The connection between birth control pills and sex drive
The connection between the birth control pill and sexual desire has been complicated from the beginning.
The pill is known to have sparked a sexual revolution, and yet for some, the cocktail of hormones that prevents pregnancy can also dampen libido.
“For a minority of women, oral contraceptive pills can cause very significant sexual dysfunction,” says Dr. Andrew Goldstein, a gynecologist and former president of the International Society for the Study of Women's Sexual Health.
a ten years agoresearchers analyzed 36 studies on the side effects of the combined hormonal contraceptive pill (which contains both estrogen and progestin). They found that 15 percent of the 13,700 women surveyed reported that their libido had decreased during the time they were on the pill. In the years since, only a few studies have investigated why this might be so, and these have not resulted in a clear consensus – especially when it comes to different versions of the pill, which contain different doses of hormones.
But what is clear is that the pill lowers users' circulating testosterone levels, which researchers say is the crucial link to sexual desire.
Reduced libido isn't recognized in the pill's safety leaflets, and many primary care doctors or gynecologists aren't aware it could be a problem either, said Dr. Goldstein – so when women do tell healthcare providers, they are often told: It can't be the pill.”
Waning desire
A loss of sexual desire can manifest itself in different ways, said Dr. Lauren Streicher, clinical professor of obstetrics and gynecology at Northwestern University. Anecdotally, Dr. Streicher has found that some women may feel changes in their libido within weeks of starting the pill, while research has shown that for others it may take months or years for a change to occur. For some, it can start with the loss of the spontaneous desire for sex and then progress to a lack of arousal in response to stimuli, she said.
One 2016 study randomly assigned 340 women to take the contraceptive pill or a placebo for three months to measure how this affected sexual function overall. The researchers measured blood levels of certain hormones and used a survey to determine how many sexual encounters participants had, and whether factors such as desire, arousal, orgasm, pleasure and self-image had changed. Although the pill did not affect overall sexual function, which was measured by adding the score from the survey results, the study found that the pill did have a negative effect on desire, arousal and pleasure.
Dryness and pain
The pill has also been linked to decreased lubrication, which can make sex painful and thus affect libido, said Dr. Goldstein.
And some people who take the pill develop a condition called ' hormonally mediated vestibulodynia, in which the tissues at the opening to the vagina become dry, painful and “very pale,” said Dr. Streicher. a Study from 2002 found that those who used oral contraceptives were more likely to develop these physical symptoms than those who did not use the pill, although the overall risk remains low.
“If someone has vestibulodynia, he or she will lose libido,” said Dr. Streicher, adding, “If your vagina hurts like hell, your brain will say, 'I don't want to do this.'”
The likely culprit
Combined birth control pills reduce the amount of testosterone in the bloodstream in two ways, said Dr. Goldstein: They suppress testosterone production and increase production of a protein that attaches to testosterone in the bloodstream and makes it inactive. Low free testosterone is believed to be a cause of low libido, decreased lubrication, and vestibulodynia.
Genetic differences mean that some people need more free testosterone than others to activate their hormone receptors. A drop in testosterone levels can therefore have a noticeable impact on them.
“The pill may have certain effects for some people and not for others,” said Dr. Caroline Moreau, associate professor in the Department of Population, Family and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health. “Understanding who is more sensitive and who are the people who may develop adverse side effects is something that we are missing for now.” She added that it is difficult to directly link biological markers, such as testosterone levels, to sexual functioning, which can be affected by stress, relationship dynamics or other circumstances.
Solutions within reach
For the subset of women who have these negative experiences with the pill, the effects are reversible, said Dr. Streicher. Although people's needs vary, the first step is often to explore alternative birth control options, especially non-hormonal options such as the copper IUD.
Women who experience a loss of libido can regain their desire almost immediately after switching to another form of birth control, she said. “People will come off the pill and in a few weeks they'll say, 'I'm doing so much better now.'”
They will also produce lubrication again over time, said Dr. Goldstein.
And for people with vestibulodynia, testosterone and estrogen creams can help revive tissue in the vaginal area, said Dr. Streicher.
“It's rare that a doctor who sees complex patients can say, 'I can make you better,'” she added, but when it comes to the birth control pill's effects on sexual desire, “we can help. ”