Male Contraceptive and Reproductive Issues

Men can have a role in preventing unintended pregnancy in a number of ways. They can: learn about the feelings and factors that may block communication about sexual expectations in a relationship; discuss contraception with a partner in advance of sexual intercourse; support a partner’s use of contraception; and purchase and use condoms themselves (both for contraception and STI prevention). In addition, many men will eventually choose vasectomy. Do men with a physical disability or illness encounter problems in such contraception-related practices that could be attributed to their condition?

The ability or willingness to use condoms is affected by a number of physical, psychological and social situations that men with disabilities may encounter. Specific physical conditions such as muscle weakness, tremors, spasticity, or impaired mobility may make condom use difficult or impossible. This is also the case for gay men with disabilities in terms of both using condoms for safer sex and negotiating condom use (in conditions that affect communication).

Conditions that impair cognition, memory, judgment, or learning can also affect the ability to determine when condom use is needed and how to negotiate condom use. Dependence on others for personal care, especially in sexual situations, can be a barrier to condom usage. If the condition interferes with erection, some men may fear that condom use will cause or exacerbate erectile difficulties or dysfunction. Others may mistakenly assume that they do not need to use contraception because they believe that their condition renders them infertile. While this section focuses on contraception, it is understood that some individuals who encounter difficulties with condom use for contraception or safer sex may opt for pleasurable sexual activities (mutual caressing, use of vibrators or other sex toys, etc.) that do not carry risk of pregnancy or, with care, of sexually transmitted infection.

The social and personal circumstances of people with a disability or illness can also have an impact on access to information and services related to contraception and sexual health. For example, men with a disability or illness may face practical barriers to purchasing condoms (income, mobility), social barriers to using them in sexual relationships (privacy, restrictive institutional policies, acceptance by others), or emotional barriers (self-acceptance as a sexual person).

This section outlines male contraceptive and reproductive issues for a number of specific conditions. The issues mentioned here may also pertain to conditions not mentioned including developmental disability and psychiatric illness. Each entry indicates, when applicable, how the condition could affect a man’s fertility, libido, or erectile function. The physical consequences of the condition that could affect the ability to negotiate condom use are also discussed.

Note: The websites used are credible sources of sexuality/reproductive related information for the conditions discussed. The text under each condition is derived from sources in the reference and/or resource sections.

Diabetes

To varying degrees, erectile difficulties are common in men with diabetes. Erectile dysfunction may result from organic factors (neuropathy), psychological/relationship factors, or a combination of both. Other symptoms of diabetes (fatigue, headache, hypoglycemia) may also indirectly affect sexual functioning as can long-term complications that damage blood vessels and associated nerves. Apart from an effect on erection, diabetic neuropathy can also cause retrograde ejaculation in which a man experiences feelings of orgasm without ejaculation. The decreased fertility reported in the partners of men with diabetes may be due to the greater prevalence of erectile difficulties and retrograde ejaculation in these men. Medical treatments are available for both of these possible effects of diabetes although men often do not raise these concerns with physicians even if they have persisted for some time.

Diabetes may thus have an effect on condom use (e.g. concern about having or maintaining erection), on communication with a partner about contraception or safer sex practices (e.g. effect of symptoms on mood), or on a man’s uncertainty about whether or not sexual activity will occur (e.g. unpredictability of symptoms, responsiveness, etc.).

As with other conditions that require control through a combination of diet, medication, exercise, and stress reduction, if there are problems with diabetes control the result may be other complications (circulation, kidney function) that also have associated sexual effects.

Rheumatoid Arthritis (RA)

Men with RA may experience decreased libido and/or incidents of erectile dysfunction due to joint pain, fatigue, depression and side effects of medication. Some studies have indicated that men with RA have lower serum testosterone levels that are associated with decreased fertility.

As in other conditions with such symptoms, condom use and/or support of a partner’s contraceptive use may be affected by uncertainty of erection and/or desire. A man dealing with symptoms that may already draw his attention away from sexual arousal may find it more difficult to attend to contraception or safer sex practices.

Spinal Cord Injury (SCI)

Infertility among men with SCI may occur because of reduced sperm motility and low sperm counts. Cord injuries can also block ejaculation or cause retrograde ejaculation. Men with recent SCI face a number of new psychosocial as well as physical sexual realities. Issues such as the lack of spontaneity in sexual encounters, reliance on others for personal care, recognition that penetrative sex is not the only way of achieving pleasure, and that ejaculation is not synonymous with orgasm, are among the many challenges they may have to their previously held views about sexuality. But with respect to contraception and fertility, not all men with cord injuries are infertile and sorting out each individual’s situation is thus necessary.

Multiple Sclerosis

Onset of MS often happens at an age when men will have had or be in sexual relationships. For men with female partners, contraception and probably condom use will have been a common experience. MS does not reduce fertility in men with MS but may affect erection and ejaculation. Demyelination of the nerves that control sexual response and bowel and bladder function can have a variety of direct and indirect effects on sexual response in men with MS. Exacerbation of symptoms such as muscle weakness, fatigue, coordination and balance problems, erectile difficulties, and dry orgasm may affect sexual functioning and some men may not have intercourse for these or other such reasons. Since MS symptoms may very over time in unpredictable ways (exacerbations followed by periods of reduced symptoms), a man who has a “down” period sexually (at least in terms of intercourse) may get out of the habit of thinking about contraception or safe sex and be unprepared when an “up” period recurs.

Commonly available medications can facilitate erection in many men with MS who have erectile difficulties. Since fertility is not affected, if ejaculation is unimpaired men with MS and their partners should be conscious of contraception to avoid unintended pregnancy. Mood changes, depression or, less commonly, cognitive impairment associated with MS may affect motivation or capacity to deal with sexual issues.

Scleroderma

Men may experience erectile dysfunction due to decreased blood flow to the penis. For men with scleroderma, there is also an increased risk of Peyronie’s disease or fibrosis of the corpora cavernosa of the penis. This condition can result in shortening and curvature of the penis which can then result in erectile dysfunction. The use of certain medications, such as anti-hypertensives, can also lead to erectile difficulties. Condom usage by men with scleroderma may be difficult since the fingers of scleroderma patients usually become fixed in a bent position. As with other conditions that affect erectile function and hand use, advance discussion with a partner about contraception and/or condom use is one way to reduce uncertainty (and thereby enhance enjoyment of sexual activity).

Cerebral Palsy

This condition generally does not affect fertility, libido, or the ability to have an orgasm. However, spasticity, involuntary movements and rigidity may affect the ability to use a condom. Communication with a partner around contraception and condom use may be affected. People who have attendant care may need support and privacy for their sexual lives including access and to and use of contraception.

Cystic Fibrosis

Cystic fibrosis does not have a direct effect on sexual functioning (e.g. desire, erection, ejaculation). However, men with cystic fibrosis who experience shortness of breath may have concerns about the effect of intercourse. In such cases, men are advised to use short acting bronchodilators 20-30 minutes before sex to avoid sexual positions that exert pressure on the chest, and to do physiotherapy exercises to dislodge mucus prior to engaging in sexual activity.

Most men with cystic fibrosis are infertile although there is the possibility that sperm might be present in the ejaculate of some men with CF. Sperm production does occur in men with cystic fibrosis but a blockage or absence of the vas deferens often limits or prevents the passage of sperm. Unless infertility is confirmed by medical tests contraception should be used.