All language subtitles for Sex.Explained.S01E03.WEBRip.x264-ION10

We're not sure why this shape
became the universal symbol of love.

But one leading theory is that it came
from the silphium pod,

so valuable
across the ancient Mediterranean,

it was printed on the currency
of the only place they grew,

the Greek colony Cyrene.

It was exported around the region
for all kinds of medical uses

and one in particular.

Soranus of Ephesus,
the foremost gynecologist of his time,

advised women to drink silphium juice
once a month,

since it not only prevents conception,
but also destroys any already existing.

Which means, our modern heart shape
may derive from an ancient kind

of morning-after pill.

But for most of human history,
birth control was a lot less refined.

There were early condoms made
of animal intestines

that were washed and reused.

And diaphragms, early versions,

were just women putting various things
up their vaginas:

wool, silk, crushed plants or animal dung,

depending on the available animal.

In Egypt, it was crocodile dung.

In India, dung of the elephant.

We'll never know for sure
how well silphium worked,

because it went extinct.

But research into its likely relatives,

like Queen Anne's lace
and devil's dung,

suggest it probably manipulated
the hormone levels

involved in getting pregnant.

Scientists eventually figured out how
to do that in a lab in the 1950s.

And it's how nearly every new type
of birth control has worked ever since.

But this method isn't perfect.

Weight gain, depression, acne...

I was just bleeding and bleeding
at a low level for months.

I would just, like, cry over, like,
things that didn't make any sense.

Cutting a cucumber, and I was like, "Why?
Like, "Is this, like...?

This is the worst, like, vegetable
I've ever, like, cut up before."

It's been over 60 years
since we invented hormonal birth control.

Shouldn't it be better by now?

This little white tablet
is more explosive than dynamite.

Sermons have been preached on it.

Men and women have argued over it.

Mary
and her team merely explain the pill,

and they nod back, but it's not consent,

because it's their man
who decides yes or no.

The doctors themselves
may not be well-informed

about the side effects.

It's hard to see what more
we could do without using women themselves

as the experimental model.

If you have a pet cat,

well, you may remember
when she started going into heat...

...as in,
when she started ovulating,

producing eggs.

And for those few days
when they're fertile,

they really want to mate.

Most female mammals look and act different
around the days they're ovulating,

called "estrus,"
signaling that they want it,

so come and get it.

Female chimpanzees
get huge sexual swellings,

goats wag their tails,

and horses wink their vulvas.

But higher primates, like humans,
are pretty unique.

We don't show outward signs that
it's our fertile few days of the month,

and we're continually receptive to sex,
whether we're fertile or not.

Scientists call this concealed ovulation,

and it took them into the 1900s
to figure out how it worked...

and how to hack it.

Ovulation mainly involves four hormones,

which rise and fall
over the course of a month.

Two of them are released from the brain,

and two come from the ovaries:
estrogen and progesterone.

To kick things off,
those two brain hormones

send a signal to the ovaries,
where roughly a dozen follicles,

each containing a single immature egg,

have been patiently waiting
for this moment.

It's winner takes all in the fight
over the limited hormone supply,

and the loser follicles die off.

Next, the winning follicle emits lots
of estrogen,

which starts
to thicken the uterine lining

and opens up the cervix,

which is now coated
with a nutrient-filled fluid

that protects any incoming sperm
on their journey up to the uterus.

Then the follicle ruptures,
releasing the matured egg,

which is snatched up
by the nearby Fallopian tube.

The sperm has a short window of time
to get to the egg, or it dies off.

But if one gets there,
that's fertilization.

The egg keeps traveling down
the Fallopian tube to the uterus

as progesterone levels rise,

which close the cervix
and turns that fluid into a sticky shield,

blocking any new sperm from getting in.

The progesterone also keeps
building up the uterine lining

into a warm, snuggly bed
where the egg can stick.

But it's not that warm and snuggly.

It's also a lethal testing ground

that not every fertilized egg can survive.

If a fertilized egg
does successfully implant,

that's a pregnancy.

Estrogen and progesterone levels
stay high,

and the ovaries won't release more eggs.

But if the fertilized egg is rejected
or there never was one,

estrogen and progesterone plummet.

And out comes that lining: your period.

And the cycle reboots.

Hormonal birth control's main cheat

is altering the estrogen
and progesterone levels in the body,

so it thinks you're already pregnant.

So, no new eggs are released.

The cervix stays plugged up,
and the uterine lining remains thin.

"The pill," released in 1957,
was the first form of this hack.

A daily dose of both synthetic estrogen
and progesterone,

marketed as Enovid in the US
and Enavid in the UK,

but only to treat menstrual problems,

which an unusually large number of women
suddenly found they had.

And when the pill hit the market
as birth control in the 1960s,

it transformed the world.

More women were able to stay in school
and have smaller families,

helping to lift millions out of poverty.

You can see that kind of profound impact
in rural Bangladesh,

starting in the 1970s.

Bangladesh had just become a country.
It was very poor.

Religiously conservative.

Most Bangladeshi women were practicing
female seclusion,

where they would not even go in public.

So, going to a clinic was a big ask
of these women.

But then in 1978,
health workers went door-to-door

in 70 randomly selected villages
every two weeks

with an array of birth control options,

including injections,
the most popular choice,

because they were discreet,
and one shot lasted for months.

Two decades later,
the results were transformative.

Compared to an otherwise
identical village...

families in a birth control village
had more education,

higher incomes, more valuable homes
and savings,

and better access to running water.

Those women also had
a higher body mass index,

and as a result,

they were 20% more likely to survive
into old age.

But the progress hormonal birth control
brought women around the world

didn't come without a cost.

Starting with that very first pill.

See, when you take the pill,

it puts those synthetic hormones
in your bloodstream,

so they travel all over the place.

The changing hormone levels
can cause headaches and nausea,

affect hair growth,
and increase water retention,

so you can gain weight.

And these hormones also play a role
in regulating sexual desire and emotions,

so you can experience changes
to your very sense of self.

And while the risk is extremely small,

estrogen increases the chances
that your blood will thicken into a clot,

which can travel to your lungs
and block blood flow,

which can be lethal.

And that first pill,

it contained ten times the amount
of hormones needed to be effective.

That high dose was primarily tested
in Puerto Rico in the '50s,

chosen because it was poor,

and the US government worried
about its overpopulation.

The US-appointed governor endorsed
a sterilization program.

By 1954,
sterilizations had nearly tripled,

the women often coerced.

So, when researchers arrived
with a reversible birth control option,

these women took it.

But they didn't know that they were a part
of an experiment

until a documentary filmmaker told them
decades later.

The women who took those pills

were the first in the world to try them.

Did you know that, doña Maria?

No.

They were experimenting with us,

without us knowing what they were doing.

Hundreds of women

faced serious side effects.

At least three died,
though it was never investigated.

It took more than ten years,
several new formulations,

and millions of women around the world
taking birth control pills

for the US Congress to finally hold
a hearing on their side effects.

It was called, after one senator
read the landmark book,

The Doctors' Case Against the Pill,

by the investigative journalist
Barbara Seaman,

who reported women experiencing

heart attacks, strokes, blood clots,
and cancer.

Thousands had died or been injured
in the US alone.

For the first five days of the hearing,

the all-male panel only invited men
to testify.

So, the women, they invited themselves.

An outburst
by a group of young women today

temporarily halted the Senate hearing
on the safety of the birth control pill.

I'd like to know why is it that scientists
and drug companies are perfectly willing

to use women as guinea pigs
and experiment testing the high estrogen,

low estrogen content of the pill.

The doses of hormones
in the pills were lowered

in the following years,

reducing the chance
of side effects like headaches, nausea,

excess hair growth and weight gain.

And some new pills were better
at reducing cramps and acne,

thanks to new synthetic forms
of progesterone.

A lot of potential side effects
still remain.

But for hundreds of millions of women
around the world,

not getting pregnant is worth
making yourself a little sicker.

And just like with those early versions,

women, and sometimes even their doctors,

don't actually know
how much sicker they'll get,

because you can't always know
until a lot of people start taking a drug.

One of those synthetic forms
of progesterone, DRSP,

was a key component
in a pill called Yaz,

which was heavily marketed in the 2000s
as way more than just birth control.

Yaz is the only birth control

proven to treat the emotional

and physical premenstrual symptoms

that are severe enough
to impact your life.

It can also help keep your skin clear.

Yaz contains a different kind of hormone
that may increase potassium.

The ad campaign worked.

For two years, Yaz
was the most popular birth control pill

in the United States.

And many young women
who didn't need birth control

bought it on its own claims
that it made PMS symptoms disappear.

Then reports of side effects started
to spread.

From blood clots to organ failure
to stroke,

thousands of women say they got sick

after taking a birth control pill
called Yaz.

Now under scrutiny

for possibly causing
serious health problems.

Using it can increase the risk
of dangerous side effects

that may even cause death.

Birth control pills roughly
triple the risk of getting blood clots...

but studies later found that DRSP
can as much as triple that risk.

And while the risk is still small,

it adds up to thousands of women
if millions are taking that pill.

As of 2015, the maker of Yaz,

Bayer Pharmaceuticals,
has settled nearly 10,000 claims

from women who got blood clots,
totaling around $2 billion.

But by that time,

a different type of birth control
was growing in popularity: the IUD.

This is the hormonal version.

There's also a different kind,
made of copper.

Both types are inserted
into the uterus by a doctor,

where it can stay for three to ten years,
depending on the brand.

We don't totally know how they work,

but we do know they turn the uterus
into a no-sperm zone.

As a foreign object in the uterus,

the IUD causes inflammation,

triggering white blood cells
to rush in and eat the sperm.

The hormonal IUD
also continuously releases a tiny amount

of synthetic progesterone, so it has a lot
of the same effects of the pill,

but with fewer side effects.

The copper IUD doesn't use hormones
at all.

Its trick is that copper
is sperm kryptonite,

for reasons scientists don't understand.

I love having an IUD.

I don't worry that I forgot
to take my pill.

I don't spot. I don't get a period.

I think I've used two tampons
in the last seven years.

I decided to get the copper IUD
because both my mother and her sister

had estrogen-related breast cancer.

So, I was advised by doctors

to get
on a non-hormonal birth control option.

The IUD is 99% effective,

in part,
because you can just set it and forget it.

In general,
birth control gets less effective

the more humans have to remember
to do something to make it work,

especially if it's during sex.

Which is why another of the most
effective methods is sterilization.

For men, "the snip" is a minor procedure

to cut or clamp the tubes
that carry sperm out of the testicles.

For women, "getting your tubes tied"
is a more invasive procedure,

which blocks or cuts the Fallopian tubes.

That's actually the most popular form
of birth control in the world.

But women usually only get it
when they've already had kids.

Meanwhile, the IUD is as effective
and can be taken out,

but only 12% of American women
using birth control have one.

And that's largely
because of a huge class action lawsuit

against one IUD, the Dalkon Shield.

Such a disaster,
it was a joke on Saturday Night Live.

If you don't agree
that the Dalkon Shield trout lure

is the most amazing trout catching
phenomenon you've ever tried,

well, sue us!

But it wasn't the fish-bait shape

that caused problems
for people who got the Dalkon Shield,

like Loretta Ross.

My first two or three years
with it were fine.

But then, I started developing
very low-grade infections.

She went to an ob-gyn,
who said she had an STD.

If I was black and femalepresenting
with an infection,

it had to be an STD, in his opinion.

Even though all the tests
were showing up negative.

He just kept searching for something
more exotic, more exotic, more exotic.

None of the treatments worked,
and six months later...

I lapsed into a coma one night.

When I woke up,
I had a total hysterectomy.

The first thing that doctor
should have done

was remove the Dalkon Shield.

It turned out
the Dalkon Shield had a design flaw.

Its braided string was too thick,

and it acted like a ladder
for bacteria to climb into the uterus.

Within four years
of the Dalkon Shield's release,

it was taken off the market.

By that point, it had been inserted
into 3.3 million women around the world.

At least 18 died.

Hundreds of thousands of women

sued the maker of the Dalkon Shield,
A.H. Robins,

bankrupting the company.

It later came out that Robins officials
knew about the wicking problem

six months before the shield went
to market.

The IUDs on the market now
are extremely safe.

The most common drawback?

Horrible to get put in.

Excruciating pain.

Every birth control option
has a drawback,

which is why a third of American women
have tried five or more kinds.

I started with the pill,
and then I went to the ring.

And then I went back to the pill.

Two forms of the pill,

the Nuvaring, um, which was interesting,

but that would come out during sex.

I've been on three different types
of the pill.

I tried an IUD.
And now I'm getting an arm implant.

And a lot of women
don't use birth control at all,

even though they don't want
to get pregnant.

In one survey of developing countries,

just 5% of women not on birth control
said the reason was access.

26% said the reason was side effects.

There is actually a birth control pill
that doesn't use hormones.

It was launched as Saheli,

and it's been on the market
for almost 30 years.

Its active ingredient is what's called

a "selective estrogen receptor modulator."

Not estrogen,

but a compound that acts
on estrogen receptors in the uterus.

So, the estrogen there can't do its job,

building up that warm uterine lining
so no fertilized eggs can snuggle in.

Since it doesn't actually affect
estrogen levels,

the balance of hormones
in your body stays the same.

So there are fewer side effects
than hormonal pills.

And you only have to take it once a week.

But good luck getting Saheli
outside of India.

That's where it was invented

and went through the large human trials
most countries require to market a drug.

And it was one of the lucky ones.

Out of every 5,000 compounds developed
in a lab,

only five make it to human trials,
and only one of those gets to market.

So finding new ways to deliver
the same hormones we already know work

is faster, cheaper, and less risky.

Birth control has sparked
thousands of lawsuits,

because mostly healthy women
are taking these drugs,

so they're more likely to notice
and sue over serious side effects.

There's also little incentive to innovate

since women are
buying their products anyway.

The mood swings have been bad.

The nausea has been bad initially,
but then you just get used to it, I guess.

Years worth of drama in my life,
years worth of medical bills,

drama while I'm traveling,

drama that I have to think about
every time I have sex,

every time I get my period.

Why go through that?
I guess 'cause condoms suck, but...

And there's
a huge potential market

the birth control industry
has left almost entirely untapped.

I'm not at all satisfied
with the options of birth control

for myself as a man
because I feel like there aren't enough.

My only option
as a guy is to use condoms, uh...

...or to... or to pull out.

So, really,
my only option is to use condoms.

If there was a commercially available
male birth control pill,

I would definitely, definitely,
at the very least, try it.

Scientists figured out
how to hack the male reproductive system

decades ago.

And large trials
in the 1970s showed some promise.

The perfection of male birth control

seemed right around the corner
for decades.

The Chinese have developed what they say

is a safe and effective birth control pill
for men.

Medical researchers reported today

they have found a chemical
that may hold the key

to a male birth control pill.

International research teams are working
on an injectable...

...birth control pill for...

...men are taking part in the first trials
of a new form of birth control.

- For men...
- Birth control for men...

- Male birth control...
- Male birth control pill.

Male birth control may be one step closer
to becoming a reality.

But it never arrived,
since trials were often cut short

because men faced too many side effects.

Side effects that might sound familiar,

like mood swings, acne,
and a loss of libido.

When approving a drug,
the FDA weighs its risks

against the risks of not taking that drug.

And men, unlike women,
don't personally face

the risks that come
with pregnancy and childbirth,

like blood clots.

Hormonal birth control might triple
a person's risk of blood clots,

but during pregnancy,
the risk is double that,

and in the weeks after childbirth,
quadruple.

And that was part of Bayer's defense
in court documents

in the wake of all those lawsuits.

And it's why Yaz is still on the market,

as are a bunch of other pills
using DRSP.

Male birth control just has
to meet a higher bar,

so the kind that has the best shot
at approval right now

doesn't use hormones.

It's a non-surgical vasectomy.

It works by injecting a gel
into that sperm carrying tube,

where it stays, killing sperm
as they leave the testicles.

A second shot is in development
that would break down the gel.

It's awaiting approval in India...

where early trials have shown
it's 98% effective,

has no major side effects

and can last over a decade.

But it hasn't gone through human trials
anywhere else,

and drug companies aren't sure

male birth control has a market
to make that worth it.

I'll be open to it.

Does that make me less of a man?

I don't know,
but I'm open to anything, honestly.

If guys had the option to sort of take
that level of responsibility,

like, leveling up
from just using a condom,

I think that would make it
a fairer conversation.

It takes two people
to accidentally get pregnant.

A 2002 survey found that 55%
of men would be willing

to try even a hormonal male birth control.

But everywhere in the world,

women get their tubes tied
more often than men get the snip.

They don't think
it's their responsibility.

I would probably personally always want
to protect myself.

I have to be responsible for my own shit.

At the end of the day,
if something did happen,

the consequences would lay on me.

And most women
around the world see the consequences

of an unplanned pregnancy as so serious,
that the choice is easy.

Which is why in the United States,

more than two-thirds of partnered women
use birth control.

It's 68% in El Salvador,

58% in Kenya,

and 80% in China.

But not everyone gets the same choices.

In 1999, it was included
in the Congressional Record.

that A. H. Robins had "conspired
in the early 1970s

to dump hundreds of thousands

of dangerous,
unsterilized contraceptive devices...

unmarketable in the United States...
into the developing world."

Those devices "were Dalkon Shields."

Loretta Ross traveled
to one of those places,

apartheid South Africa,
and shared her story.

But many women still chose to get one.

There were so few contraceptive options
available to them,

they thought that they needed
to accept the IUD

because it's what freed them up

for educational
and economic opportunities.

And I felt it was tragic.

Having a variety of options
is just as important as knowing the risks.

That's what made the Bangladesh program
so successful.

What you see in Bangladesh
is the commitment

to offer them a full range of services.

Getting a cold storage supply chain
for injectables

in a place where there are no roads
or fridges, or electricity,

that was a very big deal at that time.

And, you know,
the task of recruiting local women

to talk to women about their lives,

their needs, their desires,
their aspirations,

was a pretty big commitment.

One thing we
in the women's health movement

have never insisted upon

is a perfect contraceptive with no risk.

because every time you put something
in your body,

you're changing something.

What we ask is fully informed consent.

We need to determine for ourselves

what risk we're willing to undertake
or not.

Not have someone determine that for us,
regardless of risk.