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Dr. Jon LaPook

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Does the Pill Lower Sex Drive?

Posted: 05/13/10 03:58 PM ET

The pill that ushered in the sexual revolution may have also thrown cold water on women's libido. Fifty years ago, on May 9th, 1960, the FDA announced the approval of oral contraception. The birth control pill allowed women to control their reproductive cycle, delay childbearing, and develop careers. But it also may have the potential to disrupt sexuality by blocking normal hormonal surges that occur in a woman's cycle. Here's how.

The pill works by tricking the body into thinking it's already pregnant. The usual ovulation that occurs around mid-cycle is suppressed, along with hormonal changes that can contribute to a woman's sexual drive. Gynecologist Dr. Rebecca Booth, author of The Venus Week, described to me the period just before ovulation: "The Venus Week is the 5-7 days in the female cycle when everything is aligned to help women look and feel their best. Our hair shines, our skin glows and we feel more attractive, focused and receptive to others. It is the window each month after the menstrual period when estrogen (the feel-good hormone) and testosterone (the hormone of desire) are at their peak. It is one of Mother Nature's gifts to us as women. When we are most likely to conceive, we look and feel our best, and our brains are primed for romance."

Oral contraceptives disrupt the normal mid-cycle surge of both estrogen and testosterone, a hormone that occurs in women as well as in men. Testosterone is made in the ovaries and adrenal glands and helps fuel female libido. As Dr. Booth adds, "It would be surprising for something designed intentionally to mute fertility hormonally (i.e., the pill) not to have a muting effect on desire -- knowing what we know about the surge of testosterone and estrogen in the pre-ovulatory week (a.k.a. The Venus Week)."

Studies are mixed about whether oral contraceptives actually decrease libido in women. But a recent study of more than a thousand female medical students in Germany found that women using hormonal contraception were more likely to have sexual dysfunction than those using either no or non-hormonal contraception. Features of sexual dysfunction included problems with orgasm, desire, satisfaction, lubrication, pain, and arousal. The study was the largest of its kind but there were limitations in how it was conducted. More research is definitely needed.

What about the effect of oral contraception on the way women act and the way they are perceived by men? There is actually a serious study out of New Mexico reporting that tips given by men to lap dancers were significantly higher during the so-called "Venus Week" described by Dr. Booth -- when women are most fertile -- than at other times in the cycle. The authors postulate that the mechanism might include changes in body scent, facial attractiveness, body shape, and even language. But the mid-cycle boost in earnings only occurred in women not taking oral contraceptives. The implication is that by suppressing normal mid-cycle hormonal surges, birth control pills interrupted the normal mating dance.

Of course, nothing in medicine is simple -- especially when it comes to sexuality. There are many possible reasons for a decrease in libido and sexual function, including fatigue, depression, anxiety, physical pain during intercourse, certain medications (such as beta blockers and selective serotonin reuptake inhibitor anti-depressants), medical problems like diabetes or low thyroid, and - of course -- relationship problems. My sense is that given the large number of potential causes for sexual dysfunction, oral contraceptives play a relatively small role. But the possibility is worth knowing about. And if you're a well-rested, happy woman with no medical problems and a wonderful relationship whose love life took a dive after you started the pill, you and your doctor might consider alternatives.

For this week's CBS Doc Dot Com, I discussed the effect of the pill on female sexuality with sex therapist and sex educator Miriam Baker.


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06:45 PM on 05/18/2010
I've always suspected that the pill worked to prevent pregnancies because it made you not want to have sex in the first place. A friend and I took the pill for years in our early-mid 20s and we did not feel like ourselves: moody, uncontrollably emotional, irritable, lack of sex drive. We have both been off it for a few years and the instant we did we felt like our old selves again, raging with sexuality that had been suppressed the entire time we were on the pill. Sure it works for some women, but not us. We have found that IUDs or the Nuva ring work way better, and our significant others appreciate us being off the pill just as much as we do.
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Seeker83
01:39 PM on 05/17/2010
Hymmm.. I never knew that's how the pill worked.. Nice to know.. Hope it doesn't ever fail..
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SF TKF
Cthulhu thinks you'd make a nice sandwich.
01:35 PM on 05/17/2010
If it does I'm grateful. If my libido were any stronger I'd never leave the bedroom, let alone the house!
11:38 AM on 05/17/2010
I have two daughters and two sisters and numerous girlfriends who tried the pill. Anecdotally, we found fuller figured girls had more trouble on the pill. All I can think about that, is fuller figured women may have more intense hormonal fluctuations or disfunctions to begin with, especially if their periods were irregular to begin with. Myself included we all opted for diaphram or other less caustic methods..sexual desire seemed to return...
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nikanj
free the fnords
12:32 AM on 05/15/2010
I am wondering why you didn't include 'fear of unintended pregnancy'
in your list of causes of 'decrease of libido and sexual function' ?
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12:58 PM on 05/14/2010
Within 2 months of starting on the pill in 1981, I noticed a change in temperment. The pharmacist said the pill kills B vitamins and you should be taking a suppliment while on them. I have to wonder how many divorces have occurred over the years due to this lack of information. Crabby would not only suppress your own libido but his too.
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avicenna
04:29 AM on 05/15/2010
Most product info pamphlets that come with OC do state that the pill may cause B Vitamin (B6 in particular) deficiency and it is recommended that women ensure they are getting higher than the RDA.
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12:14 PM on 05/14/2010
I've been on the pill for 8 months. No problems and many of my PMS symptoms are gone so if anything, I have more desire. I guess it just goes to the fact that everyone is an individual.

Also, with regards to the large study, I wonder how much of an effect they found with the BC pills, with enough people any little difference appears statistically significant. What was the clinical relevance? Did they go from 103x having sex a year to 100? if so, big deal.
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FoxIslander
Fox Island...no relation to Fox News
01:16 AM on 05/14/2010
"...My sense is that given the large number of potential causes for sexual dysfunction, oral contraceptives play a relatively small role..."

....so then why write the post?
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DrLaPook
Medical Correspondent, CBS Evening News with Scott
03:29 PM on 05/14/2010
Dear FoxIslander,
Why write the post? Because even if the pill plays a relatively small role, it may be helping to lower libido in some people. And the problem is that many people don't realize there's a possible link (see the comment by jmengr).

It's very hard to separate out all the different possible variables here (the pill might increase libido in some women by decreasing anxiety related to the risk of pregnancy or by lowering menstrual discomfort).

Jon
12:45 AM on 05/14/2010
No it doesn't. I lived through the 60's and 70's. Believe me when I tell you it was paradise. Aids and fatal diseases lowered peoples sex drive.
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ConfuciusSay-
Aglets: their purpose is sinister.
11:50 PM on 05/13/2010
Interesting and well written article.

Thanks
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11:45 PM on 05/13/2010
The Pill lowers sex-drive? Figures.
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John Cunningham Bowler
10:52 PM on 05/13/2010
I suspect the effects on sexual libido of *not* taking the pill will, on average, be substantially more sigificant that the effects of taking it. There's something about unexpected pregnancies that has a stressful effect on relationships.

Still, there is a well-known and well understood way of increasing female libido - testosterone injection. Of course, most of the westerm male medical establishment only suggests it to post-menopausal women, but then, in their defence, the maternalist US medical profession have little to suggest to men who wish to *lower* their libido (the morning woody can be a real problem unless you are in a stable relationship with someone whose response is to:

1) Grab it.
2) Understand that it doesn't last more than a few minutes.
3) Realize there are no hard and fast rules with a man at 8:30AM.)

My personal opinion is that there are too many options and that chemicals always mess things up. I've certainly seen more problems from the pill than I've seen solutions in my life, though heavy bleeding is a real issue where it can help.
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LisaLisa1234
10:29 PM on 05/13/2010
The pill was never very good for me, physically or emotionally. Not only was the libido suppressed, I felt like I had no control over my emotions. Once I stopped taking it, I felt free and like myself again. I gladly gave up convenience for that.

My husband will be happy to read this & see that there's an explanation for his uber-attraction to me that "Venus" week, other than pheromones. :)
10:27 PM on 05/13/2010
"It depends." Just like everything else in life...
Progesterone makes a woman (maybe men too, I'm not taking it to find out) crank out:"Sex hormone-binding globulin (SHBG),a glycoprotein that binds to sex hormones, specifically testosterone and estradiol."

Testosterone is pretty well implicated in your sex drive. When you're younger, you may be able to take the pill with no ill effects. As you age & make less testosterone, you may pass under the threshold that powers your libido.

Barring not taking the pill, the best antidotes are zinc & exercise. A quick note for anyone thinking of stopping taking it - SHBG takes MONTHS to go away. Don't expect instant results, and don't' get discouraged when your skin breaks out, because it probably will - but it'll pass.
09:55 PM on 05/13/2010
Am I the only one who gets annoyed when men write about these types of things?