The pill could lower sex drive in young women

The pillThis month marks the 50th anniversary of the contraceptive pill, first approved by the FDA in 1960 and now the choice of contraception for more than 100 million women worldwide. By uncoupling sex from pregnancy, oral hormonal contraceptives finally allowed women to become agents of their own bodies.

Life isn’t all rosy on the pill though. The various different formulations have been associated with all sorts of side effects, the most issue being venous thromboembolism.

Now new research from female medical students in Germany has found that hormonal contraception such as the pill could also reduce sex drive.

Several previous studies have suggested that oral contraception might affect female sexual function, but overall the evidence as to whether they have a positive or negative effect is pretty mixed.

The researchers behind this study emailed female students at six medical schools in Germany and asked them to fill in an online questionnaire about their sexual function in the past four weeks and their usual means of contraception over the past six months.  A total of 1,086 women (15-20%) aged mostly under 25 years responded.

A total of 87.4% of women had used contraception in the previous 6 months, most of whom had used oral hormonal contraception (69.5%).

About a third (32.4%) of participants were considered at high risk of sexual dysfunction.  However, this figure actually isn’t too bad compared with a previous study of 78 female medical students in the US, which found that 63% were at high risk of sexual dysfunction.  Other larger studies put the rate at a more conservative 38% in Germany and 43% in the States.

When the sexual dysfunction data were analysed on the basis of single usual form of contraception (1,046 participants), women who used oral hormonal contraception or non-oral hormonal contraception were most at risk of having sexual dysfunction. Oral hormonal contraception was associated in particular with low desire and arousal compared with other forms of contraception and no contraception.

The authors suggest that the link between oral hormonal contraceptives and sexual dysfunction may be because oral contraceptives decrease the circulating levels of testosterone, “which is needed to (i) stimulate sexual desire and (ii) regulate genital blood flow and the structural and functional integrity of the genitals.”

Interestingly, smoking was associated with a lower risk of sexual dysfunction than not smoking, an effect the authors hilariously suggest might be down to the fact that “smokers might have greater ability to enjoy themselves.”

“This is a very important research investigation,” stated Dr Irwin Goldstein, Editor-in-Chief of Journal of Sexual Medicine, which published this study. “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.”

Don’t panic yet though, this study isn’t the final word and has various shortcomings, not least the possibly of participation bias – where women with perceived sexual problems might have felt more inclined to participate than women with no sexual problems – and reporting bias – where participants might have overestimated or underestimated the scale of their sexual difficulties.

Furthermore, the low response rate to the questionnaire (15-20%) means the study population probably isn’t a great reflection of all the female medical students at the eight schools studied, much less students worldwide, and, as the authors say, their stats suggest that “the factors considered can only explain a small fraction of the variability of total [female sexual function] scores.”

As it is, hormonal forms of contraception – both oral and non-oral – are the most successful forms around.  So I wouldn’t throw away your pills just yet.

  • Put off oral hormonal contraceptives? Nature Medicine has an article on the 50th anniversary of the pill that highlights some possible alternatives under development.

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Wallwiener C et al. (2010) Prevalence of Sexual Dysfunction and Impact of Contraception in Female German Medical Students. Journal of Sexual Medicine DOI: 10.1111/j.1743-6109.2010.01742.x

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British pharmacy offers morning after pill online

contraception-onlineLloyds Pharmacy has become the first high-street chemist to offer the ‘morning after’ pill emergency contraception online.

The pharmacy’s website gives the option to buy between one and three emergency contraception pills online, so women can be prepared prior to any accident.

Users need to complete a confidential health questionnaire before completing an order, which is reviewed by a GP.  By using this questionnaire system, the company hopes to avoid selling contraception to girls under 18.

Emergency contraception is most effective if taken within 3 days (72 hours) of unprotected sex, but can potentially prevent pregnancy if taken up to 5 days after.

The pills on the Lloyd’s website take 72 hours to arrive, however.  This delay is deliberate so that women who have already had unprotected sex and need emergency contraception immediately head straight to a local pharmacy, GP or family planning clinic rather than risk missing the crucial efficacy period while waiting on the postman.

Instead, the idea of online ordering is to allow women to have an advance supply to ‘prepare for the unexpected’. Steve Marinker, spokesperson for Lloyds Pharmacy, explains that women might find an advanced supply of the morning after pill useful for circumstances where it might otherwise be difficult to get hold of contraception within the crucial 3-day time window. “Maybe something’s gone wrong with their normal contraception and it’s a Saturday night,” he added, “and they might be anxious about how long it will take them to get a morning after pill, and that they might have to wait until Monday morning.”

Users also have the option to order two pills in case they vomit after taking a pill – a not uncommon side effect of emergency contraception.

Emergency contraception contains high doses of female hormones: either levonorgestrel, a synthetic progestogen, or progestin, another type of synthetic progestogen, plus estrogen. The progestogen analogues cause changes in the mucus and lining of the cervix, making it harder for sperm to reach the uterus and harder for a fertilized egg to attach to the uterus.  Estrogen, on the other hand, stops the ovaries from releasing eggs that can be fertilized by sperm.

As one might expect, the right wing press are up in arms about this development.  The Daily Mail cites Fury as High Street pharmacy sells morning-after pill online, whereas The Daily Telegraph opts for Anger over ‘morning-after pill bulk-buy offer’.  These publications are harping on the old fear that easy availability of the morning after pill will fuel promiscuity, which the current system prevents, they say, by involving an ‘uncomfortable’ interview with a pharmacist that may act as a deterrent to such behaviour.

Promiscuity surely is only a problem for society if it leads to unwanted pregnancies, whereas emergency contraception prevents this happening.  More to the point, currently a woman could walk into a pharmacy three days in a row if she wanted to create a stockpile (how much of a deterrent can a disapproving pharmacist really be?), the online ordering system just makes this process more straightforward.  I welcome Lloyd’s Pharmacy’s move as a good way of ensuring women can use emergency contraception as soon after unprotected sex as possible.

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