Why do men hate condoms?

Pale-faced, her voice low, Samar recounts what happened to her six years earlier, when she started using contraceptives. A stay-at-home mother in her early twenties who lives in the Gharbia governorate, the capital of the Nile Delta region, she decided to take hormonal birth control pills after giving birth to her first child. The result was sudden, unexpected bleeding. Samar went to several doctors to find a contraceptive method that would work better for her, but when she used an IUD (intrauterine device), the bleeding increased and was accompanied by severe weight loss. The doctors gave up.

Samar’s husband refuses to use condoms, just as her father did with her mother — a shared trait, it seems to her, among men. Her life reminds her of her mother’s, who went through the same suffering: she stopped using contraceptives, and ended up having ten children.

Another woman from a governorate in the Nile Delta, who declined to disclose her identity, revealed how much she also suffered as a result of birth control pills. She decided to start taking them after her fourth child was born, and the symptoms began with pain in her scalp, which quickly developed into a tumor. “My scalp looked like a balloon under my hair because of the tumor.” She couldn’t tolerate the pain for long. Her doctor advised her to stop taking the pills completely, and she ended up giving birth to three more children. “My husband would blame me for having so many children. He’d say: ‘Just find a way, I don’t want kids.’” To this day, she still suffers from the effects of the tumor.

Suad al-Hosseiny, a resident of Cairo, started using un IUD after having three children. It caused an increase in her menstrual blood, which turned into constant bleeding. She had to remove the IUD, and became pregnant with her fourth child. When she started using it again, the bleeding returned and lasted for five years. Even so, her husband refused to use condoms. After his death, she decided to remove the IUD, but the doctor insisted on keeping her under medical supervision after it became apparent that her uterus had become worn out.

There is a large yard in the center of the building that houses the Ministry of Health’s Mother and Child Care Center in Bahtim, a district in the governorate of Qalyubia. There are long queues on either side of the ticket office, streaming out of rooms with wide-open doors, in front of which sit women who have grown tired of waiting. There are those who have come to the clinic to check on the health of their fetus, and some to figure out why it’s taking them so long to get pregnant, which others are there in search of cheap birth control. A few lie inside, on birthing beds, writhing in pain.

Most of the women are hesitant to talk to me, but Hanan Samir begins to tell me about what she went through when she had an IUD. Her face gives the impression of someone older than her years. She tells me that she got married at a very young age: “I was a child.” She got an IUD after the birth of her first child, but it wasn’t inserted properly. “She didn’t put it in right, and it closed on my ovary.” Two days after it was inserted, “I woke up and found the sheets soaked with blood. I ran to the hospital.”

She had the IUD removed and underwent uterine curettage surgery. She had to suffer through the ordeal alone, while her husband stood by and watched — blaming her, in fact, for not going to see the right doctor.

Another woman sitting nearby confided in us a secret that her husband doesn’t know. She got pregnant by mistake, and had an abortion. “My husband didn’t know anything about it. My sister was with me — she’s the one who helped me get rid of it.” She was at the clinic for birth control pills, to avoid going through that experience again.

Most of the women I spoke to considered the IUD the best method of birth control. This is supported by several recent studies, which indicate that the side effects of birth control pills might be as serious as increased risk of cancer. A study conducted by the University of Copenhagen found that the risks of breast cancer increase with women’s use of hormonal contraception. The risk increases to 20% for those who continue to take the pills. The study was performed on 1.8 million women in Denmark under the age of 50, over a span of 11 years. 140 million women worldwide use hormonal birth control pills.

The pills ruined my mood

On the psychological side effects of hormonal contraception, one of the women I spoke to, Samah Ahmad, told me that the hormonal birth control pills she started taking after the birth of her first child caused her severe mood swings, along with headaches, nausea, and constant fatigue. She switched to an IUD after the birth of her second child, but had severe bleeding as a result. After her third daughter was born, she settled on single-hormone injections, taken once every three months. But she didn’t feel comfortable and noticed that she was gaining weight. “My body was suddenly ballooning. I weighed myself and discovered I’d put on 10 kg.” She went to see a gynecologist, who advised her to keep using the shots to figure out whether they were the reason behind the weight gain. They were. “I just hate myself whenever I look in the mirror now. I even started overeating, just to spite myself. Everyone who sees me now says: ‘What’s wrong, why did you get so fat?’”

“I’m on the pill and it made me put on so much weight. I tried doing sports, going on a diet – nothing works.” Zainab El-Sayyed describes her emotional ordeal after the weight gain that came as a result of using birth control pills. “I hate the way I look now. I run away from every mirror I see.”

Some young women decide to postpone having children. Samia Ali is one of those, but the birth control pills she started using after marriage soon affected her weight: “I’m a newlywed, but I can hardly stand myself since I went on the pill. I decided to put off having children so I can live a little first, but these pills ruined my mood.”

In previous comments to the press, Heba Essawy, Professor of Psychiatry at Ain Shams University, attributes the depression resulting from birth control pills to folate deficiency, as well as low levels of vitamins B12 and B6, which are necessary for the body’s ability to manufacture neurotransmitters that regulate mood.

I asked the women at the clinic if it would be better if their husbands used condoms, so that they would not have to go through the emotional side effects of contraceptives. My question was met with surprise. Some of them murmured unintelligibly. The more bold among them cast doubt on this choice: “They’re not reliable — they can break.” Others put men’s pleasure first: “Men don’t like anything to hold them back.”

Men’s pleasure comes first

“Questions and Answers about Contraceptives” is the name of a closed Facebook group where women can pose questions about the side effects of various contraceptives, from bleeding and vaginal discharges to excess weight gain. The group’s administrator is Shaimaa Gamal, an obstetrician-gynecologist at Ismailia General Hospital. She says she started the group in 2016 when she was no longer able to respond to all the questions from women who were suffering as a result of the misuse of contraceptives.

According to Gamal, there are two categories of contraceptives: hormonal and non-hormonal. Non-hormonal types include IUDs, condoms, and vaginal rings. Hormonal types can be further subdivided into two categories: single-hormone methods, which contain the hormone progesterone/progestin, such as the birth control ‘minipill’ taken for the first six months, and birth control injections every three months, and an implant that is inserted under the skin of the upper arm. As for combination methods which combine two hormones, progesterone/progestin and estrogen, such as birth control pills and monthly birth control injections.

Dr. Gamal confirms that the use of condoms is very low compared to other contraceptives1 , and that men usually resort to condoms only when other contraceptives put their partner’s lives in danger. She attributes that to the dominant culture, which lays the full responsibility for pregnancy on women. Despite the fact that some clinics provide women with 30 condoms per month, most of them prefer not to use it. The excuse often given is: “My husband can’t use that thing.” There is a common misconception that condoms are used only to prevent sexually transmitted illnesses (STIs), not as birth control. Dr. Gamal adds that “Eastern men, obsessed with virility, do not use condoms because of the negative misconceptions about men who use them: Men always say, ‘I’m good, I’m very healthy.’”

Mohammad Galaly, co-founder of a website called Sexology, has a different view. In his opinion, condoms are the safest type of contraceptive, a low-cost method with no side effects. From his experience of running the Sexology website, his official Facebook page, and a closed Facebook group called Sexology, Galaly confirms that the category of people who use condoms is still very small, mostly limited to highly educated young men. He adds that the women who participate in the closed Facebook group are more concerned than men about the possibility of pregnancy, and that most of their questions are about this issue. The majority of group members are unmarried and range in age between 15 and 35 years old.

The most prevalent excuse among men who refuse to use condoms is that it reduces sexual pleasure. Galaly sees this as “more of a claim than a complaint based in reality: it does lessen direct contact between the genitals, but the difference is really very small.” Other methods, such as using spermicide and getting a vasectomy, have significant disadvantages, such as the high cost or the permanence of the procedure.

A survey that mortified men

At the beginning of August 2018, I distributed a questionnaire to a group of 50 men between the ages of 25 and 55. The group included a civil engineer, a financial consultant, a teacher, an executive director, an accountant, a construction worker, a cafeteria worker, a janitor, a journalist, a pharmacist, and a management development specialist. 59% were married and 41% unmarried. The questionnaire consisted of 9 questions. Its purpose was to ascertain men’s willingness to use contraceptives, especially condoms, and to which degree men assume the responsibility for pregnancy, along with their wives or partners.

At the beginning, the questionnaire was met with strong disapproval, even shock, by some of the men. Some described it as shameful, promoting things that are against the nature of Egyptian society. But once I clarified the concept and objectives of the questionnaire, many of them agreed to cooperate. The results revealed that only 5% of the men use contraceptives themselves. This percentage indicates that the full responsibility for pregnancy is placed on the partner. It also demonstrates the reluctance of men to participate and to help reduce the effects of contraceptive use on women. The questionnaire also found that condoms were used by men only in extramarital sexual relations. It attributed the rarity of its use among married couples to cultural reasons: men reinforcing principles of masculinity, and putting their pleasure first, as though women are just vessels for pregnancy and childbirth.

Condoms are only used by men if the woman is in serious danger, such as constant, life-threatening bleeding. This result confirms that men are only concerned with women’s health in high-risk cases. 40% of the men responded that they would agree to use condoms if their wife’s health was in danger, whereas 60% would still refuse to use them.

As for new contraceptives being developed for men and the possibility of their availability on the market in the near future2 , the questionnaire group received these news with ridicule, as though they belong in the realm of fantasy. They expressed with certainty that they had no desire to use these methods, whether now or in the future.

These results reveal men’s lack of knowledge of contraceptives other than condoms; in contrast to women, who are always searching for different methods of contraception in an attempt to find something that works well for them.

The results of this questionnaire give rise to a pivotal question: How long will men continue to evade the responsibility of pregnancy — or when will men share with women the responsibility for birth control?

• 1A study conducted in the Middle East in 2014 by Rice University, called “Contraceptive Choice Among Women in the Middle East,” found that 82% of women were afraid to ask their husbands or partners to use a condom. On rates of condom use in the region, Turkey came at the top of the list (15.8%), followed by Iran (13.8%) and Bahrain (9.6%). The three countries at the bottom of the list were Saudi Arabia (0.9%), Yemen (0.5%), and Egypt (0.5%). The study — which was conducted in 19 countries in the Middle East, on a sample ranging from 15-49 years old — mentions, among reasons for the low rates of condom use, the discomfort of buying them in a public place, in particular with the common misconception that condoms are used only in extramarital sexual relations. The study indicates that there are some initiatives to tackle this discomfort, such as smartphone apps or websites that sell condoms. In addition, the Egyptian Ministry of Health provides different methods of birth control, including condoms.
• 2Monash University in Australia has recently developed a birth control pill for men. It claims that the pill is safe and does not affect men’s sexual activity, according to the first trials of the drug, conducted on 83 men for a month-long period. The new drug contains a long-chain fatty acid that works on slowing down and stopping the ejaculation of semen, and is due to be available on the markets at the end of 2018. Vasalgel is an injection approved by the American Food & Drug Administration, which works on blocking the path from the sperm to the egg. In an article entitled “Will Vasalgel be accepted by Egyptian men?”, Dr Khaled Montasser, head of the Gynecology & Dermatology Department in the Suez Canal Authority, discusses the importance of this product. He stresses that women should not have to shoulder the responsibility and repercussions of pregnancy alone, criticizing the culture of masculinity that dominates Egyptian society, which — so far — does not accept that some of this responsibility can be borne by men, by using a product such as Vasalgel.