withdrawal were the only options on the table). If a serving girl got pregnant to the lord of the manor, it was a brief chastisement for him and most likely a nunnery for her. We've always had a narrative of the “fallen woman”; the one who lost her chastity and fell from the grace of God. And yet there's been no equivalent term for a man who has done the same. Because only women deserve to be punished for their sexual acts. It’s nice to think that the days of shaming women for their sexual exploits are far behind us, but let’s be honest, slut shaming is alive and well (at least in the Australian Parliament anyway).

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We've spoken before about the double standard attributed to male and female presenting bodies. Basically, women aren't allowed to have sex for pleasure, but men are. What's fucked up though is that despite the fact that women aren't allowed to pursue sex for pleasure, they're still almost solely held accountable for the consequences. For instance, look at the commentary around women who get abortions. How often is the focus on how she should have had more self control, about how she should have just used contraception, or simply kept her legs closed? But how often do we hear an equal amount of vitriol hurled at the partner who necessitated an abortion in the first place?

We seem to view an abortion as a woman’s responsibility since she’s the one who can get pregnant and therefore is the one who needs to deal with the consequences, even though consciously we know it takes two to tango. Recently a Mormon mother’s twitter post garnered international attention when she dared to extrapolate on this exact issue.

She points out that since women can orgasm without penetrative sex or ejaculation, it’s the male orgasm that causes pregnancy: "Unwanted pregnancies can only happen when men orgasm irresponsibly [not using a condom or withdrawing]." For that reason, she says, focusing on men and male behaviour could have a massive impact on the rates of unwanted pregnancies and abortions. Naturally the majority of the internet lost its collective mind at such an assertion. Men, be responsible? How very dare!

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Contraception exists within a sexist system

There have been a large number of studies on contraception and family planning and they've unanimously come back reporting what women have known all their lives; the burden around issues of reproduction falls almost exclusively on them.

On the surface this might not sound like a lot of work, but when you break it down you’ll start to realise how much time, effort, energy and money women are investing in reproductive health.

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From doing the research on available options, to finding something that will work for their bodies and their cycles, to making the appointment with the Doctor, visits and re-visits for scripts, insertions, removals, trial and errors. Just getting access to the right contraceptive is a battle in and of itself, since many doctors won’t prescribe, for instance, long term contraceptives to women who haven’t had children.

If a woman has chosen an IUD it’s their responsibility to find someone who will insert it. If they go to their GP (as opposed to a proceduralist, like at a family planning clinic) there’s a good chance the doctor won’t have had extensive experience with the procedure and will perform the insertion without the assistance of local anaesthetic. Dudes, if you’re trying to picture this, imagine someone shoving a paperclip into your bladder via your urethra. You’d want some fucking anaesthetic, wouldn’t you?

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Once the IUD is in, it still needs to be monitored for movement or changes, because it’s possible for it to become dislodged. If the GP refuses to prescribe an IUD, they might recommend a user-action contraceptive; such as the contraceptive pill, a vaginal ring, a diaphragm, etc., which then becomes the woman’s responsibility to ensure that they’re consistently using it ‘perfectly’ for maximum efficacy. But the contraceptive pill and/or condoms sounds like a reasonable measure, right? Yeah, until you take into account that half of all the abortions performed in Australia are on women who were relying on the pill and/or condoms for their contraception.

All of this is before we begin to look at the side effects that can come from hormonal birth control, or the stress of remembering to use other methods as perfectly as possible. It’s completely understandable that some women choose to forgo hormonal or barrier contraception and rely on natural family planning or the pull out method, even though these both have some of the lowest efficacy rates in terms of pregnancy prevention. But hey, speaking of contraceptive failure, whose responsibility do you think it is when it fails?

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There’s no risk, or physical burden, to the male partner if a contraception method doesn’t work. Men will complain about condoms because it affects his pleasure, because he has the luxury of associating sex purely with pleasure. At no point is he considering that if he doesn’t wear a condom, he might have to source a morning after pill, an abortion, or childbirth for a kid he doesn’t want. This leads condoms to be less of a penis-responsibility and more of a joint effort from both parties to ensure that one gets worn (and after working in the sex industry I can tell you for a fact that a lot of men are quick to eschew that responsibility if they think no one is looking). The fact that removing a condom without a partner’s knowledge is referred to as “stealthing” and not “rape” is indicative of how little thought many men give to the consequences of unprotected sex.

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It’s interesting that taking contraceptive pills, getting IUDs, marinas, implanon, diaphragms or the assortment of other variously invasive, uncomfortable, expensive and life affecting preventatives, is considered the responsibility of the one who can get pregnant, and yet reproductive legislation is predominantly the responsibility of people who will never get pregnant.

When you start examining it closely, it’s not hard to see that women are doing a huge amount of physical, emotional and mental labour to ensure that their relationship is protected against an unwanted pregnancy. All of which feels a lot more offensive when studies show that 52% of men don’t see any personal benefit from a woman in their life having birth control.

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So why aren’t there more contraceptive options for men?

For men there are really on three options on the table. Withdrawal, condoms, or a vasectomy…that’s it. Withdrawal has a high failure rate, condoms are great and offer protection against STIs, but they can be tedious to use every single time if you’re in a long term relationship. And a vasectomy is an awesome choice, if you know you never want kids, or you and your partner don’t want any more children, but if you’re young and unsure about your future it’s a pretty permanent decision. There are many men who would happily shoulder the contraceptive burden for their female partner, so where are all the other options?

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The answer lies in the fact that medicine takes the pain or suffering of men far more seriously than it does women. For every female contraceptive that’s available, along with a litany of undesirable side-effects, there’s a male counterpart still undergoing rigorous testing to eliminate side effects altogether.

A perfect of example of this was a recent clinical trial. It was halted because the side effects were deemed too severe for participants to tolerate, even though the majority of men in the study said they were happy to keep going.

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The fact that will really twist most women’s ovaries is that the side effects these men were experiencing were significantly less than those currently experienced by women on existing hormonal contraception. But hey, this is what clinical trials are for, right? You take a pill, you say “This pill didn’t get me pregnant, but it did make me grow a tail, so back to the drawing board everyone.”

Except that this isn’t how clinical trials work for women’s drugs. Women fought for over two fucking decades to have depression acknowledged as a side effect of the contraceptive pill, and even that conclusion is still being contested by many in the medical field.

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It’s easy to think that this is an anomaly, that maybe it’s hard to prove the pill causes depression, because depression is so common these days or something. Well it’s actually completely in line with most women’s experiences of not being taken seriously when it comes to reporting pain or negative side effects to medical professionals.

In 2001 a study was done by the University of Maryland that concluded women experience pain more severely, more frequently and for longer durations than men, but that they’re consistently treated for this pain less aggressively.

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Basically, if you present as a woman people are going to assume that you’re being a “pussy” about any pain you experience, and they’ll medicate you accordingly. How does this translate to contraception? It means that when companies are testing potential male contraceptives, they’re more likely to place a higher priority on the feedback men give around side effects.

Let’s say you’re testing the same birth control pill on both men and women. The men say “This makes me feel unwell” you’re likely to withdraw the product, and continue developing it until the test group stops reporting that symptom. Whereas if the women say “This makes me feel really unwell” statistically (and historically) you’re most likely going to ignore this feedback and sell the product anyway.

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Sounds far fetched doesn’t it? Like, surely this is all hyopthetical, right? Nope. It’s exactly what happened with the first iteration of the oral contraceptive pill.

“Incidentally, [the creators] had originally looked at hormonal birth control for men. ‘It was rejected for men due to the number of side effects,’ says Grigg-Spall, ‘including testicle shrinking.’ It was believed women would tolerate side effects better than men, who demanded a better quality of life.” Those side effects are still there by the way. Men might not put up with a massively lowered sex drive, bloating, weight gain, tenderness, headaches or mood changes, but women are expected to shoulder it and be grateful for the privilege.

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Okay, but like, we all know that the contraceptive pill was developed right in the heyday of sexism and racism. No one would get away with that shit these days. If a viable male contraceptive came along, of course it would be greenlit. Well, look no further than the Reversible Inhibition of Sperm under Guidance (RISUG) project; it’s an alternative to a vasectomy, except that it’s completely reversible. RISUG has been in a state of constant improvement since 1979; but it’s still awaiting approval to be sold. But hey, maybe it has some flaws that make it really uncomfortable or dangerous. You wouldn’t want to approve an unsafe product, regardless of what gender it’s for, right? You’d think so, but hey, have you met Essure?

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Essure was developed as an alternative to tubal ligation (getting your tubes tied). Medically speaking it’s a contraceptive coil designed to induce fibrosis and block the fallopian tubes. Translating for the those of us without a medical degree,  fibrosis is defined as “the thickening and scarring of connective tissue, usually as a result of injury.” Basically it’s little chunks of metal that are shoved into your tubes to make them freak out and scar over so that the scarring blocks the passage. And yup, it got approved.

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It got approved by the FDA after two non-randomized, non-blinded, prospective studies that lacked a comparator group. In science talk, that’s a fucking half-assed study.

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Since its release this contraceptive coil has received 16,373 medical reports of side effects including: accounts of devices that broke apart inside the body, coils that migrated out of the fallopian tubes and/or punctured other organs, systemic autoimmune reactions, pregnancies (about 1,100), miscarriages and stillbirths.

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If that doesn’t piss you off, then prepare yourself for what comes next. When you hear about those effects it’s easy to speculate that maybe this was the result of some completely unforeseen aspect of the product that couldn’t possibly have been replicated in trials. Noooooope.

Fun fact: Essure coils are made from 55% nickel.

Follow up, totally random Fun Fact: Nickel allergies are known to lead to autoimmune reactions.

Additional, but totally unrelated Fun Fact: Approximately 20% of ALL women have nickel allergies.

And yet, at no point did the marketing or packaging for this product mention nickel allergies as a contraindication.

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In addition to the nickel, having a device that’s capable of breaking apart inside the body seems like something that could, and should, have been anticipated. I’m sure you don’t need an illustration to understand how painful it would be to have small shards of metal wandering around your insides, perforating your other organs. I mean, surely that one isn’t a gendered pain issue and we can acknowledge that women aren’t lying about this being a fucked up product...right?! Well in Australia the device was withdrawn by the manufacturer after the Therapeutic Goods Administration put a warning on it; however despite a class action lawsuit being led by Erin Brokovich, it’s still being inserted into our American sisters*.

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The lack of male contraceptive options isn’t solely caused by men’s pain being taken more seriously though. It’s also a case of pharmaceutical companies refusing to fund research into male contraceptives at all. Case in point, two of the three most promising options for male contraceptives are currently being researched and developed by not-for-profit organisations relying on philanthropic donations.

Vasalgel, a similar product to RISUG, has been proven to be successful in primates (who have similar biology and even more sperm than humans) but there are no pharmaceutical companies willing to take the product on, so it’s now basically relying on crowdfunding…like some kind of internet bake sale for balls.

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There’s also a pill that can be taken before sex that prevents the muscles in the vas deferens from moving sperm, thus creating ‘dry orgasms’. It’s been in development since 1988 and has proven successful in tests on rams. But, once again, no pharmaceutical companies want to take it on. Some argue that it’s because pharmaceutical companies don’t see any profit in it. This directly contradicts findings made as far back as the 1990s, where pharmaceutical company Organon discovered that a male birth control option could garner up to HALF of the current contraceptives market.

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Herjan Coelingh Bennik is a gynecology professor who helped develop the contraceptive devices Implanon and Cerazette as head of R&D in women’s health for Organon International from 1987 to 2000. When asked why these companies were reluctant to invest he replied

“The fact that the big companies are run by white, middle-aged males who have the same feeling—that they would never do it—plays a major role. If those companies were run by women, it would be totally different.”

 

Easing the contraceptive burden

It can be incredibly overwhelming to read all of this, particularly if you’re a socially conscious bloke. It can feel like you’re participating in, and benefiting from, an incredibly unfair system even though you don’t necessarily want to.

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If you’re looking for ways to make a difference and help ease the burden on a female partner, consider taking responsibility for the contraception in your relationship. This can mean buying condoms, but it can also mean researching different contraceptive options and making time to have a conversation with your partner about what’s available and suitable, if they’re open to that. You can also show your support by attending appointments for things like contraceptive implants, injections, IUD insertions, or even pap smears. It can mean going to the pharmacy to pick up the script for the pill, or looking into a vasectomy if you’re considering longer term options.

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You can also look into donating to the male contraceptive projects that are available, and get involved in advocacy to make things like the contraceptive pill available over the counter (so that women aren’t paying a doctor’s fee every time they need to get another script for it). And if you want to buy some contraceptive offsets, so to speak, to help out women who otherwise can’t afford access to contraception, you should really consider donating to the Australian Choice Fund.

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Most importantly though, you can make the time to just listen and engage with the women in your life when they talk about their experiences. Socially we tend to not believe women when they tell us about their pain, their discomfort and their health, so being mindful of that bias not only when talking about contraception, but in general, is incredibly important. Be part of the change that we need to see in the world; help to shoulder the burden.

 

That is all.

 

You may go now.

 

 

[Banner image vagina by B. Damm from the Noun Project]

*Accurate at time of writing.