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contraceptives and sexual function | Image Courtesy of Reproductive Health Supplies Coalition via Unsplash
Contraceptives & Sexual Function | Image Courtesy of Reproductive Health Supplies Coalition via Unsplash

Contraceptives and Sexual Function Considered

As pelvic floor physical therapists, we work with a lot of women who have some type of female sexual dysfunction, whether it may be pain with initial penetration, pain with deep thrusting/deep penetration, pain with orgasms, or decreased sexual arousal, desire, libido. Unfortunately, about 30-50% of women may suffer from these symptoms.

We often see women with sexual impairments have the following conditions/scenarios:

  • Postpartum (regardless of delivery)
  • Vaginismus (involuntary spasms of the pelvic floor muscles)
  • Post-menopausal
  • Vulvodynia
  • Skin inflammatory conditions such as lichen sclerosus

As you can imagine, any of these conditions listed above, or just experiencing pain with any type of sexual activity can be debilitating and impair our quality of life. To quote,

Female sexual dysfunction is associated with physiological, psychological, social, interpersonal, medical and cultural factors,”

(Gȕrbȕz, et al 2020). 

Common Types of Contraceptives

Lately, there has been more research linking the relationship between contraceptive use and possibly increased sexual dysfunction. But before we dive into sexual dysfunction topics, let’s go over common contraceptive types.

There are hormonal contraceptives (oral contraceptives, Mirena, etonogestrel implant, ring, “Depo” injections) and non-hormonal contraceptives (such as copper IUD, silver IUD).

Based on the research, hormonal contraceptives have a higher risk of negative sexual functioning compared to non-hormonal methods. This is likely due to ovarian suppression, decreased estrogen, increased androgen metabolism that results in increased SHBG levels which then leads to decreased free testosterone and androgen levels. Due to the hormonal changes in the tissue, this can lead to other conditions that increase the risk of sexual dysfunction and pelvic pain. 

Conditions Associated With Oral Contraceptives and Sexual Function

A systematic review (Champaneria, 2016) found articles that discovered:Oral Contraceptives & Sexual Function | Image Courtesy of Reproductive Health Supplies Coalition via Unsplash

  • Those with dyspareunia (pain with sexual intercourse) has a positive association with either current or past use of oral contraceptives
  • Significantly increased risk of vulvar vestibulitis in women currently on oral contraceptives (as you can imagine, can affect our sexual function!)
  • Significant relationship between interstitial cystitis/painful bladder syndrome and oral contraceptive use (we also know that women with painful bladder syndrome often experience pain with sex as well)

Libido, Sexual Desire, Lubrication & Pain

One study compared the test scores of The Female Sexual Function Index (FSFI) among different groups of those who took contraceptives and those who did not. The FSFI asks questions on sexual desire, arousal, lubrication, orgasms, overall sexual satisfaction/partner satisfaction, and vaginal penetration.

The authors of the study found that those who were taking contraceptives were significantly more likely to report pain, decreased desire, and issues with lubrication. However, they did not find a significant difference between groups on the arousal, orgasm and satisfaction topics. Among the groups, those using condoms showed the most positive scores of female sexual functioning on most topics. 

One qualitative study involved having deeper conversations with women who believe they have negative effects specifically from hormonal contraceptives. Many women who ceased hormonal contraceptives for whatever reason (forgot to get a new prescription filled, postpartum, etc.) noticed a drastic difference in sexual functioning when they stopped taking it.

A common complaint among these women was significantly decreased desire. This inspired some women to either stop contraceptives altogether or find alternate non-hormonal contraceptives. Some women spoke up about how arousal and lubrication had decreased dramatically when on contraceptives and noticed a vast improvement as soon as they stopped the contraceptive method. Women who had menstrual dysfunction, irregular bleeding, or excessive bleeding also noticed decreased arousal but felt it was worth it for the stability of their cycle and other painful symptoms.  

CONCLUSION:

Contraceptive use can affect our sexual functioning in areas of libido, sexual desire, lubrication, and pain. In addition, there are some pelvic conditions that are associated with oral contraceptives such as vulvar vestibulitis and painful bladder syndrome. There are pros and cons to any type of medication, including birth control options. Someone with menstrual pain, irregular periods or excessive bleeding, or feeling that her moods are not stabilized, may find that contraceptives outweigh the risks of the sexual side effects.

It is crucial that you find a gynecologist that you trust, and someone you can speak freely about your overall concerns, values to find the best option for you! Regardless of contraceptive use, if you are having any symptoms of painful sex, painful orgasm, vulvar pain, we can help! Contact us here.

Contraceptives & Sexual Function | Image Courtesy of Reproductive Health Supplies Coalition via Unsplash

References: 

Champaneria R, D’Andrea RM, Latthe PM. Hormonal contraception and pelvic floor function: a systematic review. Int Urogynecol J 2016;27:709-722.

Gȕrbȕz T, Gȕngör ND, Okcu NT& Yurci, A. Effects of contraception methods on female sexual function and quality of life.J Surg Med 2020;4(12):1231-1235. 

Malmborg A, Brynte L, Falk G et al. Sexual function changes attributed to hormonal contraception use-qualitative study of women experiencing negative effects. 

Moreira, et al. Sexual function and metabolic/hormonal changes in women using long-term hormonal and non-hormonal contraceptives: a pilot study. BMC Women’s Health 2020;20:240. 

What Our Patients Have to Say

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Testimonial by J.B.

My husband and I were having problems with painful intercourse. My therapist recommended that I go and get a pelvic floor evaluation from a physical therapist. Having never been treated by a physical therapist, I wondered how this really was going to help me. My husband who is a physician was very supportive and agreed that a PT evaluation would be a great idea. So i made the appointment and was blown away by what I learned. I had no idea that pelvic floor muscles could get tight and have trigger points just like any other muscle in the body. I'm a massage therapist and very familiar with tight muscles, and this new thought really amazed me. Heather's program to help relax and strengthen these muscles made such a difference. I can say that I am 100% pain free during intercourse now. Yippee! Going to the PT appointments and doing the at-home exercises was definitely a discipline, but it's 100% worth it! The rewards are amazing.

-- J.B.

Testimonial by Alexandra B.

Heather is without exaggerating AMAZING! After years of trouble with a certain part of my body, in no time, she made everything change back to equilibrium and to what would be considered normal. She explains everything in detail and therefore gives you a better understanding of why things are the way they are, and how you can work towards turning things around. I would highly recommend Heather for any type of Physical Therapy. She has created her own "Method/Therapy" through years of studying (with some of the greatest practitioners), practice and breaking down the issues of her past patients, enabling her to fine tune her own system. I'm so thankful to have found her, and I'm especially grateful for the quick recovery I've achieved, after years of distress. If you cannot afford her, I recommend you purchase her book. Although it may not be Heather in person, it can still help you to get on the right path to recovery!

-- Alexandra B., 5/20/2015 via Yelp!

Testimonial by A.W., age 32

I wanted to let you know that my pelvic floor held strong and gave me no trouble whatsoever in my trail race this morning (12 miles)! In a way, I felt like I ran better than ever because my core feels so rock solid from all the exercises you have me doing. That was especially valuable on the technical downhill - I just flew down the trail because I had confidence in my balance and form. Thank you for helping me get back to doing what I love.

-- A.W., age 32
(completed Post-partum Renewal Program using the InTone biofeedback/stim unit)

Testimonial by S.S., age 54

Heather is the best! I saw her today for terrible hip/groin pain. I was so impressed with the safety measures in place and felt completely safe . Thanks for the healing hands.

S.S., age 54

Testimonial by Rosanna R., age 35

Heather has affected my life in the MOST POSITIVE way and I am forever grateful. My husband refers to her as the "sex doctor" so you can only imagine how happy he is with my therapy outcome.

After the birth of my son I suffered from "Vaginismus", however, at the time I just thought I was broken. My "broken vagina" affected me physically but it was an emotional struggle as well. Many women in my life also suffered with pain from sex after their babies were born so I knew I wasn't alone. They told me they "just got used to it" but I couldn't see myself living that way.

Sex wasn't just painful, it was literally impossible - IT DIDNT FIT!

Read more: Testimonial by Rosanna R.,...

Testimonial by A.B.

Before I was referred to Heather Jeffcoat I was living in a nightmare. I had been married to my husband for three years and I was suffering from Vaginismus. That all changed when I visited my OBGYN and she said she knew of someone with a great success rate. To be honest I was hesitant at first because my first doctor had already told me that all I needed to do was order dilators from the internet and I should overcome my problem. She was wrong because I had followed the book on how to use the dilators with absolutely no advancements in my condition. However, that all changed when I went in for my first visit and Heather took the time to explain my condition and how we were going to work together to overcome it.

I remember leaving her office with a glimmer of hope that I could live a normal life. As my sessions continued I began to see immediate results. With only four sessions and a strict dedication to my home programs I was cured of Vaginismus. In the beginning of this process I was made aware that my health insurance company might not cover the costs, which was disappointing but today I can say one hundred percent that it was the best money I ever spent. Now thanks to Heather I am finally enjoying my life to the fullest with my husband. Thank you Heather, I can’t begin to tell you how much I appreciate all that you have done for me. I will never forget it. Those who are suffering from these types of conditions don’t be afraid because she makes you feel so comfortable and the end result is worth it. Good luck to you all and I hope you experience the success I have.
-- A.B.

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