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Women with ongoing or previous mental disorders or risk use of alcohol have greater risk of COC-induced mood symptoms. This may be worth noting during family planning and contraceptive counselling.

ObjectiveThe effect of combined oral contraceptives (COCs) on female sexuality has long been a matter of discussion, but placebo-controlled studies are lacking. Thus, the aim of the present study was to investigate if an oestradiol-containing COC influences sexual function.DesignInvestigator-initiated, randomised, double-blinded, placebo-controlled clinical trial where 202 healthy women were randomised to a combined oral contraceptive (1.5 mg oestradiol and 2.5 mg nomegestrol acetate) or placebo for three treatment cycles.MethodsSexual function at baseline and during the last week of the final treatment cycle was evaluated by the McCoy Female Sexuality Questionnaire. Serum and hair testosterone levels were assessed at the same time points.ResultsCompared to placebo, COC use was associated with a small decrease in sexual interest (COC median change score: −2.0; interquartile range (IQR): −5.0 to 0.5 vs placebo: −1.0; IQR: −3.0 to 2.0, P = 0.019), which remained following adjustment for change in self-rated depressive symptoms (B = −0.80 ± 0.30, Wald = 7.08, P = 0.008). However, the proportion of women who reported a clinically relevant deterioration in sexual interest did not differ between COC or placebo users (COC 18 (22.2%) vs placebo 16 (17.8%), P = 0.47). Change in other measured aspects of sexual function as well as total score of sexual function did not differ between the two treatments.ConclusionsThis study suggests that use of oestradiol-based COCs is associated with reduced sexual interest. However, the changes are minute, and probably not of clinical relevance.

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Objective: To increase the understanding of women who experience negative effects on sexual function when using hormonal contraception. Methods: We performed 24 in-depth interviews with women who had previously experienced negative sexual function effects while using hormonal contraceptives. The thematic analysis method was used. Results: 'After experience comes insight', 'Lubrication and desire go hand in hand', 'Mental wellbeing comes before desire' and 'The contraceptive counsellor potentially facilitates insight and decision-making' were the main themes found in the study. Conclusions: This selected group of women described lubrication difficulties and decreased sexual desire associated with both contraceptive use and the menstrual cycle. Contraceptive use became easier with age and with better understanding. The contraceptive counsellor could facilitate the process. Further choice between hormonal or non-hormonal contraceptive methods depended primarily on experienced adverse effects on mood, and secondarily on sexual function, weighed against the advantages or disadvantages experienced during the person's own menstrual cycle.

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Professor emeritus Mats Hammar, my main supervisor. How lucky I am! I have enjoyed your patience, warmth, humour, and never-ending interest in whatever was on my mind. You have supported me in many ways. Your trust in me and my work has made me grow and has kept me going on with research at times when I preferred to give it up. I am grateful for the time I spent with you. Observing how you act has taught me invaluable skills concerning research, clinics, and being a colleague. You are also a role model for multi-tasking and how to balance it with a rich private life. Professor Jan Brynhildsen, my co-supervisor. You have been following this project with enthusiasm and readiness to provide support and constructively criticise whenever needed. You have shown me a way of simple, comprehensive and first-class scientific writing and thinking! Thank you, all the women participating in the studies! Especially all of you participating in the interview study, openly sharing your thoughts with us. The trust you showed in us and in research was the fuel of the study. Professor Carina Berterö, without you, qualitative methodology would still be just a strange unknown part of research. Your patience, clear instructions and wisdom, have introduced me to a method that I'm now ready to repeat. Professor Inger Sundström-Poromaa, thank you for inviting me to participate in an RCT study. It has been a very educative journey. You are in many ways a most impressive person. Professor Elvar Theodorsson, thank you for your contributions and explanations that made some of the hormonal chemistry understandable. Cecilia Lundin! Thanks to our research study I have met a wonderful colleague, someone thinking out of the box, and a friend. I have a feeling that collaboration with you has just begun… iv Dear Louise Brynte, I'm grateful that I have got to know you. The interview study wouldn't have been the same without you. I hope that I mostly have given you a positive picture of research and the clinical work… Gabriella Falk, thank you for your endless encouragements, support and valuable opinion. Mats Fredriksson, you have not only helped me out with statistics but also taught me to not panic about it and to understand vital parts of it. Thank you! Elin Persson, such a good and thorough work you did that summer of 2013! Wherever you are nowadays, I hope you have found your way becoming a medical doctor and of course a researcher. Julia Slezak, thank you for a fruitful collaboration. Cecilia Rostedt, thank you for taking such good care of the study patients, the protocols, and my recurring confusion. Hua Dock, thank you for all the hours of hair-cutting and weighing. It would have given me gray hair to finish on my own… Thank you, Charlotte Ginstman, Ninnie Borendal-Wodlin and Gunilla Sydsjö for reading this book and giving valuable feedback before it was too late. Tack till: Alla kollegor och sköterskor både på US och Ryhov för ert intresse, trevliga samtal och kluriga frågor. Särskilt tack till Anna Ramö, Emelie Wolgast, Sofia Nevander, Anna...