Sperm Suppression

And Pain Relief

When I was pregnant the first time, I was painfully (pun intended) aware of the negative opinions swirling around about epidurals. These weren’t medical opinions—my OB was all for pain management—they were more like an overarching cultural understanding that the only true “natural birth” was one in which the baby popped out of the vagina with minimal-to-no medical intervention.

This line of thinking implied that women who needed C-sections were victims of the overly cautious medical patriarchy, those who had episiotomies had been unnecessarily violated, and those who accepted—or God forbid asked for—an epidural to numb the pain were both cowards and failures as women. There was some sympathy for those whose birth plans went awry because of complications or doctors afraid of litigation, but the message was clear that real women wanted to push through the pain. Literally.

Some of this likely has its roots in feminist arguments that putting birth in the hands of the male-dominated medical system takes power away from women, but that’s not what I was reading while I was pregnant. The message was being reinforced to varying degrees by pregnancy guides, women’s health magazines, and the early days of mommy blogs. It also came from friends and acquaintances. The ones who were my age also ate healthier than I did, didn’t get their nails done during pregnancy, and were using low-VOC paint in their nurseries. The ones who were older were women who had given birth in the early days of the Lamaze movement and felt we should all be able to do it with breath work alone. 

I tried not to listen. I wanted an epidural. It’s not that I’m a wimp: I just appreciate having been born after the advent of Aspirin, Advil, and Novocain. I turn to modern medicine for relief when I have a headache, menstrual cramps, or a bad cough. I got numbed the few times I needed stitches (and nobody told me to tough it out then, by the way). And the one time I let a dentist convince me I could get a cavity filled without Novocain, I instantly regretted it (and so did he). Why shouldn’t I ask for help when I’m being told to push a very large object out of a very small hole? 

So as not to be talked out of my position, I took a birthing class specifically for people who knew they wanted an epidural (the class for braver women met next door and was much larger). I lived in fear of the scenario you always see on television shows when the doctor says it’s too late for the epidural. And yet, when Patty the labor and delivery nurse asked me if I wanted an epidural minutes after my water broke, I hesitated. I thought maybe it was too soon, and I worried that an epidural might slow down labor (a common piece of misinformation). I asked if I should at least wait for the doctor to examine me.  

“Does it hurt?” Patty asked.

“Yes,” I replied.

“Congratulations,” she said. “You’ve experienced the pain of childbirth, now let me call anesthesia.”

I’m telling this story not because said baby is graduating from high school in a couple of weeks and I’m in a moment of intense nostalgia. (She is and I am, but no one has nostalgia for the actual act of giving birth). I’m recalling my story because research came out this week that suggests epidurals can have benefits beyond pain relief and may protect women from some dangerous health complications of delivery.

The phrase “an epidural” can actually mean a lot of things, but in the case of labor and delivery it refers to epidural analgesia—a shot given near the spine that numbs lower parts of the body (waist to knees or so) without completely paralyzing them. This provides pain relief while still allowing you to be an active participant in childbirth (read: push).

Researchers at the University of Glasgow studied records of 567,217 women who gave birth at all National Health Services Hospitals in Scotland between January 2007 and December 2019. About 22% of these women had epidurals. (This is far lower than in the US where 70-75% of women opt for this kind of pain relief.) Analysis of these records found that epidurals were associated with a 35% reduction in severe maternal morbidity during birth and in the first 42 days postpartum.

The CDC defines severe maternal morbidity (SMM) as “unexpected outcomes of labor and delivery that result in significant short- or long-term consequences to a woman's health.” Possible issues include postpartum hemorrhage, pre-eclampsia/eclampsia, infection/sepsis, and heart attack. The benefits of epidurals appear to be even greater for those who deliver prematurely—these women saw a 47% reduction in SMM.

The study, which was published in the British Journal of Medicine, can’t tell us why epidurals reduce health issues, but experts say that women who have epidurals often have lower blood pressure during labor and delivery, are more relaxed, and are able to rest during labor.  

I won’t say I was ever relaxed during labor, but I can say it didn’t hurt. Don’t get me wrong, I didn’t enjoy it, but thanks to my epidural it wasn’t the excruciating, sweating, shrieking, crying, cursing, “I can’t do this” experience that television and movies told me it would be. In fact, once I figured out that pushing a baby out is all about the poop muscles, it happened remarkably fast, as have the almost 18 years since. Hence the moment of severe nostalgia.

Hopefully, studies like this can get us past the “real women don’t need pain relief” bulls**t and allow everyone to make their own choice without guilt or shame. We also need to make sure that everyone is offered an epidural during labor. This study found that women at higher risks for SMM were actually less likely to get an epidural, and previous research has shown that poor women are less likely to be offered epidurals.

Louisiana Makes Mifepristone/Misoprostol Controlled Substances

Lawmakers in Louisiana have now declared the two drugs used in the standard medication abortion protocol—mifepristone and misoprostol—controlled substances. This leverages existing rules and regulations that are designed to make unsafe and potentially addictive drugs, like opioids, harder to get. It’s not clear why they felt this classification was necessary given that they’ve already outlawed medication abortion in their state, but the absurdity of doing so is obvious.

No one gets addicted to mifepristone and misoprostol, and they are quite safe. The mortality rate associated with medication abortion is 0.64 per 100,000 uses. It’s safer than many medications you can get in the pharmacy including penicillin (2 deaths per 100,000 users) and Viagra and its generics (4 deaths per 100,000 users). Tylenol/acetaminophen, which remains available over the counter, is implicated in over 600 deaths each year. Medication abortion is also far safer than pregnancy/birth which has a mortality rate of 18 deaths per 100,000 live births in the U.S. as a whole and 39 deaths per 100,000 births in Louisiana.

Instead of getting its s**t together and making pregnancy and birth safer in their state, lawmakers are threatening people in possession of mifepristone or misoprostol with hefty fines or even jail time. While there appear to be exceptions for providers and those who only have it for their own use, the goal is clearly to make these medications harder to get. Doctors need a specific license to be able to prescribe controlled substances, and the drugs must be stored in designated facilities. These logistical impediments alone could mean that people relying on rural clinics, for example, would lose access to these drugs.

Legislators say they’re doing this to prevent women from coerced abortion or ones in which their husbands make them a daily mife-margarita. Sure, there was that one case in Texas where that happened, but it’s far from a national crimewave, and Louisiana lawmakers have zero credibility when they say they want to protect women. (Did I mention the state’s abysmal maternal health stats?)

It's also important to note that mifepristone and misoprostol have other uses beyond medication abortion. They are used to treat miscarriages, induce labor, and stop hemorrhaging. Misoprostol is also used to prevent or treat ulcers in the stomach and the duodenum, and mifepristone is used to prevent high glucose in people with Cushing’s Syndrome.

If we remind legislators that some of the people who need these drugs aren’t pregnant women, could we get them to care?

Sperm Suppression: Male Contraceptive Gel Shows Promise

We’ve talked about a lot of potential male birth control methods here, and let’s face it most of them have been played for laughs because they just don’t seem like viable consumer products.

I don’t see the Sharper Image selling out of the ultrasonic testicle bath right before Christmas 2032 any more than I see men lining up to have nanoparticles injected into their blood, guided with magnets to their testicles, and heated to 104 degrees Fahrenheit. I also highly doubt Calvin Klein will start making special underwear with a hole for the empty ball sack so that men can look fashionable when they shove their testicles up into their pelvis for 15 hours a day to make them too warm for sperm production. (Although Jeremy White’s testicles seem to be featured prominently in the current ad campaign.)

Even some of the front runners sound dubious on paper. There’s the pill that successfully immobilized rodent sperm (a concept that still amuses me), and there’s the gel that’s injected into the vas deferens to block sperm from exiting. That one is probably closest to becoming a reality, but I still question whether men are really going to be okay with multiple injections into their scrotum.

The latest entry into the will-it-ever-hit-pharmacy-shelves race for male birth control is a topical gel that suppresses sperm production. The gel combines progesterone and testosterone and is not—in case you were wondering—rubbed right onto the scrotum. The progesterone blocks spermatogenesis, and the testosterone helps maintain sexual function. Research presented this week during a session at an annual endocrinology conference found rapid sperm suppression.

Normal sperm count is anywhere above 15 million/mL, and sperm is considered suppressed at anywhere under 1 million/mL (because the one sperm lucky enough to fertilize an egg did so with help from a lot of friends). The gel helped some men achieve sperm suppression within 8 weeks, and 86% of men in the study were suppressed by the 15-week mark. 

The presentation didn’t include information on side effects which is one of the more important considerations, and the next phase of the study will examine the gel’s efficacy as a contraceptive. Some experts are skeptical. The session’s moderator questioned whether men would remember to use their gel consistently in real world conditions or if they might accidentally shower it off. And, there are still concerns that the gel might rub off on partners. In fact, the men in the study—who rubbed the gel into their shoulders—were told to wear tee-shirts when having sexual intercourse. Not necessarily ideal, but way better than ball hugging underwear. 

The gel is being referred to as NesT. If it ever makes it to market, however, I’m guessing Nestle might have something to say about the name.