This Week in Sex is a summary of news and research related to sexual behavior, sexuality education, contraception, sexually transmitted infections, and more.
Show Gets Emergency Contraception All Wrong
We here at This Week in Sex are not regular Black Mirror viewers, but if you are and have not yet watched the episode titled “Arkangel,” you might not want to read this yet.
The science fiction show’s second episode of the season mixed up emergency contraception (EC) and medication abortion. And the internet let the show’s creator, Charlie Brooker, and the episode’s director, Oscar-winner Jodie Foster, know that they’d screwed up.
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Black Mirror, a Netflix original in its fourth season, is like the Twilight Zone for a new generation. Each episode tells a different story that takes place in an alternate version of our world where advanced technology is key. The technology that is front and center in “Arkangel” is a chip that can be implanted into a person’s brain to allow constant and complete surveillance.
The episode follows Marie, a mom who is using the chip and its accompanying software to monitor her teenage daughter, Sara. Through the chip, Marie learns that Sara is pregnant and takes it upon herself to terminate the pregnancy by crushing pills into Sara’s food.
While there are many ethical issues that are brought up in the scenario—privacy, bodily autonomy, and informed consent, to name a few—there is also a big problem with the facts themselves.
Sara learns that she has been given the pills when she visits the nurse after throwing up in school. The two have the following exchange:
“It was the EC pill that made you sick,” the nurse says.
“EC?” Sara replies.
“Emergency contraception. For terminating a pregnancy,” the nurse tells her.
“It will work in spite of the vomiting. You don’t have to worry about that. You’re not pregnant anymore,” the nurse explains.
Sara looks visibly confused. She didn’t know she had taken pills and may not even have known she was pregnant.
The show is set in a slightly different world than our own, so maybe its writers thought they could get away with having pills that can cause an abortion instantly with one dose. In fact, many of us would be thrilled for a world in which that was not just possible but easily available.
But, unfortunately, Black Mirror’s storyline just perpetuated myths and misunderstandings about the drugs we have in the real world.
While medication abortion does exist and is highly effective, it is not as simple as walking into a pharmacy and then crushing pills into a smoothie. More importantly, it is not the same thing as emergency contraception, which does not end a pregnancy.
As for medication abortion, there is a combination of drugs—mifepristone and misoprostol—that can together terminate a pregnancy. Mifepristone is usually given by health-care provider in a clinic setting. It blocks the body’s production of progesterone, which is needed to continue a pregnancy. The pregnant person later takes misoprostol, which causes the uterus to cramp and bleed similar to a very heavy period or an early miscarriage.
Most emergency contraceptive pills (ECPs) contain levonorgestrel, a synthetic progestin that is also found in many birth control pills. These pills—sold under brand names like Plan B One-Step and My Way—are available over-the-counter in drug stores. They can be taken up to five days after unprotected sex, but are most effective if taken within the first three days. Another type of ECP, sold as ella, relies on a medicine called ulipristal; it’s just as effective on day five but only available by prescription.
Both types of ECPs work by delaying ovulation. Sperm can only live in a woman’s reproductive tract for about five days. If there is no egg available to be fertilized in that time, then the woman will not get pregnant.
ECPs also do not affect an already established pregnancy. If a woman is already pregnant when she takes the pills, she will still be pregnant.
Conflating ECP and medical abortions is dangerous and irresponsible—even in a show about an alternate world. Dr. Daniel Grossman, director of Advancing New Standards in Reproductive Health (ANSIRH), a research institute at the University of California, San Francisco, told The Lily: “It’s quite clear that there are efforts under way to undo the contraceptive coverage guarantee under the Affordable Care Act. There’s been increasing restrictions on abortion. It’s very much clear that reproductive health and rights is under attack and, unfortunately, by highlighting this confusion between EC and abortion-causing medications, in some ways plays into that further.”
Yet Another Reason to Get the HPV Vaccine
In the final installment of This Week in Sex last year, we wrote about a study that found males who had not yet had penetrative sex were nonetheless at risk of contracting HPV (most likely from other sexual behavior), and reminded everyone of the importance of getting young people vaccinated early to prevent HPV which is known to cause cancer.
Now it’s a new year, and we have a new reminder of how important this vaccine is: The rate of head and neck cancers caused by HPV (likely contracted through oral sex) is rising.
These results come from a retrospective study funded by the National Cancer Institute. Researchers reviewed almost 150,000 cases of head and neck cancers diagnosed between 2002 and 2012.
The good news is that the incidence of head and neck cancers overall decreased slightly in each of those years, a trend the authors believe may be attributed to decreased cigarette smoking
At the same time, the incidence of HPV-related head and neck cancers rose 2.5 percent each year and even more so in men (2.89 percent each year). In fact, men with HPV-related head and neck cancers out number women by four to one. The researchers say that compared to patients with other types of head and neck cancers, those who have cancers caused by HPV tend to be white, younger, and have higher levels of education. They also tend to have more sexual partners but use alcohol and drugs less.
The researchers think that the rise in HPV-related head and neck cancers can be attributed to changes in sexual behavior such as having sex at younger ages, a higher number of lifetime partners, and increased engagement in oral sex. As for why men are more at risk, they note vaccine discrepancies between sexes. The vaccine was originally just recommended for women, and many people associate it only with cervical cancer.
So, we’ll start 2018 with this reminder: The vaccine now protects against the nine types of HPV known to cause cancer. The Centers for Disease Control and Prevention recommend that all young people get the vaccine at age 11 so they can be fully protected before they become sexually active. But the vaccine is available to people up until age 26.
A Male Contraceptive Will Start Clinical Trials This Year
Male birth control has supposedly been just around the corner of the calendar for decades. But nothing—other than the ever-reliable condom and the permanent-solution vasectomy—has been made available to men yet.
Will 2018 be the year that changes that? Well, no, but maybe one possible birth control method is getting a little closer.
Researchers at the National Institutes of Health have been working with the Population Council to develop a gel that can block sperm production. The gel contains two synthetic hormones. The first is a version of progestin that blocks the testes from making enough testosterone to produce sperm. The second is a form of testosterone itself to make up for the hormone imbalance that is caused when the body doesn’t make its own (testosterone is generally responsible for sex drive and characteristics such as facial hair, muscle mass, and a deeper voice). The gel is applied to the upper arm, not the genitals, and blocks sperm production for 72 hours. Men need to use it every day regardless of whether they are having sex in order to keep their sperm count down.
This combo gel will start a four-year clinical trial in April. Researchers are recruiting more than 400 opposite-sex couples in Chile, Italy, Kenya, Sweden, the United Kingdom, and the United States. The men will be required to use the gel every day while their female partners continue to use another method of birth control for at least the first few months. The men’s sperm count will be closely monitored. Once it drops below one million sperm per milliliter of ejaculate, the women will be asked to go off birth control. Then the couple will use the gel as their only form of contraception for one year, which will allow researchers to evaluate its efficacy.
Dr. Stephanie Page, a researcher at the University of Washington and the principal investigator on the trial, told the MIT Technology Review: “I am very confident that if men put the gel on every day and apply it correctly, it will be effective.”
Of course, before we see it on pharmacy shelves, we’ll have to find out if men will actually use the gel every day, if the side effects are manageable, and if there’s actually a market for male contraception after all.