Part 1: Oral Contraceptives

This is the first in a series of ten very common reasons why women may find themselves feeling low level of interest in being sexual: Use of oral contraceptives (OCs), otherwise known as "the pill."

Some women find that their sexual drive is decreased by using OCs. This is not always the case. Some women feel so freed up and relieved due to their not worrying about unintended pregnancy that it increases their desire to be sexual with a partner.

But, the unspoken problem (until just two years ago) is that OCs can really have impact on how sexually interested a woman may be. This comes to light particularly when she finds herself in an otherwise great relationship.

When there are relationship issues that decrease sexual desire, the impact of OCs may be blurred and it can become a "chicken and egg" dilemma. Here's how: A woman who goes on OCs can have a decrease in her desire. This can then cause conflict in the relationship with her partner. She and her partner may have no knowledge that the OCs may be responsible, so they start critiquing the relationship and criticizing each other -- all when it is physiological issue that caused the decrease of desire. Without this information, the couple is just going forward logically (unfortunately), but to the detriment of the relationship. And, there may be relationship issues that would have a negative effect even if OCs were not in the picture.

I sure do wish that OCs came with a disclaimer on the outside of the package (as visible as the Surgeon General's warning appears on cigarettes) that reads: "Warning! This may cause a decrease in a woman's sexual desire."

One of the mechanisms that seem to cause this change in sexual interest is connected to a woman's sex hormone binding globulin (SHBG). A rise in SHBG can occur while using OCs. That means that there is more of it. More of it is not a good thing for a woman's libido. SHBG combines with testosterone in a woman's body, the hormone that is largely responsible for sexual desire. That leaves less testosterone "free" in her body to cause sexual desire.

Are there better OCs to try? Ones that minimize that negative effect? I do not yet have the answer for that yet, but when I do, I'll be sure to pass it along here.

Just as a note: Among all the hormonal approaches to birth control (the patch, the shot, the ring, and the pill), some initial studies are showing that the vaginal ring seems to have the least negative impact on libido. Of course, we will look for other scientific studies to support that finding.

So, if you are having lowered libido and are on an OC, do consider trying another form of non-hormonal birth control (IUD, cervical cap, diaphragm, male condom, and female condom -- to name the most common) and see if there is a difference. You may need to allow a few months for normalizing. Have a blood test to measure your SHBG, free testosterone, and total testosterone if after a few months, there is no change in the desired direction.

Of course, always factor in any relationship issues when trying to unravel a situation of low sexual desire.

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