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I’ve said it before and I’ll say it again – pelvic pain isn’t in your head, it’s in your muscles.

But could it also be in your birth control?

That’s one of many questions a team of scientists from the European Society of Sexual Medicine set out to answer recently by taking a comprehensive look at the current body of research on how hormonal contraception can affect female sexuality.

Sadly, the first takeaway is no surprise. We need more research – a lot more. And of all the different facets of female sexuality they examined, pelvic floor and urological symptoms got the least attention from the scientific community.

But here’s what they do know for sure. Your “hormonal status influences all the tissues in the pelvic region, including bladder, urethra, and muscles”. And the limited amount of research available suggests that certain kinds of hormonal birth control leave women at increased risk of painful bladder syndrome, urinary incontinence, pelvic floor inflammation, and frequent UTIs. They can also decrease lubrication – a factor in painful sex that also contributes to a number of more serious conditions like vulvar vestibulitis or vulvovaginal atrophy.

But don’t ditch your pills, or rush to get your implant removed just yet. If your birth control method is working well for you and your partner, stick with it. If it isn’t – the right mindset and the right specialists can help.

If you’re contemplating making a switch, these three steps can make a big difference.

Treat the pain first. If you’re experiencing pelvic pain or urinary incontinence, schedule a consultation with a qualified women’s health physical therapist. Both conditions have many, and sometimes multiple, causes. Your birth control might have something to do with it, or it might not. Either way, pelvic pain is treatable; and getting to the root cause of your pain is a crucial part of what we do. That knowledge is a big help to your doctor, too.

Explore your options. The days of one size fits all birth control pills are over; contraception can and should be customized for every woman. The European research team wisely encourages providers to take into account a woman’s specific needs and expect them to change over time. Ideally, that begins with a big picture assessment of your psychological, physical, and relational needs and risk factors; and it ends with empowering and supporting your decision from among a wide variety of birth control options. But you may have to push for that. Even good doctors are used to simply writing the prescription that works for most of their patients. Let them know from the beginning – or starting today – that you’re the team expert on your body.

Insist on follow up. The European researchers suggest a three month check in with your provider after starting or switching contraceptives, especially if something isn’t working for you. Hormonal contraception isn’t the only form of birth control; but if you’re really committed to it, your provider can offer a different hormone combination, a different dose, or a non-oral medication (like a vaginal ring or implant) before recommending non-hormonal solutions.

Hormonal birth control works for many women; but there’s only one you. If you experience pelvic pain or other side effects while you’re taking it, don’t suffer in silence. The whole point of contraception is giving women the sex life they deserve. Make sure the one you choose works for your whole body, as well as your mind and relationship.

 

Citation

Both S., Lew-Starowicz M., Luria M., et al 2019. Hormonal Contraception and Female Sexuality: Position Statements from the European Society of Sexual Medicine. The Journal Of Sexual Medicine 16:11  1681-91.

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