Sex Drive and Birth Control

Sex Drive and Birth Control -- Debra Wickman, MD -- 03/16/04

By Debra Wickman, MD, FACOG
WebMD Live Events Transcript

Lost your libido? A lot of factors play into your sex drive, but you may have overlooked one potential culprit: your birth control. Is your contraceptive keeping you from getting pregnant in a way you didn't expect? We discussed birth control's effects on desire with sexual health expert Debra Wickman, MD, from the Female Sexual Medicine Center at UCLA.

The opinions expressed herein are the guest's alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Member question: What effects can birth control have in a woman's sexual life and can birth control effect a woman's emotions?

Wickman: We have found a definite connection between hormonal contraception and sexual dysfunction. In fact, we have been doing a research study on this issue over the past year. Specifically, this issue affects a small subgroup of birth control pill users; we estimate between 5% and 10%, so not everyone is going to have this problem.

We think the mechanism involved is an increase in a certain protein that binds the sexual hormones, like Testosterone and estrogen. We have found that taking oral birth control pills causes an increase in this binding protein. We have also found that stopping birth control pills causes this protein to decrease back to normal. So we feel that oral contraceptive pills are the cause of sexual dysfunction in a small subgroup of women, and some of the other methods available may be a good answer, though the research is ongoing for this.

Hormonal birth control can affect a woman's emotions either positively or negatively. In some cases women are prescribed birth control pills to decrease symptoms of PMS, and this can be effective. However, especially in this subgroup that has a negative sexual effect, this, in turn, affects the emotions and leads to a downhill spiral with respect to relationship issues. By suppressing the body's own estrogen levels, this can affect a woman's mood and can possibly worsen underlying depression. So the effect on mood is very individualized.

Member question: Does the birth control patch have more of an effect on libido than the pill?

Wickman: Our theory is the Ortho Evra patch has a more favorable effect on libido, because it does not involve metabolism in the liver or breakdown through the liver, and it is that breakdown in the liver that causes increase in that sex hormone binding protein. So we often switch people from the oral pill to this patch, hoping to make use of that effect. The patch does not seem to increase the sex hormone binding protein, and therefore does not decrease testosterone levels like the oral pill does.

Member question: I have noticed a slow but steady decline in my sexual enjoyment since taking Yasmin birth control pills. Can the anticramping ingredient in Yasmin be disrupting my sexual experience? I am aroused, lubricate, but rarely have orgasms any longer.

Wickman: This is not a surprising finding. Yasmin has some unique properties that make it attractive to many pill users; however, it is the most antiandrogenic pill. This is because the progestin, which you have referred to, does have an antitestosterone effect. This has not been formally studied; however, we see in our practice people taking Yasmin have a higher incidence of lower libido because of this antitestosterone effect. Switching to a different pill is indicated for your problem.

Member question: I am 25 years old and I am wondering if taking the same birth control pill (Ortho Tri-Cyclen) for 10 years now will interfere with my sex drive?

Wickman: This is a valid concern, and again, not everyone is affected this way. As I mentioned, it seems to be between 5% and 10% of pill users that end up with a problem. However, we commonly see extended use of birth control pills, as in greater than three to five years of use, resulting in decreased libido and related sexual problems.

It should not be ignored, however, that there are many noncontraceptive health benefits to long-term pill use, so if you are not already suffering from problems in your sex life, I don't recommend arbitrarily discontinuing use.

Member question: Would Ortho Tri-Cyclen have a lesser effect on libido than Yasmin?

Wickman: There are no official research studies comparing the two pills. However, in theory Yasmin has more antiandrogenic properties because of its unique progestin. I must say, though, that we see libido-lowering effects in many cases of Ortho Tri-Cyclen use, as well. So either pill could be the cause.

Member question: Is there a way to 'screen' for whether you might be a person whose sex drive would be affected by the pill?

Wickman: We have identified no specific screening device for this. However, there are tools that we use to diagnose red flags of underlying sexual problems that the patient may not even be aware of.

This is one thing we address in our center. We are promoting more awareness among general gynecologists and healthcare providers to be able to identify underlying factors that could predispose a person in general to problems. Hormone panels are not typically done as a screening tool for new prescriptions of birth control pills, so underlying hormone imbalances could result in a problem, but would not likely be picked up prior to pill use.

Member question: Can the low libido get normal over time of pill use?

Wickman: We have not found this to be true; however, we attempt to problem solve by switching to a non-oral hormonal contraceptive, which often works after a four-week washout period of not taking any hormones. Commonly, we supplement people with testosterone drops under the tongue if they must continue the oral contraceptive use, and this can definitely help counteract the negative effects on libido.

Member question: I went off of my birth control pills about six months ago and when I did I stopped getting my period. Now I also have about ZERO sex drive. Is this because I am not getting my period, or not on the birth control, or both? Would going back on the pill help me get my sex drive back?

Wickman: This problem can be distressing. However, there are many potential causes of amenorrhea. I recommend exploring this in person with your gynecologist.

Member question: I was recently on the NuvaRing, which put my body and mind in disarray. I am now back on the patch. How long till my system gets back to "normal?"

Wickman: This varies, depending on an individual's metabolism. However, within three months most people have normalized and adjusted to the new medication.

Member question: What effect does Depo-Provera have on sex drive, and how long does it take to return to normal after stopping the shot?

Wickman: We find drastically negative effects on libido in many Depo-Provera users, because it is so strongly suppressive of the body's own hormones, like estrogen and testosterone. The effects can be quite long lasting, and just like with return of menstruation, return of libido can take up to nine months. We therefore often supplement these patients with testosterone to hasten the recovery.

Member question: How about the progesterone-only pills? I'm breastfeeding my 6-month-old and am 24 years old.

Wickman: This is a very complicated issue, because in the postpartum period there are so many factors that negatively affect libido and overall sexual function. The main negative aspect of progesterone-only pills is that the person's estrogen levels and testosterone levels are suppressed by both the progesterone pill and the patient's own production of prolactin, which is necessary for breastfeeding.

Supplemental testosterone cannot be prescribed while the patient is breastfeeding; therefore the main treatment we provide is some localized supplemental estrogen in the vaginal area to help improve the circulation and sensitivity of the genital area. Once breastfeeding is concluded, it's recommended to return to combined contraceptive, ideally the patch or NuvaRing.

Member question: I have tried three different types of birth control pills and all three totally knocked out my sex drive. Now I am considering an IUD, but different things I have read say that the IUD may affect sex drive also. Is this true?

Wickman: It is reasonable to consider an IUD in light of that history with oral birth control pills. The IUD that is likely to have the best effect or least interference with libido is Mirena IUD. This has not been formally studied, and in fact we are in the process of designing this study comparing Mirena IUD with birth control pills, but what we have found in our patients is a favorable effect using the Mirena IUD. This method is not as good for people who have not given birth, but this has to be evaluated on an individual basis, based on the size of the uterus and medical history. So far, we have not seen a significant effect on a woman's libido when she uses Mirena IUD.

Member question: I just had the Mirena IUD inserted (I'm age 49, but not in menopause yet), and I'm wondering about decreased libido with this form of contraception. What is known about this?

Wickman: Formal studies have not yet been performed on Mirena and libido, though as I mentioned, we will be looking at that question in our center shortly. At age 49, the Mirena IUD is an excellent contraception, and we feel should have minimal effect on libido. However, at age 49 you are in a rather high-risk category for other hormone fluctuations, i.e. perimenopause that can definitely impact sexual function. If you experience this, you should have a hormone panel done and evaluation without simply blaming the IUD.

Member question: I'm 57 years young and had a hysterectomy when I was 37. Since then I've notice a decrease in sex drive. I have taken everything that my doctor recommends: patches, pills, you name it. I haven't noticed any change at all; my symptoms are dry vagina and hot flashes. Other than that, I feel and look good because I'm healthy and workout, including yoga and weights. But now that I'm pushing 60 I would like to be able to desire and enjoy sex.

Wickman: We have a multidisciplinary approach to this, and this involves a lot of trial and error, as each person is so unique. We have had some success with herbal preparations, which are nonprescription, specifically Xzite, and some success with Avlimil.

There are factors, such as genital blood flow or small nerve fiber damage that a person in your age group can be affected by, and this requires in-person evaluation to decide other ways to help. However, we find testosterone supplementation is typically an overlooked but very important part of postmenopausal hormone therapy, and you should consider this.

Member question: I have been looking into Xzite supplement to increase my wife's desire for sex but we are worried that the herbs in the supplement may affect her birth control effectiveness. Should we worry?

Wickman: This has not been directly studied; however, we have had no reports of this being a problem. In fact, I have not seen Xzite react negatively with any medications our patients are already taking.

Moderator: Do you have any final words for us, Dr. Wickman?

Wickman: The field of women's sexual function is a new and exciting area and there are many questions yet to answer. We provide individual evaluation and therapy to patients who come to Los Angeles; however, we also make phone consultations for people who cannot make the trip. We are happy to problem solve and make recommendations by phone for those who desire it. These appointments can be scheduled by calling the Female Sexual Medicine Center at UCLA, at (310) 794-3030.

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