When your sex drive is sputtering, you may want to take a closer look at several factors in your life.
In fact, it's natural for people to ask: Is the loss of sexual desire due directly to taking the birth control pill? The answer to this question - which has been asked for more than 40 years, since the oral contraceptive was introduced - may now be less murky, according to researchers at the Ohio State University Medical Center.
Dr. Jonathan Schaffir, an obstetrician and gynecologist with the medical center, reviewed more than 25 years' worth of studies, examining the relationship between oral contraceptives and libido, and concluded that the pill has little, if any, effect on a woman's sex drive. His study was published in a recent issue of the Journal of Sex & Marital Therapy.
The issue has roots in the early forms of the pill, developed in the 1960s, which often contained high levels of estrogens and progestins - many times as much as 80 to 150 micrograms in single doses. The makeup of birth control pills caused many women to become bloated, feel breast tenderness or experience nausea.
'These side effects could easily have caused women to feel extremely uncomfortable, translating into decreased libido,' noted Schaffir. 'Also much less was known about the human sexual response at that time, which could have led to information based on opinion and not on fact.'
Schaffir made a critical assessment of the published information, to see if there is a way to predict whether certain types of hormonal contraception - or certain segments of the population - are more prone to changes in libido.
Schaffir noted that some women, indeed, experience a change in libido while taking oral contraceptives, but he could find no predictable patterns for this in the literature.
When looking for a consistent biological effect of hormonal contraception on sexual desire, androgens would probably be the factor most suspected to play a role, said Schaffir. 'It was shown that the birth control pill decreased the concentration of free androgens, including testosterone, but that doesn't necessarily translate to a loss of libido. Chemical changes occurred, but they did not apparently impact sexual behavior for the vast majority of women,' he said.
Similarly, the effect of progestin on women's sexual desire was not dramatic. 'A small minority of all the users of progestin were actually bothered by a low libido,' said Schaffir.
Based on his review of studies dating from 1975 to 2004, Schaffir found that only a small minority of oral contraceptive users experienced a negative effect on sexuality. Furthermore, he found no reliable predictor of a negative effect in those who experienced such side effects.
'Studies showed that it was a problem for a small number of women using birth control pills to experience decreased libido, but it didn't happen predictably in any specific sub-population, or with any particular type of hormonal contraception,' said Schaffir. 'In fact, changes in sexual desire could as likely represent a combination of biological, psychological and social phenomena as any hormonal effect.
'The available literature illustrated that decreased libido is an idiosyncratic, unpredictable reaction in a small minority of women,' stated Schaffir.
Schaffir reassured patients and clinicians that women should continue to use oral contraceptives without fear of an adverse effect on libido. 'Don't let such fear factor into your decision of whether to take hormonal birth control pills,' said Schaffir.
If you are experiencing a diminishing sex drive, you may want to ask yourself:
• Have you recently started taking a medication?
There are some medications that are known to interfere with libido, and antidepressants are probably the most notorious group, said Schaffir. You may want to consult your physician, because stopping or changing the medication could be effective, he said. Schaffir and other researchers at Ohio State are part of ongoing FDA phase II and phase III trials, involving hormonal and non-hormonal medications that some day may directly improve sexual drive, noted Schaffir. But currently there is no one pill that you can take for a lack of libido.
• Have you recently had increased tensions or stresses in your sexual relationship?
The only thing that to this point has been consistently effective in treating low libido is sex therapy, or couples therapy, in which you talk with a counselor about a relationship or discuss sexual goals, noted Schaffir. This emphasizes the fact that such a difficulty is probably many times psychological, and not just biological, he said.