Male contraception has barely changed in a century. What comes next?

From hormonal gels to non-hormonal pills and injectable vasocclusion technologies, researchers are pursuing new ways to expand male contraception beyond condoms and vasectomy.

Review: Male contraception: a historical analysis of the condom, vasectomy, and future innovations. Image Credit: Nikola93 / Shutterstock

In a recent review in the International Journal of Impotence Research, researchers traced the history of male contraception and discussed recent innovations that could potentially expand the choices available to men. While early condom-like sheaths were often used to prevent disease, modern condoms provide a low-cost and convenient option, but pregnancy can still occur with their use. Vasectomy, a surgical procedure in which the vas deferens is ligated, is more effective but generally considered permanent, and so may be unsuitable for men who might want children in the future. New hormonal and non-hormonal approaches are being explored as potential alternatives to these conventional methods.

Male contraception has changed considerably over the years. While people used withdrawal and abstinence in historical times, condoms and vasectomy later became more established options. The reproductive health environment has also changed, particularly after the Dobbs v. Jackson Women’s Health Organization Supreme Court decision overturned the constitutional right to abortion access. The review authors argue that additional reversible contraceptive options are urgently needed to broaden family planning choices for men and their partners.

In the present review, researchers examined the lay literature and peer-reviewed publications on the history of male contraception and discussed future directions.

Traditional male contraception and its limitations

Barrier male contraception was first recorded in 3000 BC. During this period, a goat bladder was reportedly used as a penile sheath in Crete. Around 1000 BC, ancient Egyptians documented regular use of linen penile sheaths, including for protection against schistosomiasis. Ancient Romans used linen or animal intestine or bladder sheaths to help prevent sexually transmitted infections. During the Industrial Revolution, Charles Goodyear developed rubber vulcanization, paving the way for large-scale rubber condom production by 1860, after which more durable rubber condoms replaced lamb- and goat-bladder or intestine-based sheaths for preventing pregnancy.

Rubber condoms became widely available in the late 19th century and were later issued to German and British soldiers during the First World War to prevent venereal diseases. With the introduction of latex in the 1920s, the quality of condoms further improved, particularly their strength, thinness, and shelf life. Latex condom usage by Allied forces during the Second World War normalized condom usage across the US and Europe, and the acquired immunodeficiency syndrome (AIDS) epidemic extended their use to other nations during the 1980s, as increased health and sex education became available worldwide.

Vasectomy was initially performed instead of castration to manage benign prostatic hyperplasia (BPH) symptoms. The procedure improved voiding function in some individuals, but it produced minimal changes in others and was associated with deaths. Eugen Steinach promoted this procedure as an anti-aging treatment during the 1920s. Sigmund Freud and poet W.B. Yeats were among those who underwent the Steinach procedure. While officials performed vasectomies as involuntary sterilization procedures under eugenic programs targeting people deemed “undesirable,” voluntary vasectomy is now an established method of male contraception and family planning.

While condoms are low-cost and readily accessible, their effectiveness depends on correct and consistent use. People may be allergic to latex and also experience less pleasure during sexual intercourse. Vasectomy is more effective but is intended as a permanent form of contraception. Because of these limitations, researchers are testing hormonal and non-hormonal methods intended to provide reversible contraception.

New directions in male contraception

Some earlier trials of hormonal contraceptives were discontinued because participants experienced side effects that they found difficult to tolerate. Reported side effects included changes in mood, libido, and lipid metabolism. They also included acne and potential concerns about sexual development in adolescents. A phase IIb trial completed in 2024 evaluated a daily testosterone (T) and nestorone (NES) gel application to reduce sperm production. By 12 weeks, sperm counts fell to ≤1.0 million/mL of semen in 82% of participants, a level considered effective for contraception. Phase I trials are evaluating dimethandrolone undecanoate as a novel contraceptive.

Among non-hormonal approaches, the review cites animal studies in which YCT-529, a retinoic acid receptor (RAR) target, was reported to be 99% effective and reversible. In addition, a phase Ia trial in 16 men found that a single dose of YCT-529 was well tolerated. The study reported no effects on heart rate, testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), mood, or sexual desire. Animal studies are now exploring on-demand contraceptives targeting sperm motility.

Obstructive methods are also under investigation. A recent phase III clinical trial reported azoospermia, or an absence of sperm in semen, in approximately 77% to 97% of individuals three weeks after a RISUG® injection. Valsalgel is being developed in the United States, while polyurethane and silicone-based compounds have been studied in China, with human evaluation planned. The ADAM™ hydrogel, assessed in 25 subjects for 90 days, had no reported procedural adverse events, and most adverse events were mild during the first 14 days.

Based on the findings, the history of male contraception dates back more than 5,000 years, with methods continuously evolving over the years. Condoms and vasectomy remain established male contraceptive options, while researchers are developing hormonal and non-hormonal approaches for reversible contraception. These efforts could expand family planning options for men and their partners, tailored to individual preferences.