sex – Helen Jaques

This 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

Being in good or excellent health increases the quality and quantity of sex for middle aged and older people, according to a big study that delved into the sex lives of 6,000 American adults aged 25-85. Plus being fit can keep you sexually active into a ripe old age, unlike your unhealthy peers.

The study also had a whole raft of other expected findings, some rather expected (e.g. men are more interested in sex) and others maybe less so (such as more than a third of men aged 75-85 are sexually active, as are 17% of women the same age).

The cross sectional study, published in the BMJ, looked at two large American health surveys: the national survey of midlife development in the United States (MIDUS), which assessed in 1995-6 adults aged 25-74, and the national social life, health and aging project (NSHAP), which in 2005-06 looked at people aged 57-85.

Overall, men were more likely than women to be sexually active and be interested in sex. Between 69% and 87% of men of all ages reported being sexually active in the past six months, compared with 43% to 76% of women, and men were significantly more likely to report being interested in sex than were women (66% versus 53% among those aged aged 25-74 and 62% versus 21% in those aged 57-85). These gender differences increased with age and were greatest in people aged 75-85 years: 38.9% of men compared with 16.8% of women were sexually active.

On the other hand, overall, sexual satisfaction was similar in the two genders: among sexually active respondents, about two thirds of men and women reported a good quality sex life. These proportions also changed as women aged though, so that only half women aged 57-85 who were sexually active reported a good quality sex life compared with nearly three quarters of men.

A novel aspect of this study was the use of a new measure devised by the authors called “sexually active life expectancy” – that is, the average number of remaining years a person could expect to remain sexually active.

At the age of 30, men had a sexually active life expectancy of 34.7 years (i.e., to within 10 years of the average life expectancy of 74.8 years) and women had 30.7 years (to 20 years less than their life expectancy of 80.6 years). This means that men spend 78% of their lives sexually active, compared with 61% for women. At 55, these figures changed to 14.9 remaining years for men and 10.6 years for women.

For me the most interesting finding was the link between good health and good sex. Men aged 25-74 who were in very good or excellent health were more than twice as likely to be sexually active than their less healthy counterparts, whereas women of the same age were 60% more likely to be sexually active.

Of those people who were sexually active, men and women who were in very good or excellent health were 70% more likely to report having a good quality sex life than those who were in less good shape, and were 40-80% more likely to be interested in sex.

Good health also increased how long people would remain sexually active compared with people reporting fair or poor health: men in very good health at age 55 were projected to gain on average 5-7 years of life as sexually active, whereas women were projected to gain 3-6 years.

It seems like good health keeps people keeping on in more way than one…
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Lindau S & Gavrilova N (2010) Sex, health, and years of sexually active life gained due to good health: evidence from two US population based cross sectional surveys of ageing. BMJ 340 (mar09 2). DOI: 10.1136/bmj.c810

The pill could lower sex drive in young women

A healthy life leads to a healthy sex life