Friday Flashback: Is The Pill Killing Her Sex Drive?

This is a tricky issue because all the needed science hasn’t been done. I’m not one of those who thinks “Big Pharm” is out to get us all, but there is no doubt that drug companies, and a lot of others, don’t want this to be true – and if it is true, they don’t really want the word to get out.

Complaints of the pill killing sex drive have been around as long as the pill has, but the claims have been dismissed as anecdotal. Some respond by pointing out that some women have more sex when they go on the pill. An initial increase in sex is likely because sex is easier and there is less concern about birth control failing – this increase in sex has nothing to do with the pill changing the body or the mind, it is a simple matter of one less hurdle to being sexual. The reality is many of the women who have more sex at first will later complain of loss of sex drive. Others will point out that going off the pill rarely results in a significant increase in sex drive. This is true, but it turns out it’s not proof the pill is innocent, but rather evidence that what the pill does may be far worse than previously imagined.

The science below is from a well-done study that was released January 2006(1) .

The pill changes a woman’s hormones. Given that our hormones directly and indirectly affect our minds and our bodies, it’s easy to see how this could impact sexuality. The pill does several things that harm a woman’s ability to want or enjoy sex. Firstly, the pill reduces production of testosterone by the ovaries. While it’s true that testosterone alone does not drive a woman sexually, it is part of the equation, and when testosterone is reduced it often harms a woman’s libido. The second way the pill affects a woman’s sexuality is by increasing the liver’s production of sex hormone binding globulin (SHBG). SHBG is a protein that attaches to free testosterone in the bloodstream. This locks the testosterone up, making it unavailable for the body to use. Therefore, in addition to having less total testosterone, much of what is left is inactive. Thirdly, the pill contains progesterone – a hormone known to reduce sex drive. A rise in progesterone after ovulation is why most women’s sex drive drops suddenly and strongly at mid cycle. A drop in progesterone shortly before menstruation means some women have a drive boost shortly before their period starts.

So if it’s hurting her sex drive, she just stops using it and everything is fine, right?  Sadly not. In studies of SHBG levels women on the pill had four times the levels of women who never took the pill; however, women who had stopped taking the pill had SHBG levels twice as high as those who never took the pill. So yes, there was an improvement, but the women didn’t return to pre-pill levels. The study only looked at women off the pill less than a year, so it’s not known if levels of SHBG eventually drop to normal. Some doctors and researchers think the body may be permanently changed. At least one research group is looking for a way to reverse this change.

Currently, more is unknown that known. We don’t know how widespread, how serious, or how long-term the pill’s damage to sex drive is. We do know that for at least some women it’s very bad, and the best current research suggests that every woman should experience some sex drive loss from the pill. I don’t mean to be an alarmist, and I’m not giving medical advice here, but I think any couple using the pill for contraception should know the facts – or at least the facts we have.

1 Impact of Oral Contraceptives on Sex Hormone Binding Globulin and Androgen Levels: A Retrospective Study in Women with Sexual Dysfunction J Sex Med. 2006 Jan;3(1):104-13. Abstract
More information: Birth Control Controlling Your Sex Drive?

[This post first appeared February 27, 2010.]

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