Science Vs - Birth Control - The Biggest Myths

Episode Date: November 30, 2017

Everyone’s got a myth or two about birth control they want cleared up. Like... is 'pulling out' AKA withdrawal really such a bad idea? Does the pill change your brain? Are IUDs safe? And why isn’t there a pill for men, already?! We ask gynecologist Dr. Amita Murthy, neuroendocrinologist Dr. Nicole Petersen, men’s health researcher Prof. Robert McLachlan and a whole roomful of experts on sex -- teenagers. UPDATE 05/12/17: We have updated this episode to further emphasize that the pre-cum studies are only very small. Use withdrawal at your own peril! Check out our full transcript here: http://bit.ly/2P5creH Selected readings:The Guttmacher report on unintended pregnanciesNicole’s research on the brainThe Nurses’ Health Study results on oral contraceptivesA history of the Dalkon ShieldThe latest on male contraception Credits: This episode has been produced by Wendy Zukerman, Shruti Ravindran, Heather Rogers and Rose Rimler. Our senior producer is Kaitlyn Sawrey. We’re edited by Blythe Terrell. Extra editing help from Alex Blumberg and Eric Mennel. Fact checking by Michelle Harris. Sound design by Martin Peralta and Bobby Lord. Music written by Bobby Lord.  An extra thanks to Dr Aparna Sundaram at the Guttmacher Institute, Dr Sarah Prager, Prof Brittany Charlton, Dr Lisa Iversen, Prof James Trussell, Dr Sara Holton. Big thank you to Libby Shafer and all the Chicago teens, plus Jonathan Goldstein and Joseph Lavelle Wilson. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Hi, I'm Wendy Zuckerman and you're listening to Science Versus from Gimlet Media. This is the show where we pit facts against f***ing. On today's show, birth control. And this is obviously an episode that is a little bit grown up, so if you're listening with some very little people around, maybe save this episode for another time. So, birth control. You probably think you know what's up. You read the instructions on your box of condoms.

You've been taking the pill since you were a teen. In fact, you've been having sex for years. You think you've got this. But get this. According to one large survey, nearly half of unwanted pregnancies in the US happened while the couples were using birth control. Yeah.

So there's something weird going on here. And on top of that, we just seem to be bombarded with scary news stories about the birth control that we do have. There are thousands of complaints about the IUD. A new study suggests that women who recently used certain birth control pills may increase their risk of breast cancer. Taking birth control may cause depression. And then these guys think we're crazy. And you're like, you don't know what I'm going through.

So is our birth control really that bad? And why are so many of us getting pregnant while we're on it? Science versus to the rescue. And we know that contraception is a huge, huge topic. So we've pulled out all the stops, we've looked over the hard evidence, and we've come up with three areas where we think there is a lot of confusion. It's a menage a trois, if you will. One, withdrawal. Is it really a one-way ticket to getting knocked up? Two, the pill. Will it make you crazy and give you cancer? And three, IUDs. Are they safe? And finally, we're going to find out if the male pill is the future of birth control.

When it comes to birth control, there are a lot of misconceptions about contraception. But then there's science. Science versus birth control is coming up. After decades of shaky hands caused by debilitating tremors, Sunnybrook was the only hospital in Canada who could provide Andy with something special. Three neurosurgeons, two scientists, one movement disorders coordinator, 58 answered questions, two focused ultrasound procedures, one specially developed helmet, thousands of high-intensity focused ultrasound waves, zero incisions, and that very same day, two steady hands. From innovation to action, Sunnybrook is special. Learn more at

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Quantum Magazine's podcast, The Joy of Why. New episodes drop every other Thursday, starting February 1st. Welcome back. To guide us through some of the misconceptions about contraception, we spoke to someone who was really excited about sex. Your mum. No, we actually spoke to some teenagers in downtown excited about sex. Your mum. No, we actually spoke to some teenagers in downtown Chicago about sex and they were kind of nervous but kind of excited

and a lot of them were just anxious about birth control. Some were worried about their side effects and others didn't want to get pregnant young. Their parents had had them when they were teens and they didn't want to get into the same situation. So Caitlin Sori, our senior producer and I, sat with them. We were in a half circle and it was all very safe spacey. I'm Katie. This is Wendy. So let's begin. Okay. And it was clear that the school system had drilled one thing into their heads. Always the takeaway is like, oh, but don't forget abstinence is the best. Abstinence is the true key to happiness.

When was the first time you knew about like a condom or the pill? Honestly, probably from a movie, right? Like Mean Girls or something. Don't have sex because you will get pregnant and die. We soon started talking about what a lot of these teens actually do. And we got to talking about withdrawal. That is when a guy pulls out before he comes. Now, withdrawal isn't a new idea. Even my friend's grandma has a term for it. She calls it getting off the train before you stop. But it does seem to be getting more and more common. Nearly twice as many unmarried men say that they use withdrawal

compared to about a decade ago. And a large survey of women found that around a third of them said that they had used it in the last month. Some journos are now calling this the pull-out generation, which explains the knowing giggles from the teens. Have you guys heard of people using it? So, are we in for a flood of unintended pregnancies? This takes us to our first question. How well does withdrawal actually work? OK, so you take 100 couples who use it for a year, and what happens? A study published this year found that around 20 couples would get pregnant.

That's one in five. And this is what's called typical use, because scientists recognise that people don't always do this stuff perfectly. In this case, a guy might not be pulling out every time in time. And one of the girls that we spoke to, she was petite and really sparky, she had heard one reason why the guys weren't pulling out in time. We'll call her Linda.

I know sometimes when the guy's penis is feeling numb, he might not get the feeling that he's actually going to cum, just that he doesn't get, like, those senses that he's about to cum. So he cums inside of her. OK, so this numb dick theory was firmly debunked by the guys in the room. In fact, this very cool kid slouched in a bright red hoodie was very confident in his ability to pull out. We'll call him Eric.

I'm 100% from the 3.1. I've never failed, just put it like that. Do you know when it's coming? Have you got enough notice? It's a feeling. My spidey senses be tingling. So what if those spidey senses kick in and men do pull out at the right time? Then what are the chances that a couple would get pregnant?

Well, it turns out getting to this figure is harder than you might think. So the story that we often hear about why withdrawal isn't perfect, even when you're 100% from the three-point line, is because of pre-cum. You know, that little bit of liquidy stuff that comes out of the penis before the main event. But is that true? How much of a problem really is pre-cum? To answer this very question, we spoke to Dr Amita Murthy, a gynecologist at New York University. Fans of the show will remember Amita from our episode on abortion. She compared a fetus to a burrito. And so we thought she'd be the perfect person to tell us about what happens when you don't feel

like a burrito. How did you learn about contraception? Like, did your parents ever give you the sex talk? no are you kidding conservative indian family absolutely not no i got the sex talk at school and i was horrified and when did when did that has that changed oh for me no no with niceties out of the way can you really get pregnant from pre-cum yes technically. Technically, yes. Technically. But really? Yeah, there's sperm and pre-ejaculate. Do we have any data on like the rates of women that get pregnant from pre-cum? No. You looked at me like I was insane. How is someone supposed to know? How am I as the doctor supposed to know if she got pregnant from sperm

from pre-ejaculate or from regular ejaculate? I want data. Listen, I can give you a study to do. The next time you're having sex, take some pre-cum, put it under a microscope, and check how many sperm there are. We'll start the Kickstarter campaign. Luckily, we don't have to start it. Turns out it's already been done. Several years ago, 27 British men wanked for science. They plonked their pre-cum in a petri dish and the scientists then had to act fast because sperm doesn't live long outside the body. So within two minutes, an assistant nabbed the dish and squinted at its contents under a microscope. And so, what did they find?

Well, they concluded that only about a third of the guys had enough active swimmers in their pre-cum to get someone pregnant. And another small study published last year found that an even smaller share of men had swimmers in their pre-cum. Now, since these are both small studies, it is hard to know how often pre-cum will have swimmers in it. But still, with what we do know, where does that leave the pull-out generation? Well, using this work, another group of scientists have estimated that if 100 couples use withdrawal perfectly for a year, that is, they nail that timing every time, only four will get pregnant. Yeah, four.

And as Amita says, it's really hard to estimate this kind of thing. But one study said that withdrawal was almost as good as using condoms perfectly. It's hard to imagine any sex ed teachers around the country sharing that statistic with you. Conclusion. Using withdrawal perfectly, you are playing pre-cum roulette. And for now, we actually need more research

to know how much pre-cum doeslette. And for now, we actually need more research to know how much pre-cum does have swimmers in it. From what we know, though, it doesn't seem to be a bad method of contraception. Still, if guys aren't always pulling out in time, your chances of pregnancy jump to around one in five. Next up, one of the most common birth control methods, the pill. Millions of women around the world are on it, and it basically works by releasing synthetic hormones, that's estrogen or progesterone or even both,

and that means you don't release an egg for the spermy to find. Now, if you're on it and you take the pill every day at the same time and you never forget, that's perfect use, your risk of pregnancy is really low. It's less than 1%. But if you're forgetful, you don't take it every day, that's typical real world use, then your chance of getting pregnant is around 7%. That's about 1 in 14. But we heard a lot of other stories when it came to taking the pill. In fact, a few of the teens that we spoke to had friends who had struggled with depression while on the pill. And Linda, that sassy chick who had heard about numb penises, said that her

moods were all over the place. Her friend had a similar story. I had like really bad mood swings, terrible. It was like super bad, even when my mom would notice. And my mom's my best friend. And so she's like, what's wrong? Did something happen? I'm like, no, like, why do you care? And this isn't just affecting teenagers. If you look at studies into why women quit taking the pill, mood swings is a reason that constantly crops up. So our next big question, is the pill mucking up our brains? Nicole Peterson is at the University of California in Los Angeles, and she studies how hormones like those found in the pill affect our brain. When I started this line of research, I was shocked to find that there had been almost no work done. What did you think about that? Well, I mean, honestly, at the time, I thought if no one's researching it,

then it must not matter. You know, it must not affect the brain or else for sure we'd know by now. And how much of this is to do with the patriarchy? Oh, geez. Well, you know, I'm my own opinions, but yeah, I mean, for sure that's got to be part of it, right? But there's kind of this narrative that women are just emotional. That's just how they are. So if they take a pill that makes them emotional, what's the difference? But things have been changing, and research into how the pill affects the brain have been ramping up.

And here's what we know. We know that hormones, like those found in the pill, can latch onto proteins in the brain and influence how it works. In fact, Nicole says there's no way for the pill to work without affecting hormones in the brain. And we even have some early signs that the pill might actually be changing the structure of some women's brains. Nicole found evidence of this in a study of 90 women from a couple of years ago, and that finding got a ton of media attention, which inspired a lot of headlines. I ran a couple of them past her. Birth control pills may alter the state of your brain, says scary new study.

Another one said contraceptive pills shrink part of your brain influencing emotions. And then another one said birth control pill may shrink your brain. How did they do? I think all of those are really a dramatic overstatement of the finding. I think what people immediately assume is if something's thinner or smaller in the brain, that must be bad. But Nicole says that we still need to do more work here to know that the changes that we're seeing aren't just chance findings. And if these findings do hold up, then Nicole says we have another problem

because we don't know what these brain changes mean for the women. Now, when we look at other studies, the picture that's emerging is that the pill will affect different women in different ways. Yes, there is evidence that the pill can make women feel worse and possibly increase their risk of depression and maybe even suicide. But there is also evidence that for some women, the pill can stabilize their mood, making them feel better. I mean, how do you know if you're going to be someone who really benefits from the pill and

maybe it smooths out your mood and you don't have mood swings or PMS anymore. Or maybe you're going to be someone who has a terrible response and you experience this, you know, unbearable depression and anxiety. And I think what's difficult is it's hard to know which one you're going to be. That is, science can't predict how you'll feel if you go on the pill. And while we do hear a lot of scary stories about the pill, some work has found that more women feel better on it than feel worse. For example, one study of more than 3,000 women found that 70% felt less feelings of depression after they were on the pill for a few months compared to 10% who went downhill. Okay, so that's mood swings in the brain. But there is something else that has dogged the pill for decades,

and that's its link to cancer. But things are pretty confusing, particularly if you watch the news. A new study suggests that women who recently used certain birth control pills may increase their risk of breast cancer. The latest research shows it could help protect you from certain cancers for up to 30 years after you stop taking it. So is the pill ramping up your cancer risk or reducing it?

To clear this up, we actually have some really solid science here. Two very large recent studies tracked well over 150,000 women for decades. And what did they find? Well, women on the pill did have a higher risk of breast cancer. But the pill lowered women's risks of other types of cancers, like ovarian. And all in all, it actually evened out. Yeah, in both studies, overall, women on the pill didn't have a higher risk of cancer

compared to those not taking it. Conclusion. On average, women on the pill aren't at an increased risk of getting cancer overall. The pill can change your mood and perhaps increase your risk of depression, but some women feel better once they take it. The effects are different on different women. And you know what else has different effects on different women? And the pill is pretty good for stopping that, if you take it right. By the way, we know that lots of women have other concerns about the pill. We didn't get time to tackle them all.

But after the break, the super effective birth control that no one is taking. Is it time for men to take on the burden of birth control? Absolutely. Welcome back. So we've just covered the female pill and pulling out. Our next stop is the IUD, aka the intrauterine device. And our gynaecologist, Dr. Amita Murthy, is a big fan of them. Great. Love them. Why do you love them? They're very effective. Set it and forget it. 99% effective at preventing pregnancy.

Wow. 99%. Yes, the IUD has one of the lowest failure rates of all contraceptives. It's tiny and can look like a mini pogo stick, and a doctor puts it in your uterus. And it basically makes the uterus a hostile place for the sperm and the egg to get together to make a baby. But even though they're so effective, only 7% of American women use them.

You see, some women are freaked out by the idea of an IUD. The teens we spoke to were definitely a bit wary. Is this something you'd want? That would gross me out. I don't know why. It's just, like, the idea of having something, like, in my uterus is, like, it would just freak me out. Mostly I've seen, like, girls just super scared of getting it

because of, like, not being able to be pregnant. But I know a ton of girls that have seen, like, girls just super scared of getting it because of, like, not being able to be pregnant. But I know a ton of girls that have said, like, I don't want to get the implant, I don't want to get the IUD because, you know, I do want kids in my future, just not right now. The idea that the IUD could damage your uterus is understandable, particularly if you go back a little in time. In the 1960s, a gynaecologist in Baltimore created a new design for an IUD. It had these five prongs and it was designed to stay in place in the uterus so it could be

really effective. The design looks like a really scary amoeba scorpion, has like prongs and crazy nonsense on it. And this is critical. The new IUD had a special braided string so doctors could pull it out when a woman wanted to get pregnant. So the inventor, that Baltimore doctor, published a study showing that his IUD was better than its competitors. Soon it hit the market with this splashy name, the Dalkon Shield. And it was a commercial success.

More than two million women got it. But soon problems started to arise. In the early 1970s, there were several cases where women with the device actually got pregnant. And doctors at the time were advised to leave the Dalkon Shield in place when that happened. But a handful of women got serious infections and then lost their babies.

Some of the women even died. A doctor at the time, C.D. Christian, documented what was happening. My mother's always wanted me to be a doctor. OK, this isn't Dr Christian. We found the next best thing in our office. This is Jonathan Goldstein. So the doctor noted that for the women who got infections and then died, it actually happened very quickly. The greatest concern is the rather

insidious yet rapid manner in which these patients become ill. In three of the five noted maternal deaths, the first symptoms, which were disarmingly innocuous in and of themselves, occurred within 31 to 72 hours of death from sepsis. By 1975, 219 women using the Dalkon shield had had miscarriages, and 13 women died. Thousands sued the manufacturer and the shield was taken off the US market. But Amita says that these horror stories have stoked fears about the IUDs for decades. Fears that it will hurt you and ruin your uterus. So, are IUDs inherently dangerous? Well, no. It turned out that there was something wrong with the Delcon shield.

That special braided string that helped doctors remove it. That allowed bacteria to climb up into the woman's uterus. And so then all IUDs were thought to be causing infections and thought to be the same, whereas really the Delcon shield had a design flaw. Amita says that IUDs on the market today are safe. Several studies have now concluded that newer designs don't cause infertility. And infections are rare because they've changed the design. They still have a string, but not that braided one that caused the infections. Plus now,

the FDA recommends that on the rare occasions when women with an IUD do get pregnant, that device is removed. But still, IUDs aren't perfect. So there's a risk of causing a hole in the wall of the uterus at the time of insertion. And what's the hole in the uterus? Like they just accidentally puncture it like the doctor. Yeah, we just accidentally puncture it and it closes on its own. This happens about once for every thousand IUDs that go in. And we reached out to several gynos who studied this and they all agree that most of the time, while a perforated uterus sounds scary,

it's actually nothing to worry about. But they did say in very rare cases it can cause complications. Conclusion. The IUD is super effective and quite safe. Its bad reputation can be traced to an IUD that's been off the market for years. So there's one last thing that we want to tackle today, and that's the male version of the pill. Well, taking the contraceptive pill has been the responsibility of women for years, but... Is it time for men to take on the burden of birth control?

Absolutely. Yeah, is it time? Because so far, the options for men are pretty lame. There's vasectomies, which are typically permanent, and, yes, there are condoms, which are pretty good, but they can slip and they're far from perfect. So where's the male version of the pill? We found just the person to ask. Hello. Yes. Hey, Rob. Thanks for having me.

Robert McLaughlin is a professor of men's health at Monash University in Melbourne, and he's been working on one of the most promising birth control methods for men. And Rob, he knows that he's up against a finely oiled machine, the testicles. So how do you turn off a machine that every day makes tens of millions of sperm? How do you slow it up and stop it? So how do you stop that orchestra? Well, you have to imagine here that you're inside the testicle, right? As I do regularly. See if that works for you. And you're surrounded by all these tubes, all these coiled tubes.

And in between those coiled tubes, you've got the testosterone-secreting cells. So if you're a guy, your brain will tell those testosterone-secreting cells to do what they do best. Pump out testosterone. And you need that to make sperm. So this all means that if you want to stop sperm from being made, you've actually got to stop this process somehow. And here's how Rob does it.

He tricks the brain by actually giving men testosterone. The brain says, oh, well, you know, I can see you've got plenty. I don't need to do anything anymore. It turns off the hormones that are driving the testicle. So if you like, the testicle becomes redundant. It's no longer needed to make testosterone or sperm. It just gets shut down. And that machine will grind to a halt. Now, it takes a few months. It doesn't happen overnight. But it does happen. Rob also gives men another hormone to help block that sperm production. And he finds that for most men,

the number of sperm they have plummets and babies don't get made. In fact, over the decades, these kinds of male contraceptives have been tested on more than 2,000 men. And a review paper published more than 10 years ago concluded that male hormonal contraception is, quote, well-tolerated, end quote, and 95% effective.

And a more recent review paper found that it was getting even better results than that. Now, we've had 20 or 30 years' research. It actually works. Rob says that this male contraception has some side effects, which are a bit like the female pill. There are reports of mood changes and even depression. But Rob says that the real kicker is how men have to take this drug. And how is it delivered? Can you take it in a pill? No, you can't. There is no male pills.

Testosterone cannot be given by a pill. When you swallow testosterone in a pill? No, you can't. There is no male pills. Testosterone cannot be given by a pill. When you swallow testosterone in a pill, it breaks apart before it gets to the brain. So men would most likely have to get their dose in a shot or potentially in an implant. But still, great. We have the technology. The male shot works. But Rob tells us there's one big reason why it's not here. I mean, one of the disappointing things is the pharmaceutical industry were involved in this research until about five years ago. And both the big companies that were involved, one pulled out about a decade ago. No pun intended. Indeed, about 10 years ago and one about five years ago. Ultimately,

Rob says the big ph farmer just doesn't think there's a market for the male shot. But is that true? Well, several surveys have found that at least one in four men worldwide would consider using something similar, which is actually a lot of men. And we did a little market survey of our own. Back in Chicago, we talked with Spidey Sense cool guy Eric and the other teens about it.

I got a question. I heard y'all say something about a male pill. I mean, do it stop me from getting somebody pregnant? Yes. Oh, aye. It's not a pill, though. It's a shot. So it's a shot of testosterone, sometimes in the butt.

You're shaking your head. You're not interested in that? Negative. I'm really interested in that? Negative. I'm really not. That's uncomfortable. I'm good. It's uncomfortable, but imagine us trying to get an IUD in. Yeah.

Okay, boy. With your vagina, they're like opening it up and putting something in there. But it's not his vagina, so it's not like they care, you know? He said it's uncomfortable. You don't have one, that's why you don't care. Conclusion. We have a male shot and it works, and the side effects are pretty limited.

But Big Pharma just isn't that into it, and that's probably why you can't buy it right now. So, when it comes to science versus birth control, does it stack up? Withdrawal. Well, if you're super vigilant about getting off before you stop, it may not be such a bad approach, but you're still playing pre-cum roulette. The pill.

It's a good way to prevent pregnancies, but what about mood swings? Well, there is some evidence that it might increase your risk of depression or getting mood swings, but it also might make your moods better or not affect your moods at all. And right now, science can't predict how the pill is going to make you feel. And what about cancer? Well, overall, women on the pill don't get cancer at a higher rate than women who aren't on it. IUDs, the new ones are safe and very, very effective and the only serious risk is a small risk of perforating your uterus.

The male pill, well, it's the male shot, it exists, but since Big Pharma has pulled out, women and men will have to wait. The thing is, if we want to prevent unintended pregnancies, then we have to start getting comfortable with having discussions that get into uncomfortable territory. And one thing that's kind of uncomfortable here is that there's no perfect mode of contraception. They all have some risks and some side effects, and none of them are fail-safe when it comes to stopping babies. Which is why...

Oh, but don't forget, abstinence is the best. What a shame that sex is so much fun. I guess that's why we risk it for the biscuit. That's science versus birth control. This episode has been produced by me, Wendy Zuckerman, Shruti Ravindran, Heather Rogers and Rose Rimla. Our senior producer is Caitlin Sorey. We're edited by Blythe Terrell.

Extra editing help from Alex Bloomberg and Eric Mennell. Fact-checking by Michelle Harris. Sound design by Martin Peralta and Bobby Lord. Music written by Bobby Lord. An extra thanks to Dr Aparna Sundaram at the Guttmacher Institute, Dr Sarah Prager, Professor Brittany Charlton, Dr. Lisa Iverson, Professor James Trussell, Dr. Sarah Holton, Libby Schaefer and all the Chicago teens,

thank you so much for the time you took to talk to us, plus Jonathan Goldstein and Joseph LaBelle Wilson. Next week, we'll be back with a cracking episode about chiropractors. Are they a bunch of shysters or a solution to back pain? And then they used to get me to swing you from your feet every day for 10 seconds. Yeah. I'm so nervous for me in retrospect. If you're in New York this Monday, that's December the 4th, I'll be talking with Muj Zadi at Greenspace in Manhattan. It should be lots of fun.

Come and say hello. Details are in the show notes. And if you want more details about this episode, sign up to our newsletter. There's a transcript with a bunch of footnotes and links. Head to gimletmedia.com slash newsletter and sign up there. I'm Wendy Zuckerman. Back to you next time.