Abstract
Study question: What are the motivations, experience, and acceptability of thermal male contraception (TMC) in men using TMC as the only couple contraceptive ? Summary answer: Men wished to share the role of providing contraception in a couple and to avoid the use of hormones. Sexual satisfaction was significantly improved.What is known already: Two male contraceptive methods inducing spermatogenesis suppression have achieved contraceptive efficacy, on a large population for hormonal contraception and a smaller one for thermalcontraception (TC). The suppression of sperm counts to below 1 million/mL results in fertility rates commensurate with female pills. TC is obtained by wearing 15 hours/day a contraceptive underwear (CU) inducing a 2C increase in testicular temperature (Mieusset & Bujan 1994). As no commercially available male thermal contraceptive exists, little information regarding the acceptability of this approach to men has been reported and only one publication analysed the hypothetical acceptability of TMC (Amouroux et al. 2018). Study design, size, duration: We contacted 72 men who had started the CU testing phase between June 2011 and September 2019. The participants completed an anonymous online survey of 93 questions exploring population characteristics, contraceptive histories, motivations for choosing TC, patient experience at the successive phases of use, relations with partner and environment, and satisfaction with TC. Sexual life was evaluated by rating (1 to 4): frequency and pleasure of sexual intercourse, sexual desire, morning and intercourse erections. Participants/materials, setting, methods: Among men who had reached the contraception use phase, the quality ratings of sexual life were compared over time, from the contraceptive method used before TC (“N-1” method) to the 2 previous methods (“N-2” and “N-3”)): “N-3” versus “contraception use phase”, “N-3” versus “CU testing phase,” and “CU testing phase” versus “contraception use phase.” These comparisons were made for all 5 sexual life parameters by a paired samples Wilcoxon signed rank test. Main results and the role of chance: Sixty-seven men responded (93% response rate);63 participated in the survey (94% participation rate). The median age was 31 [21-52], 30 men (48%) had a Master’s degree or more, 49 (78%) had no child and 24 (38%) no parental project. Among the men whose couple’s contraception method immediately before TC (N-1) was a female method (n ¼ 36/63, 57%), the 2 main reasons for switching to a male method were the wish to share the role of providing contraception in a couple (n ¼ 31/36, 86%) and the willingness to take responsibility for contraception (n ¼ 21/36, 58%). The main motivations for choosing TC were “not using hormones” (n ¼ 59/63, 94%) and using a method regarded as “natural” (n ¼ 49/63, 78%). Most of men (68%) adopted the method in less than 2 weeks. During the contraception use phase (n ¼ 59 men), they described: i) significantly improved sexual satisfaction (3,49§0,29/4) compared to that experienced with previous contraceptive methods (3,27§0,58/4;p<0,01); ii) high female partner confidence (100% rather/totally confident partner) and support (88% rather/totally supporting partner); iii) improved self-esteem (n ¼ 35/59, 59%). The main negative point was discomfort, reported by 24% of the men.The overall satisfaction score of using TC was 3.78§0.46/4, and 100% would recommend TC to other men.Limitations, reasons for caution: The study population may seem small (63 men). However, it is not different from that of the previously pubished studies on men using hormonal contraception, which included 20, 38, 79 and57 men, respectively. Our study also lacked a similar questionnaire for the female partners. Wider implications of the findings: Men using TC successfully assumed the responsibility for and performed a daily task to provide couple contraception. This positive evaluation of TC together with its previously published contraceptive efficacy and reversibility on a small population, should encourage the development of this method.