Taking the Pill May Clash With Cupid
Forty years ago, the birth-control pill freed women from fear of pregnancy and gave them the ability to engage in spontaneous, uninterrupted sexual intercourse. So it is somewhat ironic that recent research has found that for a minority of women, the pill has the unintended and surprising effect of diminishing sexual desire.
According to a review of research on the adverse behavioral effects of oral contraceptives published recently in the journal Medical Aspects of Human Sexuality, nearly a third of American women who begin using oral contraceptives stop within three months.
Review author Cynthia Graham of the Kinsey Institute for Research in Sex, Gender and Reproduction, said that among the reasons women say they stop taking the pill are dampened sexual interest, emotional volatility, physical side effects, forgetting to take the pill and the end of a relationship.
“There is this long-held assumption in the medical literature that the pill will increase sexual desire,” said Graham, a clinical assistant professor of gender studies and psychiatry, who has been investigating the behavioral side effects of the pill since the early 1990s. “But there is a subgroup of women who experience these negative sexual side effects, and we think that we should find out why that is.”
Research into the adverse sexual side effects of the pill has been greatly neglected, said Graham. “When one considers the millions of women who take the pill worldwide and the fact that the pill has been around for four decades, it is outrageous. In contrast, there is already research being done on possible side effects of the male contraceptive pill, which is still in the developmental phase.”
With a paucity of data, Graham and other researchers claim there is no way to predict which women are likely to be more susceptible to the pill’s adverse effects on mood and sexuality, or which oral contraceptive formulas might bear more responsibility for the negative effects.
“We couldn’t find any good demographic predictors such as mood before starting the pill or sexual experience variables,” said Graham. In another study published a year ago in the journal Contraception, Kinsey Institute researchers found that the best predictors of discontinuation of oral contraception among 80 women (who were 18 years and older and in committed, sexually active relationships) was dampened sexual interest and an increase in emotional volatility. About 87% of the women who stopped taking oral contraception did so reportedly because of a decrease in spontaneous sexual thoughts, less frequent intercourse, difficulties with sexual arousal and negative mood change, according to the study.
Researchers have had a difficult time teasing out whether the effect is due to pill-induced hormonal fluctuations or because of emotional volatility. “We looked at the relationship between mood and sexuality in an earlier paper and it’s not that the two are not related but they do seem to be separable,” said Graham.
To find out how oral contraceptives might be affecting the mood and sexuality of women, a 1995 double-blind, placebo-controlled study examined the effects of low-dose oral contraceptives on 150 women living in two different countries. Half of the women lived in the Philippines, and the other half in Scotland. The women had been sterilized or had partners who’d had vasectomies. Women were assigned either a placebo, or a combined oral contraceptive (which contains synthetic estrogen and synthetic progesterone) or a progesterone-only contraceptive (which contains only synthetic progesterone, less commonly used).
The women took the pill for four months, during which behavioral effects were assessed through self-ratings of sexual function (frequency of sex, spontaneous sexual desire and enjoyment of sexual activity), and responded to surveys about the quality of their marriage and questionnaires about their mood and menstrual cycle.
Twelve of the 25 Scottish women taking the combined oral contraceptive reported reduced sexual interest and less frequent sex, according to the study. But the combined oral contraceptive did not have the same effect on the Filipino women. There were no adverse effects on mood or sexuality among any of the women taking the progesterone-only pill.
Researchers explain that differences in behavioral effects might be related to the different ways the two groups of women felt about sexual relationships, generally.
In baseline assessments taken by the researchers before the women started taking the pills, the majority of Scottish women described initiating lovemaking, feeling close and comfortable with their mate, maintaining high sexual interest and generally enjoying sexual activity. Conversely, the Filipino women were less likely to initiate sex, had less sexual interest and felt less close and less comfortable with partners during sexual relationships before taking the pill.
“The [Filipino] women did not become more sexual when on the pill,” said Graham, who added that cultural differences likely had an impact. “There was no evidence of a positive effect on their sexuality. They didn’t have much scope from the baseline for a negative effect to be found. We were also looking at a different cultural group, and the women said it was hard to talk about the subject of sex with the interviewers.”
It has long been believed that progestogens have a negative effect on sexual interest, said Graham. For example, synthetic progesterones are used to treat sexual offenders, she said.
It is possible that the combined-oral contraceptives impact on sexual interest may have something to do with a reduction of testosterone, which is often assumed to be the main hormone correlated with maintaining a healthy libido in women as well as men.
But it is difficult to isolate what parts of a squashed libido are due to side effects of oral contraceptives, to normal waning of sexual interest in long-term relationships or other causes. “Libido in women is very complex but with men it is like a switch,” said Dr. Andrea Rapkin, a professor of obstetrics and gynecology at UCLA School of Medicine. “I have heard this complaint about decreased sexual interest from patients on the pill.”
Researchers such as Graham hope that physicians, clinicians and women themselves will consider the pill as a possible culprit when there is loss of sexual desire. “We don’t assume that women coming to see us with complaints of decreased sexual interest are on the pill, but if you take a careful history from a woman, then adverse effects from the pill might be explored,” said Graham who is also a certified sex therapist.
“Our point is that this issue should not be ignored and that it warrants research. Clinically, I have seen women come off the pill and notice an improvement in their sexual desire. That is what drives this research, the belief that it is clinically significant.”
