Decreased Sexual Desire and "The Pill"

>> Wednesday, July 6, 2011

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This week Carla sent in this question: “Dr. KnowYourV, I’m worried and so is my husband because since I started taking birth control pills it seems like my sexual desire has decreased a lot. I have talked to other friends of mine and they said they felt the same, which made me feel a little better, but it is still bothering my husband. I don’t know if I should continue with them or change to something different. Is it hurting my body and is it permanent? Please can you help me?”

Hypoactive sexual desire disorder has been defined as a persistent or recurrent aversion to or absence of sexual fantasies, thoughts, or desire for sexual activity, which causes distress for the person experiencing it. It was previously thought that this was experienced most commonly by pre- and post-menopausal women due to expected hormone changes. Now, we know that women of any age can have an imbalance of hormones that can cause sexual dysfunction.

Oral contraceptive (OC) methods work by regulating a woman’s hormones in such a way that both follicular stimulating hormone (FSH) and luteinizing hormone (LH) are suppressed. This prevents the normal stimulation of ovarian tissue preventing the maturation of eggs therefore preventing ovulation.

So, OCs are a combination of estrogen and progesterone designed to mimic the menstrual cycle, but maintain a balance so ovulation is stopped. There are good side effects from this like reduced PMS, clearing of the complexion, reduction of migraines, menstrual cramps, shortened number of days bleeding, and less blood flow with periods. In regards to sexual desire, it can be because of this balancing of hormones and the lack of ovulation that many women feel decreases their sexual desire. Perhaps this is true because so many of us feel a welcome increase in sexual desire during ovulation.

We know from current research and studies in women that sexual function is also linked to androgen levels (testosterone) and decreased libido is linked to androgen insufficiency. The symptoms of androgen insufficiency include diminished sense of well-being, dysphoric mood, fatigue, and decreased libido and sexual pleasure. In a recent review OCs were considered among the top drug-related causes of androgen insufficiency in women. It is the hormone manipulation of estrogen and progesterone, causing the suppression of follicular stimulating hormone (FSH) and luteinizing hormone (LH) surges that have a direct effect of reducing testosterone levels. Women on OCs have lower levels of free and total testosterone when compared with women who do not take OCs.

Hypoactive sexual desire or sexual dysfunction can be present in over 50% of women even when oral contraceptive pills (OCs) are not involved. Many of you reading this are too young to remember Masters and Johnson’s ground breaking work in the 1950’s and Kinsey’s work in the 1960’s that were the first ever to describe the components of normal sexual activity. We have come a long way since then and currently attention is being focused on the study of sexual dysfunction in women. FINALLY!!! It is about time women’s health becomes a priority.

The good news is women can add back testosterone without affecting “the pill’s” ability to prevent pregnancy. More studies are being done, as it seems libido is affected by the progestin component of “the pill” and this may be an easy fix. Meanwhile, talk with your doctor as this can be more involved and complicated requiring you to have blood drawn for laboratory evaluation and further testing. You may also want to discuss alternative types of contraception or androgen/testosterone add back therapy.

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