Love and Sex Prescription

By Dipika Dandade, M.D.

QUESTION
Could the birth control pill be affecting my libido? I hear people talking about this one a lot, though no one has a definitive answer.

ANSWER
Decreased libido can be grouped under the general term “Female Sexual Dysfunction” (FSD). FSD refers to the decreased desire to have sex, inability to become aroused or orgasm or painful intercourse. There are various causes of decreased libido, including psychological factors, such as depression; medical problems, such as high blood pressure or diabetes; or medications.

Oral estrogens, found in oral contraceptive pills, can affect libido. They do so by increasing a protein called sex hormone binding globulin (SHBG). SHBG binds to testosterone, decreasing the amount of free or active testosterone. Most people are familiar with testosterone as a male hormone, but women actually produce testosterone as well.

Testosterone plays an important role in female sexuality both directly and indirectly. It increases blood flow to the genitalia, facilitating physical arousal and orgasm. It is also a precursor for the production of the hormone estrogen, which is vital to sexual function. For example, decreased estrogen levels can lead to, among other things, vaginal dryness and painful intercourse.

You might try a lower-dose birth control pill to see if this improves your libido. Or you can opt for a different type of birth control. For example, the ring (NuvaRing) or the injection (DepoProvera) might work better for you. If you want to avoid hormonal contraception completely, condoms or the Paragard IUD might be right for you.

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