Hormonal Contraception and Female Sexuality: Position Statements from the European Society of Sexual Medicine (ESSM)

Abstract

Introduction Hormonal contraception is available worldwide in many different forms. Fear of side effects and health concerns are among the main reasons for not using contraceptives or discontinuing their use. Although the safety and efficacy of contraceptives have been extensively examined, little is known about their impact on female sexual function, and the evidence on the topic is controversial. Aim To review the available evidence about the effects of hormonal contraceptives on female sexuality in order to provide a position statement and clinical practice recommendations on behalf of the European Society of Sexual Medicine. Methods A comprehensive review of the literature was performed. Main Outcome Measure Several aspects of female sexuality have been investigated, including desire, orgasmic function, lubrication and vulvovaginal symptoms, pelvic floor and urological symptoms, partner preference, and relationship and sexual satisfaction. For each topic, data were analyzed according to the different types of hormonal contraceptives (combined estrogen-progestin methods, progestin-only methods, and oral or non-oral options). Results Recommendations according to the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence criteria and specific statements on this topic, summarizing the European Society of Sexual Medicine position, were developed. Clinical Implications There is not enough evidence to draw a clear algorithm for the management of hormonal contraception-induced sexual dysfunction, and further studies are warranted before conclusions can be drawn. A careful baseline psychological, sexual, and relational assessment is necessary for the health care provider to evaluate eventual effects of hormonal contraceptives at follow-up. Strengths & Limitations All studies have been evaluated by a panel of experts who have provided recommendations for clinical practice. Conclusion The effects of hormonal contraceptives on sexual function have not been well studied and remain controversial. Available evidence indicates that a minority of women experience a change in sexual functioning with regard to general sexual response, desire, lubrication, orgasm, and relationship satisfaction. The pathophysiological mechanisms leading to reported sexual difficulties such as reduced desire and vulvovaginal atrophy remain unclear. Insufficient evidence is available on the correlation between hormonal contraceptives and pelvic floor function and urological symptoms.

Is Mode of Delivery Associated With Sexual Response? A Pilot Study of Genital and Subjective Sexual Arousal in Primiparous Women With Vaginal or Cesarean Section Births

“…A substantial proportion of the sample (42%) was on hormonal contraceptives, and although research suggests that the majority of women on hormonal contraceptives do not experience a general change in sexual function, there is some evidence to suggest that hormonal contraceptives reduce lubrication and arousal. 78 In the present study, more women in the NP group were on hormonal contraceptives than the postpartum groups; thus, if hormonal contraceptive use dampened physiological arousal, one would expect this effect to be more pronounced in the NP group. Therefore, it is possible that the large effect sizes found in the present study may actually be an underrepresentation of the magnitude of this effect.…”

Do high‐dose progestins impair sexual function in women treated for endometriosis? A prospective observational longitudinal study

“…Recently, reduction in libido and alterations to sexual functioning have been reported in a minority of women using progestogens and estrogen-progestogens as hormonal contraception. 20 This study included all women using hormonal contraception and did not focus on the specific population of women with endometriosis. Although hormonal treatment can positively affect sexuality by reducing pain, they could also have negative impacts on desire, arousal, lubrication, and orgasm.…”

“…First, we tested the impact of several factors on the SAQ score at T1, adjusted for the SAQ score at T0. Those factors were “pain as the main indication for endometriosis consultation at T0,” “pelvic pain >70 mm at T0,” “dysmenorrhea >70 mm at T0,” “deep posterior endometriosis at T0,” 17 “assisted reproductive technology (ART)” (for infertile women), 18 “EQ‐5D >0.83 (median index in the population) at T0,” “depression or anxiety at T0,” 19 “exposure to high‐dose progestin at T1,” and “exposure to other hormonal treatment at T1” (micronized progestin pills, micronized progestin device, combined oral contraceptive pills, or a gonadotropin‐releasing hormone agonist) 20 . These are all dichotomous (yes/no) factors.…”

“50 Shades of sex” under hormonal contraception

“…It has been as well a formidable weapon turned against gender inequality breaking new ground in relationships and social roles, even though family planning is an unfinished agenda. The use of HC has driven sexual revolution at multiple levels giving people the possibility to separate sexuality from procreation reliably and to experience pleasure and intimacy in a biopsychosocial perspective [1]. However, health care providers (HCPs) face the challenge of women reporting sexual side effects of HC, which have been proven in some longitudinal studies in conjunction with mood side effects [2,3] and may influence adherence and satisfaction with a given prescription in high-income countries.…”

“…However, health care providers (HCPs) face the challenge of women reporting sexual side effects of HC, which have been proven in some longitudinal studies in conjunction with mood side effects [2,3] and may influence adherence and satisfaction with a given prescription in high-income countries. In spite of the amount of research in this field, mainly pointing at finding differences related to the biochemical characteristics of both estrogens and progestogens, there are still several gaps in our understanding of the impact of HC on sexuality [1]. The majority of studies aimed at capturing the role of changing the hormonal environment in the domains of the sexual response have presented inconclusive results, not allowing at present to draw a clear algorithm for the management of HC-induced sexual dysfunction.…”