The Sexist

The Feminist Implications of Male Reproductive Health

As women continue to fight for control over our own bodies, we're also faced with a parallel battle: Advocating for men to share responsibility for the physical, emotional, and financial burdens of reproductive health.

I'm currently working on a story that touches on a lighter side of this problem—sex partners who don't quite understand how your birth control method actually works. If you've ever heard any bizarre theories about how exactly that pill stops babies from popping out of your ladyparts, please let me know.

But the tendency to place the burden for reproductive health on women reaches into far more serious territory. Case in point: Gardasil, the vaccine that prevents against HPV, was initially exclusively developed for use in young women, even though the virus affects 75 percent of men and women under 50. What's up with that?

In the new issue of Ms. Magazine, Dr. Adina Nack of California Lutheran University attacks the issue of the HPV vaccine's inconsistent application among men and women. According to a Ms. press release:

The CDC recommends “routine” vaccination for females ages 9-26 but, last October, after the FDA approved Gardasil for prevention of genital warts in boys and men, the CDC voted in favor of a lesser recommendation of “permissive” use in males that is likely to make the vaccine less affordable for men.

Translation: While the CDC permits use of this vaccine among both men and women, it only recommends that women receive the vaccination. The effect is that men will be less likely to elect to receive the Gardasil vaccine, and that health insurance companies will be less likely to provide adequate coverage for that use.

Gardasil is chiefly advertised as a method of preventing cervical cancer among women, an approach which glosses over the serious medical problems that HPV can cause in men—including genital warts, anal cancer, and oral cancer. There have been a few recent developments in providing access to the vaccine to young men. Today, in light of a Gardasil study that found the vaccine "successfully prevents deadly anal cancer in men," the CDC's Advisory Committee on Immunization Practices (ACIP) met to consider the expansion of the HPV vaccine in men [PDF]. Yesterday, Health Canada approved the vaccine for use in Canadian men aged 9-26 in order to prevent genital warts.

Why have we been slow to recommend this vaccine equally to both men and women? Men's reproductive health has not traditionally been medicalized like women's bodies have been. Women are accustomed to being subjected to annual medical check-ups on the status of their sexual health, including what sort of damage HPV may be looking to exact on their cervix. Men aren't. So while I'm forced to receive my annual pap smear and raft of STD tests in order to receive a refill on my birth control prescription, my male sex partner is subject to no such requirement. When you start considering the possibility of injecting young people with three doses of a vaccine that, like all vaccines, holds possible side-effects, women are the natural recipient of such a remedy. Their bodies have already been engaged in these issues, while male bodies have so far been kept at a distance.

As Nack notes, advocating for men to take control of their reproductive health can only help women:

“Feminists have a vested interest in advocating for policies and circumstances around the world that shape men’s ability to develop healthy sex lives, which, by definition, has to include respect for the rights of those with whom they partner, regardless of gender,” says Patricia Rieker, Ph.D., a sociologist at Boston University and Harvard Medical School and coauthor of Gender and Health (Cambridge University Press, 2008).

Nack's piece is entitled, "Why Men’s Health Is a Feminist Issue." And women's health is a men's issue, too. As Nack notes, we can't be solely concerned with how STIs will affect our own bodies when we're responsible for spreading these viruses to each other. "Women’s health—especially reproductive health—is usually the focus of sexual-health discussions but men’s health also deserves women’s attention—and not just because women care about their sons, male partners and male friends," she writes. "It almost goes without saying that women can also be infected by their intimate partners, and since the great majority of women primarily have heterosexual relations, that usually means by men."

  • Charlie

    Another possible reason: the government thinks HPV is gay.

    My understanding is that 'The Pill' sends the soul of the fertilized egg to limbo by blocking its implantation in the uterus.

  • LeftSidePositive

    ^^

    I can't tell if that's brilliant satire or really f#$@#ing scary...

  • Melanie

    Well... and this was from a doctor.... I was told that it actually stops you from ovulating but sending your body into state of menopause. Replacing your own hormones with a low dosage, and since your body produces hormones and drops eggs from the same place......... neither happen. Then when you take the "sugar pill" your body drops the egg and sheds the lining all in few day period... no pun intended.

  • Richard

    I think women's bodies can be overmedicalized, but I do not think you do any leg work to prove that this is the case for Gardasil at all. A really simple search into Google (I didn't have to much leg work either it seems), shows that a number of medical studies discuss that.

    The only point you seem to make is that the vaccine “successfully prevents deadly anal cancer in men.” How much of the time? Does the potential side effects and cost outweigh on a societal level the relatively smaller amount of anal cancer?

    I think this is really a case where you have to make argue in medical testing terms. If there was a study showing that in fact the benefits to men were higher (or equal) to women , then it would support your point, but if there is a I cannot find it. You just assert that its true.

    Just to clarify, its really likely that vaccinating all men with Gardasil would provide positive benefits to males, but so would 50 other vaccines. The point of the medical panel is to figure out how to balance that cost benefit.

    Also, reading the articles over you can't help but suspect the Merck's money motive is playing a role in the push for expansion to men.

    I think looking at the scorned reports from the CDC is a good start.
    http://www.cdc.gov/vaccines/vpd-vac/hpv/default.htm

    http://www.medicalnewstoday.com/articles/166998.php
    http://www.aafp.org/online/en/home/publications/news/news-now/clinical-care-research/20091027acip-hpv-vacc.html

  • Jess

    Richard: vaccinating women against HPV is benefiting women AND men. Vaccinating men against HPV would benefit more men, AND more women. Why does the burden for sexual health need to fall, yet again, to women?

  • http://toysoldier.wordpress.com/ Toysoldier

    Jess, there are two separate issues: the purpose of the vaccine and sexual health needs.

    Firstly, the purpose of the vaccine is specifically to protect women from HPV. That the vaccine may potentially address medical issues faced by a small percentage of males is incidental. The only reason for males to get the vaccine would be to prevent HPV in women. That would mean boys and men would face largely unnecessary side-effect risks for medical problems they likely will never experience for someone else's potential benefit. There is no comparable instance in which women are asked or required to get vaccinated for men's sake.

    The most logical solution would be to require vaccination for females and make the vaccination for males optional, as the former would sufficiently ensure that females would be protected against HPV, which is the purpose of the vaccine.

    Secondly, males and females have different sexual health needs. As a result of women being able to get pregnant, they face several health issues males do not. It is not burdening women to suggest that women and only women bear the responsibility for their own sexual health needs. And while I cannot be certain, I am fairly convinced that there are no women getting prostate examines on men's behalf or getting tested for sperm counts or getting checked for testicular cancer.Those are burdens that do not fall to women, along with issues like erectile dysfunction, circumcision, ligament damage, etc.

    So I do not see how women are unfairly burdened.

  • Jess

    Toysoldier, you don't even bother to read the articles, do you? "Gardasil is chiefly advertised as a method of preventing cervical cancer among women, an approach which glosses over the serious medical problems that HPV can cause in men—including genital warts, anal cancer, and oral cancer."

  • Mrs. D

    I certainly hope Charlie and Melanie are being sarcastic. If not, please, please, please do some research on how the pill works. There's no ovulation except in incredibly rare circumstances and no "abortion"-like process.

    This is what happens when we remove comprehensive and medically accurate sex education from schools, people...I knew at as a wee - okay, maybe not so wee, maybe pre-teen - little one how the pill worked.

  • http://toysoldier.wordpress.com Toysoldier

    Jess, I read the quote. It would be helpful if those advocating for vaccinations would also read all available material about it. According to the Centers for Disease Control and Prevention:

    -About 1% of sexually active men in the U.S. have genital warts at any one time.

    -Penile cancer is rare, especially in circumcised men. In the U.S., it affects about 1 in every 100,000 men. The American Cancer Society (ACS) estimated that about 1,530 men would be diagnosed with penile cancer in the U.S. in 2006.

    -Anal cancer is also uncommon—especially in men with healthy immune systems. According to the ACS, about 1,900 men will be diagnosed with anal cancer in the U.S. in 2007.

    So while the vaccine may potentially address medical problems men can get, the medical problems themselves are rare and uncommon. To echo Richard's point, if the evidence showed the vaccine provided equal or greater benefits for males it would support Hess' point. However, according to the CDC the evidence does not, in which case there is simply the assertion that the vaccine is just as beneficial to males.

    That said, how the Gardasil vaccine constitutes an unfair burden to women remains unclear.

  • VS

    I can't find the link to it anymore, but I'd swear I read in a trade paper that a big part of the reason that Merck ended up focusing on women was that they had a great deal of difficulty in the beginning getting and then keeping male participants in their clinical trials. Why? The test for men involved a device that looked rather like a microplane which was used to remove skin samples from the penis. In a way, I think this does go back to your point. Women are so used to being poked, prodded, and scraped that they, in general, did not have as much of a problem with Merck's testing. Men, on the other hand, generally aren't used to it, especially in regards to their sex organs, so they balked at testing.

  • LeftSidePositive

    Toysoldier,

    Do you realize how rare and uncommon it would be to have an adverse event from measles in this day and age? Extremely, extremely rare. And yet, every child is recommended to get a measles vaccine. While the risk to any given person is very small, the overall benefit to humanity is huge. And, when vaccination rates drop we see outbreaks of measles and kids dying from thoroughly preventable illnesses like Haemophilus influenzae.

    Also, do the math. 1% of men having genital warts at any given time is well over a million people. Do you just not care about thousands of people who are getting these wholly preventable cancers? Are you not willing to partake in a very low-risk public health measure that might help you and will certainly help thousands of other men annually? Vaccination would be a huge help to public health.

    Another thing is the question of herd immunity. People thinking "oh, it's relatively unlikely that I'll get the disease, so I won't get vaccinated" is a huge problem in public health, leading to things like measles outbreaks as soon as that herd immunity goes down. Also, there is a fundamental ethical disparity if some people are able to enjoy the benefits of herd immunity and not share in the costs by being immunized, since they are freeloading on others' immunity.

    There is also a very significant issue in the variability in seroconversion. Vaccines aren't equally effective in all people. If a woman is immunocompromised and continually exposed to the virus through her partner(s), she still could get HPV even if she has been vaccinated. Herd immunity will generally protect those who have a weak response to the vaccine, but this is a public health issue that requires high vaccination rates to benefit the whole population.

    Another thing, have you ever heard of a RESERVOIR?! How on earth could HPV be meaningfully reduced if it is thriving in half the population? There is a reason we were able to eradicate smallpox but not malaria. So, men, think about it--who wants to be a mosquito?

  • Emily H.

    Toysoldier complains about every post on this blog, on the grounds that feminists are biased and don't care about men's problems or men's issues. Then when Amanda writes a post explicitly pointing out that "feminists have a vested interest in advocating for policies and circumstances around the world that shape men’s ability to develop healthy sex lives," he's mad about that too. If Amanda had argued *against* men getting the vaccine, he'd be all up in the comments section, insisting it's just like the feminists to trivialize men's anal cancer. Shut the hell up, dude. Your arguments don't make any sense.

  • http://toysoldier.wordpress.com Toysoldier

    LeftSidePositive, if you read the last of Richard's links you would see that the ACIP recommended leaving the decision to vaccinate males up to doctors as per the males' (or presumably their parents') request. That recommendation came from the CDC who has actually researched the issue, so the ACIP's recommendation should carry some weight.

    As for people "freeloading on others’ immunity," it is immoral and unethical to force people to get vaccinations simply to "share in the costs by being immunized." The purpose of vaccination is to protect those most at risk and prevent the spread of the disease, not to punitively stick it to those who are less at risk.

    Emily, Hess does not argue that feminists have a vest interest in men's sexual health. Her post "[advocates] for men to share responsibility for the physical, emotional, and financial burdens of reproductive health." Her other position comes from her agreement with Pack's statement that "women can also be infected by their [male] partners," meaning that the concern is not for men's sexual health, but for women's sexual health.

    However, even giving Hess the benefit of doubt, why focus on HPV? Prostate cancer effects 1 in 6 of men. HIV/AIDS effects thousands of men in the United States, as does herpes and hep B. Many men experience erectile dysfunction. Why pick the one instance in which feminists advocate vaccinating men specifically to lower women's risks for contracting a virus? Why not pick a more problematic sexual health concern for men and perhaps link to organizations like The Prostate Cancer Foundation and help raise awareness about a very serious sexual health problem men face?

  • Mrs. D

    Um, because prostate cancer research is already well-funded (http://well.blogs.nytimes.com/2008/03/06/cancer-funding-does-it-add-up/ , noting that prostate cancer has the second-highest funding level per death of all cancers), and isn't something you can contract from your intimate partner (because those types of things SHOULD be a shared burden to eliminate), and ALSO because testing for prostate cancer is routine while testing males for HPV is impossible (there is no FDA-approved HPV test for men: http://www.cdc.gov/std/hpv/stdfact-hpv-and-men.htm).

  • LeftSidePositive

    Toysoldier,

    Your understanding of public health is nonexistent. For instance, schools can prevent students from enrolling if they do not have their vaccination in order. The fact that many schools are being lax about this is a huge problem and is very vociferously condemned by the medical community and pediatrics especially. Also, health workers are very frequently required to get vaccinations even if the risk to them is extremely small, because they might carry pathogens to their immunocompromised patients. So yes, society can, and frequently does, require individuals to get vaccinated for the greater good over their own personal benefit.

    And, have you actually ever listened to a panel on medical ethics? I have. Many, many times, from leaders in the field. And individuals freeloading off of others' immunity is a very serious ethical concern, and is issue #1 in the ethics of vaccination programs.

    Also, it's COMPLETELY bogus to say people who are "less at risk" shouldn't be vaccinated. A disease can't possibly be effectively controlled, much less eradicated, if large numbers of people are still exposed to it and carrying it to others. Even a small conversion rate with such wide exposure leads to a high incidence, and preserves the disease as a significant cost to individuals and society.

    This notion of yours that we should just ignore a less common disease is asinine in the extreme. Are you also in favor of banning dermatology? Doctors work in all different specialties and work to alleviate human suffering in a variety of ways, and none of these should be put on hold for another. But, if that is in fact how you feel, I'm sure you will be perfectly willing to see funding terminated for research and prevention of all conditions that affect you and your family until malaria is eradicated.

    You love to pop up on these articles and declare that feminism will never be "good enough" until it abandons whatever women are concerned about and devote their time and money to a cause that benefits men. Well, I call bullshit. Really, we can see right through you, and this rhetorical tactic is not the least bit clever or convincing. There are literally thousands of causes to advocate in this world, and it's ludicrous to demean important work that people are doing in a variety of fields by saying they'll only be "worthy" to you if they focus on some other cause instead.

  • Pingback: BEDSIDE MANNERS: Why This Feminist Cares about Men’s Health | Girl with Pen

  • http://toysoldier.wordpress.com Toysoldier

    Mrs. D, HPV research is well-funded (in 2009 HPV/cervical cancer research collectively received $109 million in non-ARRA funding and $17 in ARRA funding), most people's immune system fights off the STD within two years without need of the vaccine, and the FDA approved use of the HPV vaccine in boys and men last October. So the focus on HPV rather than on HIV/AIDS, Gonorrhea, Chlamydia, Herpes and Syphilis, all of which present far more potential health risks for men, seems odd if the concern is actually about men's reproductive health needs rather than a perceived inequity regarding a vaccine for a virus that rarely results in health risks for men.

    It just seems more prudent and important to focus on diseases that impact men more.

  • LeftSidePositive

    Toysoldier's hypocrisy shines through:

    "It just seems more prudent and important to focus on diseases that impact men more."

    RIGHT, BECAUSE YOU'RE A SELF-CENTERED AND SELF-ENTITLED MAN.

    Furthermore, there IS NO VACCINE for HIV/AIDS, Gonorrhea, Chlamydia, Herpes, or Syphilis. So, how, exactly are we supposed to focus our vaccination efforts on them?????? What kind of nonsense is that?!

    And, please consider yourself totally unqualified to ever render an opinion on public health, EVER. Really. This ignorance is phenomenally shocking.

    How common is diphtheria in the US? Not really. What is the likelihood of having a serious adverse event from chicken pox? Very, very small. And yet, we vaccinate against these diseases.

    As for rarity, the incidence of phenylketonuria is one in FIFTEEN THOUSAND live births. And yet, every newborn is screened for it. Why? Because the risk to the individual is quite small (it's a pinprick), and intervention can let people who otherwise couldn't lead very full & happy lives. Are you honestly going to say that we should just stop screening for PKU because it's not that common and there are more scary diseases out there?

    Your whole premise is total idiocy.

  • LeftSidePositive

    Ladies, here's a question for you:

    If there were an analogous situation--that a virus could infect you with a relatively low rate of negative effects, but could cause significant morbidity and mortality to your (in this case, male) partner(s), would you really complain about being vaccinated? Would you consider it acceptable that you could potentially do significant damage to your partners' health, and not feel ethically compelled to take a relatively simple health precaution that would alleviate the suffering of others?

  • TJ

    @LSP, thank you for bringing up the very important point that men can be carriers of the disease, while most of the effects of the disease are felt by women. Although most men may not have symptoms (and typically don't), they are definitely able to pass it on to their partners. On top of that, it's not like you can wear a condom and be protected... there is no way to truly prevent yourself from contracting this disease UNLESS you get vaccinated.

    So since everyone can be affected by this disease, it makes sense that everyone has a hand in preventing it. If, as a woman, I never would have gotten this disease without the carrier (men), doesn't it make sense for the carrier to have a hand in getting rid of this disease? To not be the avenue in which the disease grows its population?

  • LeftSidePositive

    Look, Toysoldier's derailing technique is a classic!

    Thanks to Dorothy for introducing me to this brilliant site:

    http://derailingfordummies.com/#moreimportantly

    As with the best of all these techniques, this step operates on several levels. First of all, it communicates to the Marginalised Person™ that you think the entire debate is trivial and below consideration, indicating you entirely disregard their feelings and emotions. Secondly, you disown responsibility for your part in the debate and anything that you've said that may have been discriminatory or offensive.

    Finally, you reinforce your Privilege® by suggesting that it is Privileged People's® job to set the agenda for the Marginalised Group™. After all, how could they possibly know what issues they should prioritise for themselves, they're far too inferior and stupid! You, with your objective, ractional Privileged® perspective, on the other hand, know exactly what is most important and it is definitely not confronting you with your own bigotry and ignorance!

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