By Paul & Lori Byerly
Elsewhere we have discussed the effectiveness of the pill and other forms of hormonal birth control, and which might destroy a fertilised egg and which do not. Here we would like to warn couples about the sex-related side effects of pills, patches, shots, implants and hormone rings. All forms of hormonal contraceptive alter a woman's hormones, so it is to be expected that her sexuality would be affected. It is only in the last few years that we have begun to see how significant these sexual side effects are. Getting the full story will take many years of research, and frankly it's not research that very many want to fund. What we lay out below is known to the scientific community, but most of it is not commonly shared with women considering the pill or other forms of hormonal contraceptives.
For the ease of discussion, we will talk about "the pill" here, with a section at the bottom discussing how other hormonal forms of birth control may differ. In general, the following things are true of all hormonal methods of birth control to one degree or another.
It has been known for a long time, and proven by studies as early as 2005, that the pill suppresses a woman's sex drive. Determining how much of a change is difficult since most women go on the pill to become sexual, or expecting to become sexual, or after the birth of a baby. Few women have sex with the same man for several years using another method, then go on the pill and continue to have sex with the same man. Even when a woman in an ongoing relationship goes on the pill, the ease of sex the pill provides usually means an initial increase in sex. This accounts for reports based on short term studies that say pill use increases sex. However, there is a change that can be measured, and a recent study showed that women on the pill have less sex than those not on the pill, and lower sex drives than those who have never used the pill.1
Going off the pill does not immediately return a woman's sex drive to normal. In fact, there is good reason to suspect that it takes many years, and possibly never returns to what it would be had she not used the pill. This is based on levels of sex hormone-binding globulin (SHBG) in women using the pill, women who have stopped using the pill, and women who have never used the pill. SHBG is a protein that binds to sex hormones - including testosterone. The more SHBG in a person's body, the less free testosterone in the body. One small study showed mean levels of free testosterone dropped by 69% and 89% with two formulations of one pill!2 This means less testosterone available to do the things testosterone does - which includes fuelling sex drive.
Studies show that going on the pill increases SHBG levels to four times normal. Six months after discontinuation of the pill, levels were still about double those of women who had never taken the pill.3 For the few women followed for a year, the levels did not drop between six and twelve months. It had been expected that SHBG levels would fall to normal in a few weeks; high levels a year out indicate some change in the body that has not yet been explained. The researchers hypothesised that long-term pill use could cause changes that lead to increased gene expression of SHBG. It is possible that use of the pill means life-long lower free testosterone levels, with a resultant lower sex drive.
The researchers who brought this problem to light suggested that the pill would cause a variety of sexual side effects.3 A study presented Oct 31st, 2011 found this was true.1 Women on the pill experienced less arousal, had fewer orgasms, had difficulties with lubrication, experienced decreased pleasure, and had less frequent sex than women who had never used the pill. Given that free testosterone levels do not return to normal when the pill is discontinued, we can expect these problems to persist, to some degree, long after pill use is stopped.
For women sexual attraction is determined in large part by body odour, with that determined largely by genes related to the immune system. In short, women are sexually drawn to men who have significantly different immune systems. This results in children with strong immune systems, and probably keeps women from being sexually attracted to close relatives. However, when a woman is taking the pill, this changes and she is sexually attracted to men who have immune systems similar to her own.4
The first problem here is that if a woman is attracted to a man while on the pill, she will be less attracted to him when she goes off the pill. On the other hand, if she is attracted to him while not taking the pill, starting the pill will reduce her sexual attraction to him. This means choosing a spouse while on the pill is a bad plan! It also means going on the pill after deciding to marry will reduce a woman's sexual desire for her husband, and by extension limit the couple's sex life.
A new study released October 2011 found that women who choose a partner while on the pill had less enjoyable sex than women who were not taking the pill when they choose their partner.5 The women on the pill had lower sexual satisfaction, were less attracted to their partner, had increasing sexual dissatisfaction over time, were slightly less sexually adventurous, and had fewer orgasms.
The research to date is enough to provide only a rough picture of what the pill does to a woman's sexuality. It is known that sexual feelings and expression vary a great deal from woman to woman, so we suspect the pill’s affects on sexuality will also vary from one woman to another. Among other things, it has been hypothesised that testosterone levels are more important to some women's sex drives than it is for other. This could mean some women suffer less of a drop in sex drive. However, this would not change the physical effects of testosterone, which include better lubrication and greater genital sensitivity.
A woman's mind and emotions play a significant part in her sexuality, so the pill may less negatively affect more sex positive women, women more in love, and women with more loving husbands. On the other hand, this would mean the pill would make mentally or emotionally based sexual problems even worse.
Different women focus on different parts of the genitals for sexual pleasure; some are only or primarily clitoral, while others depend more on internal structures such as the g-spot and the uterus. It is unknown how the pill affects different areas of the female sex organs, and it is possible that this could mean the pill limits some women more than others.
Also unknown is how various combinations of hormones and various amounts of those hormones act. More of the same hormone means more of a negative effect, but how much more has not been fully studied. Do some combinations do less harm, while others do more? Another unknown is how length of pill use plays out; does taking the pill for years do more harm, and/or longer term harm than taking it for a few months?
There are a number of forms of hormonal contraception on the market. In addition to pills, there are shots, implants, rings worn in the vagina, and patches applied to the skin. These use a wide array of hormones, a variety of dose strengths, and introduce the hormones into the body if different ways. It has been suggested that hormones that bypass the digestive system might have fewer or lower side effects, but this has not been proven. The non-pill methods tend to have lower levels of hormones, but whether this reduces sexual side effects, or my how much, is not known. Both anecdotal evidence and trials designed to show safety and effectiveness of non-pill devices report loss of sex drive as a side effect, but good studies have not been done on this. Our best guess, based on the limited available evidence, is that all hormonal contraceptives have long-term, possibly life long, side effects.
The pill and other forms of hormonal birth control are very effective, easy to use, and allow for sexual spontaneity in marriage. Many are compatible with the belief that life starts when sperm and egg unite. However, the research on negative sexual side effects is alarming - especially the indication that such side effects can last years or even decades after the item is no longer being used. We see use of the pill and other hormonal methods as a trade off, with the couple's sex life losing out. This is a personal decision that each couple needs to make for themselves, with as full an understanding as possible of what they are giving up if they choose to use the pill. Pill use means the wife is less sexually interested in her husband, less easily aroused, and less orgasmic. Pill use means less sex and more struggles over sexual frequency. We would not wish these things on anyone!
If you are currently on the pill: Going off the pill cuts the affect on testosterone levels in half within a week or two. It is not known if this cuts the side effects as much or as quickly, but anecdotal evidence points to sexual benefits from going off the pill. We think any couple using hormonal contraceptive should prayerfully consider whether they should continue. For other ways to prevent pregnancy, see our article on birth control.
1 Not yet published study be Nicole Smith a doctoral student in the Department of Applied Health Science in IU's School of Health, Physical Education and Recreation. Co-authors: Kristen N. Jozkowski, College of Education and Health Professions at the University of Arkansas; and Stephanie A. Sanders, IU's Kinsey Institute for Research in Sex, Gender and Reproduction, and the Department of Gender Studies in the College of Arts and Sciences.
2 The effects of oral contraceptives on androgen levels and their relevance to premenstrual mood and sexual interest: a comparison of two triphasic formulations containing norgestimate and either 35 or 25 μg of ethinyl estradiol - Contraception Journal Volume 76, Issue 1 , Pages 8-17, July 2007
4 MHC-correlated odour preferences in humans and the use of oral contraceptives. Proceedings of the Royal Society of London B.
5 Relationship satisfaction and outcome in women who meet their partner while using oral contraception. Proceedings of the Royal Society of London B.
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