Do oral contraceptives diminish libido?

Published:

Dr. Myrtle,

Is it true that birth control pills take away sexual drive?


Oral contraceptive use is common.

Over 30 million women choose to prevent pregnancy in the US.

  • The leading choice (37%) for contraception is hormonal control of ovulation (“the pill”--oral contraceptives, injections, patches & implants).
  • Non-reversible surgical sterilization (female and male) are used by 36%.
  • On-demand barrier methods (male & female condoms) are used by 18%.

What is the relationship between hormonal contraceptives and libido?

Studies evaluating a relationship between hormonal contraceptives and possible effect on sexual desire have been mixed. This is because sexual desire (libido) is multi-factorial, with three main contributors:

  • Social (relationships, availability of partners, privacy)
  • Psychological (personal attitudes, personal experiences, reaction to cultural beliefs)
  • Physical (physical pain, ability to achieve arousal, hormonal status)

Dysfunction in any or all of these areas can cause depressed sexual desire. Yet studies of the relationship between libido and contraceptive use have never distinguished between these different contributors to libido. The consequence of this faulty understanding has been a blended hodge-podge of risk-factors in research studies, leading to the overwhelming conclusion that there is no effect.

No Effect? You say “high”, I say “low.”

Consider the following likely scenario: Imagine that a group of women contraceptive-users is asked about their libido.

  • Some women, who use hormonal contraception, prevent pregnancy in a behavior that is well removed from the behavior of sexual activity. They take a pill, slap on a patch, or get an injection well away from the moment that they are sexually involved. The consequence of this would be to “increase spontaneity”, but “allow for pregnancy prevention” unrelated to the desires of their partner. These women might report a boost in their perception of sexual desire.
  • Other women, who have a prolonged depression of their sex steroids due to hormonal manipulation, might suffer physically from the effects of low testosterone. Low available testosterone levels cause known side-effects of muscle aches, fatigue, depressed mood, etc. These women might report suppression in their perception of sexual desire.

Both groups experienced a change, but in opposite directions. Add the results of group one with group two, and you get “no change” because they’ll statistically cancel each other out.

Evidence of Prolonged Testosterone Suppression

Some researchers believe that the persistent elevation in “Sex Hormone Binding Globulin” or SHBG after discontinuation of oral contraceptives leaves the woman in a persistent state of "low hormones", specifically referring to the removal of available testosterone from her blood stream. Several aspects of this are very concerning:

  • The suppression has been shown to continue for up to 11 months after the hormonal manipulation is stopped.
  • Women are trying to prevent pregnancy, not change hormonal blood levels of non-reproductive hormones.
  • Women are not informed of this possible risk, nor the potential for the duration of effect.

Preserving Libido & Making Informed Choices

However, because libido has multiple contributors, it is not the case that every woman should stop using hormonal pregnancy prevention. Each woman should evaluate her specific risks and benefits.

  • Women who use hormonal manipulation who also notice a depression of sexual desire or energy need to consider whether stopping will bring a higher quality of life.
  • Women need to understand that it may take months after stopping before they notice an improvement in their mood, energy and libido.
  • Women who may be prone to decreased libido need to consider their options before using hormonal manipulation. The state of current research is such that it is not known how prolonged the effect is.
  • Women who use hormonal manipulation to prevent pregnancy are already at higher risk of short-term (curable sexually transmitted infections) and long-term problems (cancer, blood clots, heart attacks, stroke, and incurable sexually transmitted infections). Is this potential change in libido the additional factor which would lead her to make different choices?

Barriers Are Good Sexy Choices

For women who want to avoid unnecessary complications yet still protect themselves reversibly from pregnancy, sexual barriers are their best option.

Sexual barriers:

  • Are on-demand. You don’t need to use them when you aren’t being sexual.
  • Have no long-term, irreversible effects.
  • Prevent transmission of sexually transmitted infections.
  • Have male and female options. Women can be in control of their barrier protection.
  • Reduce the potential interactions between medications and hormone systems in your body.
  • Have no associated increased risk of cancer.
  • Reduce cervical cancer risks.

Take Care,

Dr. Myrtle

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