Sexual Dysfunction and Metabolic/Hormonal Changes in Women Using Long-Term Hormonal and Non-Hormonal Contraceptives

Abstract

Background Female sexual dysfunction is a common condition that negatively impacts the emotional health and quality of life of the affected individuals. Long-acting reversible contraceptives (LARCs) are becoming increasingly popular due to their effectiveness and convenience. LARCs can be hormonal (etonogestrel releasing implant—ENG and Levonorgestrel intrauterine system—LNG) or non-hormonal (copper intrauterine device—CuIUD and copper-silver intrauterine device—SIUD). There are very few studies that assess the influence on LARCS on sexual function are lacking.This study aimed to assess changes in sexual function as well as metabolic and hormonal parameters in women after implantation with LARCs. Methods In this prospective cohort study, we assessed 80 women who visited the Military Police Hospital in Brazil for LARCs placement. The study participants were divided into 4 groups according to the type of LARC received: ENG n = 17; LNG n = 21, CuIUD n = 18 and SIUD n = 23. The four groups were evaluated twice (prior to LARC placement and approximately 3 months later) for sexual function, using the Female Sexual Function Index (FSFI) and Female Sexual Quotient (QS-F) questionnaires. Metabolic and hormonal parameters were also assessed using blood tests. p < 0.05 was considered to indicate statistical significance. Results We observed an improvement in sexual function with CuIUD placement according to QS-F (p < 0.017) and SIUD (FSFI: p = 0.06 and QS-F: p < 0.001). However, ENG worsened sexual function according to FSFI and QS-F (p < 0.001 and p = 0.003), across all domains. A decrease in sex hormone-binding globulin (SHBG) was observed for all groups (LNG: p = 0.019; ENG: p = 0.024; CuIUD: p = 0.010; SIUD: p = 0.022) and an increase in total testosterone levels (p = 0.007 and p = 0.003) and prolactin (p = 0.049 and p = 0.001) with CuIUD and SIUD placement. Hemoglobin levels increased with LIS (p < 0.001) and ENG (p = 0.025) and decreased with CuIUD placement (p < 0.001). Conclusion The use of non-hormonal LARCS improved sexual function, especially in the desire domain. Etonogestrel implants, had a negative influence on sexual function, probably by blocking ovarian function, and thus reducing the production of androgens and estrogens. SIUD placement was superior as it improved sexual function, interfered less with hormonal levels, and did not decrease hemoglobin levels.