Sexual function and combined oral contraceptives: a randomised, placebo-controlled trial

Abstract

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.

Sexual function changes attributed to hormonal contraception use – a qualitative study of women experiencing negative effects

“…The existing literature is conflicting and mainly based on observational studies and a few randomised clinical trials focussing on the question of causality, comparisons between different oral contraceptives and reproductive hormone level changes [4][5][6]. One randomised study found no causality [7], another reported a small but clinically nonsignificant negative effect of combined oral contraceptives on sexual desire and lubrication [6]. Despite these uncertainties, many women may attribute impaired sexual function to their hormonal contraceptives, leading to difficulties finding a suitable method [8].…”

Friend vs. Foe: Cognitive and Affective Empathy in Women With Different Hormonal States

“…Regarding modulating effects of hormonal status, sex hormone related differences have been observed in various emotional processes ( Montoya and Bos, 2017 ; Lundin et al, 2018 ; Lewis et al, 2019 ), including empathy components such as emotion recognition and affective responsiveness ( Derntl et al, 2013 ). In line with former studies ( Derntl et al, 2013 ; Radke and Derntl, 2016 ), hormonal status was associated to differences in the affective component of empathy.…”

“…With regards to hormonal status, evidence is accumulating that female sex hormones like estradiol and progesterone (i.e., endogenous as well as synthetic) affect a variety of socio-emotional processes such as mood, fear processing, and sexual desire as well as arousal ( Montoya and Bos, 2017 ; Lundin et al, 2018 ; Lewis et al, 2019 ). It has been suggested that menstrual cycle dependent as well as OC-induced changes in mental states and behavior may be explained by a differential binding of endogenous (i.e., due to changing concentrations) as well as synthetic sex steroids (i.e., due to slightly different binding properties) to receptor sites of brain regions involved in socio-emotional processing (e.g., limbic areas and frontal cortex; Toffoletto et al, 2014 ; Barth et al, 2015 ; Louw-du Toit et al, 2017 ).…”

“…This differential binding and the resulting changes in transcription cascades can lead to hormone-induced changes of neural activity as well as brain morphology ( Toffoletto et al, 2014 ; Barth et al, 2015 ; Rehbein et al, 2021 ). Due to these modulatory effects of hormonal status on brain regions relevant for socio-emotional processing, it would not be surprising if next to influences on mood, fear processing and sexual desire ( Montoya and Bos, 2017 ; Lundin et al, 2018 ; Lewis et al, 2019 ), hormonal status also affected empathy.…”

Sexuality and mood changes in women with persistent pelvic girdle pain after childbirth: a case-control study

“…It was initially validated in post-menopausal women but has shown reliability and validity in university women as well [15]. The Swedish version has been used in studies on oral anticontraceptive [16] and polycystic ovarian syndrome [17]. The original MFSQ contains 19 items, but several studies have used shorter versions, in which the number of items varies from nine to 17.…”