What happens when the thing that is supposed to help you have more care-free sex actually disrupts your sex life, messes with your sexual function, and steals your sexual desire or even your ability to orgasm?
Birth control has been a great invention that allowed women, for the first time, to control whether they wanted to have children in the near future or not. This allowed women to leave the household, get an education and contribute to society. It also helped to alleviate the anxiety around getting pregnant so that they can focus on the important part – enjoying sex.
But sometimes birth control can not only interrupt your usual sexual functioning but it can actually lead to female sexual dysfunction.
Has this ever happened to you?
When does a problem with sexual function become female sexual dysfunction (FSD)?
FSD is a group of sexual problems that women (or vulva owners for the sake of this post) may have, which includes: a lack of sexual desire, impaired arousal and lubrication, inability to achieve orgasm, or pain with sexual activity. These problems can be present from the onset of sexual activity or develop later after a period of normal sexual function.
The key point to make here is that this sexual problem is PERSISTENT or RECURRENT, and it causes SIGNIFICANT DISTRESS and INTERPERSONAL DIFFICULTIES for the woman. This is not just a minor inconvenience.
Just to be clear, this would mean that people who are asexual, or have no desire for a sexual relationship, do not have FSD because it is not causing them significant distress.
According to a few epidemiological studies, the prevalence of female sexual dysfunction can range from 27% to 70%!
The problem with FSD is that it is so complex and the causes of it are so multi-factorial.
Sexual function can be influenced by biological, psychological and social factors. Biological factors may include certain medical conditions and medications, like contraceptives, which is what we are talking about today.
But we shouldn’t forget the importance of psychological and social factors which may include mental health issues, like depression or anxiety, stress, previous sexual trauma and relationship conflict.
Female sexual function is assessed with the Female Sexual Function Index (FSFI) and a score is given. This is how we measure the level of sexual functioning and whether there has been any change over time. It evaluates six domains including: sexual desire, subjective arousal, lubrication, orgasm, sexual satisfaction and dyspareunia (the fancy word for painful sex).
Do birth control pills affect sexual functioning?
There have been far more studies about sexual function with birth control pills or oral contraceptives, compared to the other contraceptive methods available. And while there are many different types of contraceptive methods available, oral contraceptive pills (OCPs) and the IUD are the most common in developed countries.
Surprisingly, studies have shown mixed results when it comes to sexual function with OCP use. Some studies show that OCP use has a negative effect on sexual functioning, while others show a neutral or even positive effect on sexual functioning.
What do we do with this information?
What we can do is break down those studies and provide an informal sort of guideline, finding which OCPs in particular are a safer bet for maintaining sexual functioning.
Which types of birth control pills are better for sexual function?
According to studies done comparing different OCPs, the following hormonal combinations with ethinylestradiol (EE) have shown some promise to be good choices for women who may have developed an impairment in sexual functioning after trying a certain type of OCP, or are worried about OCPs disrupting their normal sexual functioning:
- EE 20ug/Drosperinone 3mg – Brand name: Yaz
- EE 30ug/Drosperinone 3mg – Brand name: Yasmin
- EE 30ug/Gestodene 75ug – Brand name: Minulette/Femodene ED
- EE 20ug/Levonorgestrel 100ug – Brand name: Loette/Meliane
It’s important to remember that everyone is different. This means that what might work for one person, may not work for another. So it is important to speak to your healthcare provider about changing your type of OCP if you feel it is not working well for you.
There was actually a study done in Thailand investigating the effects of Yasmin and Meliane on sexual function, and they actually found significant improvements in the domains of sexual desire, arousal, sexual satisfaction and orgasm. This may be worth investigating further.
But how do OCPs ACTUALLY affect sexual functioning at the biological level?
Unfortunately, the answer is: we are still not sure.
A huge problem we face is that the endocrinology (or hormonal control) of female sexual function still hasn’t been studied adequately. The studies still remain scarce and underfunded.
One potential mechanism for the reduction in libido or sexual desire when taking OCPs is the oestrogen-induced increase in sex hormone-binding globulin or SHBG. These raised levels of SHBG bind to free circulating testosterone in the blood, which is the active form of testosterone in the body, thus making the testosterone inactive.
In addition, OCPs inhibit the production of androgens (like testosterone) in the ovaries and adrenal glands. This further reduced level of active testosterone in the blood.
This theory is based on the fact that certain women respond to testosterone treatment when they have hypoactive sexual desire disorder – or lack of sexual desire.
Another mechanism whereby OCPs may affect sexual function is the direct negative effect that the progestin component can have on the brain. But this still needs to be studied further.
What about the copper-IUD?
The copper-IUD or copper loop has also been studied with regards to sexual function. It was found that the only domain of sexual function that was significantly affected was the domain of sexual pain.
It is thought that the presence of a copper-IUD causing sexual pain may lead to a decrease in arousal, lubrication and orgasm; which may then lead to further sexual pain, leading to a vicious cycle of sexual pain and impairment in sexual function.
As for the Mirena-IUS, a small study done in Poland found that the did not influence sexual functioning in the majority of women.
Before starting any form of contraceptive method, it is important to discuss your sexual functioning with your healthcare provider. This level of functioning needs to be evaluated again soon after starting your chosen method of contraception; later on, to determine whether there has been a significant impact on sexual functioning; and whether we need to consider changing the method used altogether.
This is the only way to determine whether it is the contraceptive method in question causing the problem.
General side effects of hormonal contraception are well known, but research on the effects of hormonal contraception on sexual functioning remains underfunded. We know that hormones such as oestrogen, progesterone and testosterone play a role in sexual function but their effects need to be studied further.
It is worth noting that despite over 50 years of use, there is still no way to accurately predict which women are more likely to experience impaired sexual functioning or which formulations are more responsible. In contrast, studies on the male contraceptive pill, although still in the development phase, have already included a full evaluation of the possible sexual side effects.
What we can do at this stage is single out and recommend the few types of OCP that have been shown to have fewer sexual side effects compared to others.
If you have developed any disruption in your sexual functioning due to one type of OCP, consider changing to another type, such as Yaz, Yasmin, Minulette/Femodene ED, or Loette/Meliane.
Did you find this helpful? Let me know in the comments! I’d love to know!
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