April 12, 2012

Q&A: Oral Contraceptives & Sex Drive

It is true that hormonal contraception has been linked with low desire among women.

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condom and birth control pills

condom and birth control pills

Question: I’m a 22 year old woman, and have almost entirely lost my sex drive. I am in the mood for sex perhaps once every two months, and even then it takes me a long time to get my body into a state of arousal. My low sex drive is causing me to fear intimacy (because it could lead to sex, which feels like a dreaded, somewhat painful chore), which is destroying my relationship. I had read that oral contraceptives are increasingly being shown to have a negative impact on sex drive in studies. I have my annual GYN exam soon and am wondering what other options might work for us – condoms are not an option for my boyfriend for very real reasons. What can we do?

We get some version of this question regularly, which basically boils down to: is it true that oral contraceptives (the birth control pill) and other hormonal birth control are linked to low desire among women? And if so, what other options are available for couples who want to have sex but don’t want to become pregnant?

Sexual Side Effects

First, it is true that hormonal contraception has been linked with low desire among women.

That said, we need significantly more research to understand the why and the how and whether there are certain brands of birth control pills (or other types of hormonal contraceptives) that are less likely to cause sexual side effects than others.

There isn’t much funding available for this type of research—which is a shame given how many couples it impacts.

Some Options For You

Condoms are an option for many couples, but some—like you two—don’t feel they’re a good option for you. If size is an issue, you two might consider looking for smaller or larger sized condoms that will be comfortable for him.

If he’s had emotionally difficult experiences related to condom use (say, perhaps he was molested as a child and the sexual experiences involved an adult man who was wearing a condom) he may find it helpful to meet with a counselor or therapist to talk about any issues that are currently interfering with his life.

Intrauterine devices (IUD) are an option. While there are hormonal IUDs available there is also a non-hormonal IUD available and you may find it helpful to talk with your healthcare provider about the IUD as an option. It’s more expensive in the short-term but if you’re not planning to become pregnant for a long time, if ever, it may be a very good option to consider.

If your boyfriend can reliably—and I mean, VERY reliably—ejaculate when he wants to and hold off until he’s ready (i.e., if he can easily control the timing of his ejaculation) then withdrawal (“pulling out”) is another option to consider. It’s less effective that hormonal birth control but it’s more effective at preventing pregnancy than many people believe.

 Go Natural

Various natural family planning methods are yet another option that may interest you. They don’t involve taking hormones; however, they’re most effective when health educators and/or nurses or doctors walk you through the most reliable ways to tell when you are likely to conceive and when you are very unlikely to conceive.

True, it means that some days of the month may be days you decide to skip sex so as not to become pregnant but frankly it sounds like right now there are far more days that you’re skipping, or rather avoiding, sex because of your feelings related to low desire.

Finally, although low desire is not necessarily “in your head”, you expressed ways that this frustrates you and is getting in the way of your relationship. This can become a difficult cycle, full of challenging relationship dynamics. Meeting with a sex counselor or therapist may be helpful. You can find one through sstarnet.org.

Next Question: Chlamydia From A Bikini Wax? Chlamydia Risk And Transmission

I had a yearly exam in January, then started getting bikini waxes. I noticed some strange things going on down south so I got another exam in June. After the exam, the doctor called to tell me that I had chlamydia and to warn me about having unprotected sex. I only had protected sex between the January and June exams. Between the two exams, I had 3 partners, all with condoms. All three claim that they have gotten tested and that they don’t have chlamydia. Is it possible to get chlamydia from a bikini wax?

Read Dr. Debby Herbenick’s response.

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