"Sexual problems can have a negative impact on both quality of life and emotional well-being, regardless of age," said researcher Dr. Lisa-Maria Wallwiener of the University of Heidelberg, Germany. "FSD is a very common disorder, with an estimated prevalence of about two in five women having at least one sexual dysfunction, and the most common complaint appearing to be low desire."
"The causes of FSD are multifunctional and in recent years the possible role of hormonal contraception has been discussed," said fellow researchers Drs. Christian and Markus Wallwiener, University of Tuebingen, Germany. "Women tend to be aware that sexual dysfunction is often influenced by various factors such as stress and relationships, but our study has shown it might also be influenced by exogenous hormone application."
1,086 women were included in the study (roughly 2.5% of the overall female medical student population in Germany), who completed questionnaires designed to identify problems with sexual function, as well as other lifestyle factors including desire for children, pregnancy and whether they were smokers. 87.4% had used contraceptives in the last 6 months, and 97.3% had been sexually active within the last four weeks.
To analyse the effect of contraception on sexual function, women using multiple forms of contraception or who had not been sexually active within the last four weeks were excluded, leaving 1046 participants. Of this figure, 32.4% were considered at risk for FSD: 5.8% at high risk for hypoactive sexual desire disorder, 1% for arousal disorder, 1.2% for decreased lubrication, 8.7% for orgasm disorder, 2.6% for satisfaction problems, and 1.1% for pain.
The participants were then divided into four subgroups of oral (hormonal) contraception (OC), non-oral hormonal contraception (NOHC), nonhormonal contraception (NHC), and no contraception (NC). The group at lowest risk for FSD (highest sexual function score) was NHC (31.0), followed by NC (29.5) and OC (28.3), with NOHC (27.4) at highest risk. For desire and arousal, both OC and NOHC groups were at highest risk.
The method of contraception and smoking status were significant factors for total sexual function scores, with smokers scoring higher than non-smokers. Other factors including age, prior pregnancy, desire for children, and partnership status were not significant. Women not in stable relationships (regardless of contraception use) had higher desire but lower orgasm scores.
"In future research it would be interesting to see if there is a difference between the dosage of estrogen and the various synthetic progestins used in hormonal contraceptives in terms of an impact on female sexual function," added study researcher Dr. Harald Seeger, also of University of Tuebingen, Germany. "We would also urge some caution in interpretation of our present results and would like to highlight that this type of study cannot demonstrate causality but rather association and there might exist a multitude of factors that have an impact on female sexual function."
"This is a very important research investigation", stated Dr. Irwin Goldstein, Editor-in-Chief of the Journal of Sexual Medicine
. "There are hundreds of millions of women, in particular young women at the beginning of their sexual lives, who regularly use hormonal contraception for many years. The irony is that these women are provided a medication that enables freedom from reproductive worries but these same women are not provided information that there are significant adverse sexual effects that may ensue.
"Agents that interfere with the hormonal milieu of women may adversely affect their sexual lives"