Does Contraception Lower Female Libido?: Debunking 1 Flesh, Episode 3

Welcome loyal and new readers to episode 3 of my attempt to debunk the dangerous myths and outright lies that the students over at 1Flesh seem intent on propagating. Today’s post will explain how overarching, the-sky-is-falling statements such like, “the pill lowers women’s sex drives!” are misleading and, oftentimes, outright lies. As always, paragraphs in italics are taken directly from their site.

Let the games begin, and may the odds be ever in your favor! ( 😉 ) 

For almost fifty years, American men and women have relied on contraception for liberated, satisfied sex lives, free from fear and unwanted consequence. And by and large, contraception has provided…for men. Women, on the other hand, are far more dissatisfied with their sex lives.

Interesting fact, in the article 1Flesh cites here, the researcher behind the study referenced in the article found the following:

Several factors to a woman’s lack of sexual satisfaction, including:

  • Sex gets shoved to the bottom of the “to do” list for women. And when they do have sex it becomes just another task.
  • Women are not getting their emotional needs met during sex. An orgasm might not be the point.
  • Many women strive for unrealistic physical perfection seen in the media and are unhappy with some aspect of their physical bodies.
  • Women don’t ask for what they want in bed, fearing their partner will be hurt or leave them.
  • Medications such as antidepressants can reduce a woman’s libido and ability to reach orgasm.

Not really seeing specific forms of contraception anywhere in there, but let’s continue.

Recent surveys found that 63% of married women would rather be watching a movie than having sex with their husbands,

Ah, the half-truths continue. Watching a movie was just ONE of the things married women said they would rather be doing. But moving on…

Forty-eight percent of those surveyed in that article said they married the best sex of their life, while 87% said they were extremely happy, very happy, or somewhat happy with their sex life. Only 16% said they were unhappy.

Also, it should probably be noted that no margin of error was provided with this survey.

and, according to the 2010 National Survey of Sexual Health and Behavior, only 64% of women report having an orgasm in their last sexual encounter.

Again, the study tied this to contraception how, exactly?

Also, I’d like to point out this gem from the study:

“Adults using a condom for intercourse were just as likely to rate the sexual extent positively in terms of arousal, pleasure and orgasm than when having intercourse without one.”

Bring on the barrier contraception!

Strike 1 for the anti-contraception crowd (well, actually strike I-don’t-know-exactly-what, but much higher than 1).

It is entirely possible that part of women’s sexual dysfunction is the result of the birth control pillA study published on May 4th, 2010 in the Journal of Sexual Medicine, reported that sexual functioning was negatively correlated with use of contraception in a study of over 1,000 German medical students. They reported both reduced sexual desire and arousal, indicating a potential link between contraceptive hormones and lack of sexual satisfaction. In an editorial published with the study, Dr. Irwin Goldstein of the Journal stated, “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.”

Let’s look more closely at this study, and criticisms of the study, shall we?

First, the study participants were only asked whether or not they were in a stable relationship, not how long they’d been in a relationship. As many studies have shown (see, e.g. Maintaining Desire in Intimate Relationships), sexual frequency and desire tend to plummet over time. And as Kim Wallen, an Emory University professor of psychology and endocrinology has stated, “We know that long-term relationships increase the risk of sexual dysfunction – a condition easily treated with a new partner, which is many times more effective than any drug or hormone.” Further, women taking oral contraceptives are more likely to be in long-term relationships (where, again, their risk of sexual dysfunction is greatest) than those who use other forms of birth control.

Second, this study was observational and non-clinical. For those not familiar with the scientific method ::cough:: 1Flesh ::cough:: this means that participants were not randomly assigned to use various methods of hormonal and non-hormonal contraception; participants had already chosen their method of birth control. According to Anita Clayton, a professor of psychiatry at the University of Virginia who treats women with sexual dysfunction, “There could be something different about women who choose oral contraceptives a opposed to choose another method. We don’t know if that characteristic is what has a negative effect on sexual functioning, and we can’t tease it out from [this study].”

Third, can I point out that this study dealt ONLY with GERMAN MEDICAL STUDENTS. I mean, I hate to beat a dead horse here, but this doesn’t sound like the best way to devise a sample pool…

Finally, take a look at this line from the conclusions section of the study:

Women using contraception, especially hormonal contraception, had lower sexual functioning scores.  However, the impact of an androgenic or antiandrogenic progestin content or different dosages of EE as modulating factors of female sexual function seemed negligible. (emphasis mine)

While I applaud this study for its effort as a step in the right direction, such a poorly designed survey cannot really be cited with any level of authority for any conclusion other than conclusions for that VERY specific population. Further, even the study authors state that that the impact of progestin or different dosages of estrogen as a factor of female sexual dysfunction was negligible.

If we want to look at some other studies that shed some light on the interactions between contraception and female sexuality and sexual function, we can look at a 2010 meta-analysis of existing research on the impact of various contraception methods on female libido, where we find that combined oral contraceptives (OCs – commonly known as “The Pill) don’t have a consistent impact on sex drive. Progesterone only methods (e.g. Depo Provera) can SOMETIMES decrease libido and cause vaginal dryness and painful intercourse, while irregular bleeding can also lead to vaginal dryness and vulvar irritation, both of which are increased post-partum and while breastfeeding. Further IUD users see no significant impact on libido, and female sterilization procedures actually show a POSITIVE impact on sex drive unless a woman is undecided about the procedure. Finally, condoms and NFP are neutral in terms of sex drive.

If we want to look at individual studies, a Finnish sample of 2,081 women aged 33–43 years found that the usage of OCs had no significant effects on sexual function. The use of hormone-based intrauterine systems was, however, significantly associated with less pain and more desire, arousal, and satisfaction In a 2005 validation study of 500+ participants, we learn that OCs were NOT positively OR negatively linked to any of the sexual domains of the FSFI (The FSFI was developed as a brief, multidimensional self-report survey for looking at  key dimensions of sexual function in women. The scale consists of 19 items that assess sexual function over a 1 month period and yield scores in six areas: sexual desire, arousal, lubrication, orgasm, satisfaction, and pain), but that use of non-hormonal IUDs resulted in fewer arousal, satisfaction, and pain problems. A 1996 study found that OC user had more desire, but less lubrication than non-OC users, BUT that the association varied with the type of OC used. Finally, a 1994 study found that OCs might have a possible impact on female desire (either increasing or decreasing it) and that the impact was dependent upon the type of OC used. And these are just a small sampling of the research available on contraception on female libido.

Doesn’t really sound like contraception is to blame for low sex drive, now does it?

Granted, we are complicated creatures, and there are all sorts of influential factors regarding a woman’s sexuality: the health of her relationships, self esteem, stress levels, and overall physical health, to name a few.

Bravo for this recognition. No, seriously, 1Flesh, thank you for it.

At the same time, the human range of emotions and desires are intricately integrated with the human body’s hormonal activity, so a hormonal influence on a woman’s sex drive should be seen as a natural part of the equation, and therefore be respected.

No problem here. Except, of course, for the fact that 1Flesh doesn’t actually understand how hormonal contraception works, or how it impacts libido, as will be demonstrated below.

The problem with hormonal contraception is that it increases estrogen (and sometimes progesterone) levels in a woman’s body, fooling it into acting as though pregnant in order to surpress ovulation.

First, hormonal contraceptives can’t just contain estrogen. Some can contain only progesterone (progestins), but you can’t have an estrogen-only contraceptive. Strike 2.

Second, um, I just…yeah. God help us if anyone a 1Flesh every decides to go into the field of obstetrics or gynecology. For people who claim to know all about natural family planning, they seem to have a very flimsy grasp on what actually happens during a menstrual cycle and pregnancy.

The way hormonal contraception ACTUALLY works is by maintaining an artificially high level of circulating estrogens. In a woman with a normal menstrual cycle who is NOT on OC, the level of estrogen rises until about day 11, and then drops off dramatically, which triggers an increase in LH(lutein hormone) and FSH, which in turn triggers ovulation. By maintaining a high level of estrogens (which, by the way, is NOT what we see in pregnancy), OCs prevent the drop, thereby preventing ovulation. Strike 3 – normally I’d say they’re out, but it’s more fun to play along, so I guess I’ll do that for a bit.

In an actual pregnancy, a woman’s sex drive is frequently reported to fluctuate dramatically, often increasing during the first trimester of pregnancy and tapering off during the second two, dropping off drastically postpartum. How these fluctuations are influenced by estrogen and androgen levels is poorly understood, and most will collectively blame “hormones.”

I don’t even know where to begin with this. Pregnant women’s libido does vary throughout pregnancy, but this is almost entirely based on the individual woman and her individual situation.

Poorly understood? Maybe by college sophomores. Not so much by the scientific community, though. For example, here’s a study on how the androgen testosterone influences sex desire.

But it is no secret that women typically experience dramatic changes in sex drive during the course of pregnancy.

Is 1Flesh just randomly linking to pages that mention a low sex drive in women without looking to see how much they support its assertions?

Further, please see below as to why they hormonal changes experienced in pregnancy have pretty much nothing in common with the hormonal changes experienced by women on oral contraception.

It would be naïve, then, not to expect a similar change in sex drive with the use of hormonal contraception, which creates an ‘artificial pregnancy’, but involves none of the emotional and relational satisfaction that comes from a healthy pregnancy and anticipation of a child.

Oh, you silly, silly 1Flesh people. Talking again about thing you don’t understand.

Here, once again, is a chart for you that shows precisely what hormone levels look like in a normal menstrual cycle, and what they look like in a woman taking oral contraceptives:

Top two graphs are for normal menstrual cycle.

Bottom two graphs are for a cycle using oral contraception.

And here’s a pic of what hormone levels look like during a normal pregnancy:

As you can see, oral contraception levels out women’s hormone levels, instead of the fluctuating hormone levels seen during a normal menstrual cycle, or the steep rise in hormone levels during pregnancy.

Now, 1Flesh, explain to me precisely why you think that different hormonal level patterns will produce the same result. I’ll wait…

::insert jeopardy music here::

No answer? Okay, moving on, then.

We have put women in a medical situation that has no precedent in our experience. In short, hormonal birth control’s effect on a woman’s sexual satisfaction is a possible detriment, and needs to be studied as such.

No precedent? Hmmm… Anyway, I agree that we should be studying women’s sexual satisfaction, and all of the things that could possibly impact it. Funny thing is, contraception is one of the things we actually HAVE been closely studying. See the studies above. That doesn’t mean we don’t need to keep studying things, but pretending like it’s never been studied before is just silly.

The study of German medical students cited earlier in this article is so important because thus far, it is one of a kind. In the 50 years of American history in which hormonal contraception has been legal, there has been virtually no reliable research conducted to determine if contraception is really meeting one of its goals: allowing women to be sexually satisfied.

Oh, wow. That’s exactly what you just did! LOLZ. Please, 1Flesh kids, do some reading before spouting off such nonsense. LOTS of research has been done. Some of which was mentioned by me above, and all of which, by the way, are referenced in the report you cited at the beginning of your post.

In granting women sexual “liberty”, they could be physically cheapening a woman’s ability to be satisfied sexually. The scientific community responsible for reproductive health must critically reevaluate if their current agendas for hormonal contraception are based on women’s best interests.

Again, LOLZ. I’m all for further scientific research into sex and sexuality. But claiming that the reproductive health community doesn’t have women’s best interest at heart without any evidence to back up such a claim is seriously laughable.

If you’re interested, check out a method of side-effect free family planning.

If you don’t consider higher risk of pregnancy a side-effect, most definitely follow 1Flesh’s advice here. For returning readers, yes, it’s once again a link to the Creighton Model. ::face palm::

Till next time,

– H

© Heather Parker and Antigone Awakens, 2012-2013.

9 thoughts on “Does Contraception Lower Female Libido?: Debunking 1 Flesh, Episode 3

  1. Anonymous

    Did you even read any of the studies? This isn't even debatable stuff any more — OC use is associated with diminished sex drive.

    From http://www.drnorthrup.com/womenshealth/healthcenter/topic_details.php?topic_id=128

    (Birth control pills are comprised of potent synthetic estrogens (for example, ethinyl estradiol) and synthetic progestins (for example, norethindrone) that diminish the levels of follicle stimulating hormones (FSH) and luteinizing hormone (LH), two pituitary hormones. This results in the metabolic suppression of ovarian function, including both the suppression of ovulation and testosterone production!

    In addition, OCs also cause a marked increase in the production of sex hormone binding globulin (SHBG) in the liver. (This is the main binding protein for sex steroids.) The higher the SHBG levels, the more hormones are “bound” and unavailable for biologic effects on tissues. In the recent study on the pill’s effect on testosterone, researchers found that SHBG levels were four times higher in pill users than in those who had never used the pill. This means that although a woman taking OCs produces testosterone in her body, it’s unavailable for normal uses such as stimulating her sex drive.

    Way to not tackle the mechanism.

    And you're ignoring this study: http://onlinelibrary.wiley.com/doi/10.1111/j.1743-6109.2011.02597.x/abstract

    C'mon kid, get with the times.

    Reply
  2. Heather

    Hey, you know what’s super fun? I actually DID read the study. In it’s entirety (you could have found it here (http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&ved=0CGQQFjAB&url=http%3A%2F%2Fwww.nahealthassoc.com%2Fsystems%2Ffile_download.aspx%3Fpg%3D236%26ver%3D3&ei=H-caUOLPLuTF6gH5kYHwDw&usg=AFQjCNER2-9b4MfEE8–2T5Cw4wjKDp16A&sig2=4myckcU587hsRKVCqI7MCA) and read it, too, if you’d bothered to look). And not just what someone else wrote about it. Want to know what else is super fun? That was a retrospective study, not a prospective study. Why is that problematic? Because a PROspective study watches for outcomes, while a RETROspective study looks backwards to examine exposures to suspected risk factors in relation to an outcome that is established at the start of the study. Unfortunately, RETROspective studies, such as this one, have error due to confounding and bias. For example, in this study, it means that we can run into the problem of women who are more likely to have sexual dysfunction for some other reason choosing oral contraceptives as a method of birth control than other women.

    Further, that study did NOT associate any of its finding with evidence of sexual dysfunction or reduced libido in the subjects. Though a baseline of FSFI measurements taken, no measurements were taken at the end of the study. Ignoring the mechanism or not, if you’re not actually looking at whether or not what you’re observing is impacting libido by using the standard FSFI survey, then you can’t claim that it does. Isn’t science fun?

    I’d encourage you to read some of the studies I linked directly to in the blog post to read more about how oral contraceptives (through both meta-analysis and single studies) has been found not to negatively impact women’s libido.

    And, no, I’m not ignoring the second study at all. I think it’s an interesting study on a very limited sample size (22) concerning ONE type of oral contraception, i.e. Yaz. I definitely think that others should look at this study, examine possible biases, and develop a larger sample pool to determine if the effects noted in this study hold true across a larger sample. But at least this one was prospective.

    Again, I’m going to stand by my assertion that making a blanket statement that “oral contraceptives lower women’s sex drives!” is unsubstantiated by science, based on all of the studies I linked to above. Even the study that 1Flesh originally cited, when read in it’s entirety stated that even though women on oral contraceptives had lower FSFI scores, the effect of oral contraceptives was negligible.

    Hope that helps your understanding a bit.

    Best,

    H

    p.s. I was brave enough to put my name out there for you guys in my comments. It’d be nice if you guys were brave enough to do the same. Cheers!

    Reply
  3. Andrew O'Brien

    Heather,

    Is this really an attempt to make Hormonal Contraceptives sound appealing? To artificially change a woman's body?

    “The way hormonal contraception ACTUALLY works is by maintaining an artificially high level of circulating estrogens. In a woman with a normal menstrual cycle who is NOT on OC, the level of estrogen rises until about day 11, and then drops off dramatically, which triggers an increase in LH(lutein hormone) and FSH, which in turn triggers ovulation. By maintaining a high level of estrogens (which, by the way, is NOT what we see in pregnancy), OCs prevent the drop, thereby preventing ovulation.”

    I think this is where we will have our eventual stalemate. The above sounds appealing, but only if we view a woman's cycle as a bad or inconvenient thing. I don't view a woman's menstrual cycle as a bad thing, nor do I view her fertility as a bad thing. I really do appreciate your willingness to explore this stuff with 1flesh, but for me (and others) the real shame of Oral (hormonal) contraceptives is that they undermine the awesomeness of a woman's body and fertility.

    Reply
  4. Heather

    Hi Andrew,

    Thank you for your comment.

    No, this wasn't an attempt to make hormonal contraceptives (aka OC) sound appealing (though I, and millions of other women in the US and around the world find them so); it was an attempt to counter the lies and inaccuracies published by 1Flesh.

    You may be right that this is where we have our stalemate. I don't view my cycle as a bad or inconvenient thing. But I also am not willing to limit my sexuality or sexual behavior to only those times when I would naturally be less fertile. I'm a woman, and I enjoy sex (GASP!) with a monogamous partner when we both want to engage in sexual intercourse, and not only when it's “safe” to do so in terms of avoiding pregnancy. I do appreciate having an understanding of my cycle, and have actually used TCOYF's symptothermal method in the past, but I find it to be much more helpful in aiding those who would like to achieve pregnancy, than those who wish to avoid it.

    I respect those who view it differently and wish to use a form of NFP to both avoid pregnancy and to achieve pregnancy; however, I do NOT respect those who lie about other forms of birth control in an attempt to “trick” women into believing the only form that is good or safe for them is a form of NFP.

    Best,

    Heather

    Reply
  5. Andrew O'Brien

    Heather –

    Just dropping by to let you know I read your response to my above. I don't really have much to add.

    As you say: Best,

    Andrew

    Reply
  6. anniecanhazcheezburger

    It's all well and good to view a woman's natural cycle as a good thing (I do; I look forward to making good use of it when I become a mother someday), but it's quite another when it's used a means to control my behavior. I began using hormonal contraception after I was married, and it has only served to help me take control of my health and sex life. I, like millions of women who use hormonal contraception, have not felt any bit of undermining in my body. I experience absolutely no side effects, but am able to delay pregnancy until my husband and I see fit to stop delaying. It's done nothing but good things for us.

    However, I'll leave the heavy lifting to the very capable Heather, who has done her research and homework, and I'll stop spouting anecdotes.

    Great work, Heather. Thank you for writing these!

    Reply
  7. Sarah

    After reading through 1Flesh and Heather's blogs I'm noticing a trend here. Each side of this issue needs to look at the fundamental values the other is defending. You are trying to explain a deeply human philosophical position with empirical science and the scientific method…good luck. What ends up happening is a tennis match of patronizing, demeaning, verbal abuse. If you look at the values being defended here and there, maybe a respectful debate could occur. That may actually be enlightening!

    Reply
  8. Heather

    Sarah, no, that's not what's happening here. I DO NOT CARE which method of family planning / contraception people choose for themselves. At all. What I DO care about is the fact that 1Flesh was spreading misinformation about the Creighton Method and about other forms of contraception in an effort to scare people away from forms of contraception other thatn the Creighton Method. That's wrong. And THAT'S what my posts were about.

    Promote the Creighton Method (or your own preferred method of birth control) all you won't – but don't lie about what it does for you, and don't lie about other forms of contraception, either.

    Reply

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