Soon after the first oral contraceptive was approved in 1960, The Pill quickly became one of the world’s most popular birth control methods. More than 100 million women worldwide have used it, and among American women age 18 to 44, The Pill has been used by a whopping 82 percent.

Oral contraceptives have been the subject of more than 44,000 research publications, but fewer than 100—one-quarter of 1 percent—have dealt with its effects on women’s sexuality. The findings of those reports have been all over the map. Some show increased erotic interest, better sexual functioning, and greater sexual satisfaction. Others show the opposite—libido loss and sexual impairment. And some show no sexual effects at all.

This post summarizes the current confusion and suggests ways women might deal with it.

How The Pill Works

Birth control pills contain a combination of two female sex hormones, estrogen and progesterone (progestin). Formulations vary and over the past 50 years, dosages have diminished, but whatever the brand, the hormones in the Pill tinker with women’s pituitary hormones to suppress ovulation.

In addition, oral contraceptives decrease ovarian production of androgens, the female form of testosterone, which kindles sexual desire. This suggests that the Pill might suppress women’s libido. But most women produce more androgens than necessary for fully functional sexuality, so despite Pill-induced suppression, most women still synthesize enough androgens to maintain libido and sexuality.

Potentially Sex-Enhancing Effects

The Pill has many effects that may increase erotic interest and improve sexual function:

• Effective contraception. The Pill gives women total control over their reproduction, virtually eliminating anxieties about unintended pregnancy. This can feel freeing and boost sexual interest and energy.

• Relief from painful menstrual cramping. Monthly cramps can destroy interest in sex. By taming cramps, the Pill can restore it.

• Relief from premenstrual syndrome. The irritability, bloating, breast tenderness, and other symptoms of PMS can reduce libido and impair sexual functioning. The Pill minimizes PMS symptoms, making sex more possible and enjoyable.

• Less menstrual bleeding. Profuse bleeding can lead to iron-deficiency anemia, which saps energy, including sexual energy. The Pill reduces the volume of menstrual flow, and can restore energy.

• Suppression of endometriosis. Endometriosis causes severe menstrual cramping, pelvic pain, pain on intercourse, and other symptoms that detract from lovemaking. The Pill often relieves them.

• Reduced risk of uterine fibroids. These benign growths increase menstrual bleeding and can cause iron-deficiency anemia. The Pill makes them less likely, preserving sexual energy.

• Relief from severe acne. Severe acne destroys self-esteem, often taking sexual interest with it. The Pill is so effective at reversing this condition that three brands of birth control pills are FDA-approved treatments.

• Increased libido. Because the Pill suppresses androgens, one would think that it would reduce libido. However, some Pill-takers report greater sexual interest.

Potentially Sex-Impairing Effects

The Pill also has effects that may also impair sexual function:

• Loss of libido. Pill-induced androgen suppression can diminish or destroy erotic feelings.

• Less vaginal lubrication. Vaginal dryness can make sex less comfortable and enjoyable. Lubricants usually take care of it, but not always.

• Vulvar pain. Pill use for more than a year or two increases risk of pain during and/or after intercourse.

• Thinning of the inner vaginal lips and vaginal entrance. Erosion of this tissue can make genital play uncomfortable.

• General sexual malaise. In one of the largest studies, German researchers surveyed 1,086 women medical students, 752 of them oral contraceptive users. The Pill takers scored lower on the Female Sexual Function Index.

The Upshot

What should we make of all this? For women concerned about unintended pregnancy or plagued by severe cramps, PMS, endometriosis, fibroids, severe acne, or profuse menstrual bleeding, Pill-induced relief may well pique libido and enhance lovemaking. But for women who develop vaginal dryness, vulvar pain, thinning of the vaginal lips, or general sexual malaise, the Pill may deflate libido and impair sexual function.

This explains why some studies find sexual enhancement while others find impairment and still others find no effect. It comes down to the individual woman, her medical situation, and how she reacts. In the words of one research review: “The inconsistent, contradictory findings make a case for individual variation.”

If you’re taking the Pill or considering it:

• Understand that it can have a wide range of sexual effects.

• Be sensitive to your own reactions. Disregard friends and clinicians who say, “The Pill doesn’t do that.” On the contrary, almost any sexual effect is possible.

• Consult an expert. Family doctors can prescribe the Pill, but if you notice any changes in your sexual demeanor, you might consider consulting a family planning or Planned Parenthood clinician, who is probably more familiar with the nuances.

• Continue to focus on your reactions over time. Some of the Pill’s possible sex-impairing side effects can take a year or more to develop, for example, vulvar pain.

• If the Pill’s disadvantages for you outweigh its advantages, choose another contraceptive. With proper use, many are very reliable. A counselor at a family planning clinic or Planned Parenthood can itemize the pros and cons of all methods.

References:

Bancroft, J. and N. Sartorius. “The Effects of Oral Contraceptives on Well-Being and Sexuality,” Oxford Review of Reproductive Biology (1990) 12:57.

Battaglia, C. et al. “Sexual Behavior and Oral Contraceptives,” Journal of Sexual Medicine (2012) 9:550.

Burrows, L. J. et al. “The Effects of Hormonal Contraceptives on Female Sexuality: A Review,” Journal of Sexual Medicine (2012) 9:2213.

Caruso, S. et al. “Preliminary Study of the Effect of Four-Phasic Estradiol Valerate and Dienogest (E2V/DNG) Oral Contraceptive on the Quality of Sexual Life,” Journal of Sexual Medicine (2011) 8:2841.

Davis, A.R. and P.M. Castano, “Oral Contraceptives and Libido in Women,” Annual Review of Sex Research (2004) 15:297.

Graham, C.A. et al. “The Relationship Between Mood and Sexuality in Women Using an Oral Contaceptive as a Treatment for Premenstrual Symptoms,” Psychoneuroendocrinology (1993) 18:273.

Hatcher, R.A. et al. Contraceptive Technology. Ardent Media, NY, 2004.

Mathlouthi, N. et al. “Sexuality and Contraception: A Prospective Study of 85 Cases,” Tunisia Medicine (2013) 91:179.

Pastor, Z. et al. “The Influence of Combined Oral Contraception on Female Sexual Desire: A Systematic Review,” European Journal of Contraception and Reproductive Health Care (2013) 18:27.

Schaffir, J. et al. “Oral Contraceptives Vs. Injectable Progestin in Their Effect on Sexual Behavior,” American Journal of Obstetrics and Gynecology (2010) 203:545.

Schaffir, J. “Hormonal Contraception and Sexual Desire: A Critical Review,” Journal of Sex and Marital Therapy (2006) 32:305.

Strufaldi, R. et al. “Effects of Two Combined Hormonal Contraceptives with the Same Composition and Different Doses on Female Sexual Function and Plasma Androgen Levels,” Contraception (2010) 82:147.

Wallwiener, M. et al. “Effects of Sex Hormones and Oral Contraceptives on Female Sexual Function Score: A Study of German Medical Students,” Contraception (2010) 82:155.

Wallwiener, M. et al. “Prevalence of Sexual Dysfunction and Impact of Contraception in Female German Medical Students,” Journal of Sexual Medicine (2010) 7:2139.

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