What You Need To Know
Like most OB/GYNs, I’ve prescribed my share of birth control pills, even though I’ve long argued that there are safer alternatives that are just as effective when used conscientiously. As long as you don’t mind putting your ovaries on "automatic pilot" and ignoring your fertility, there’s nothing that comes close to the pill for sheer convenience. That’s why oral contraceptives (OCs), which ushered in the sexual revolution in the 1960s, are now used by more than 100 million women worldwide, many of whom love them and do well on it. But like most magic bullets, the pill definitely has a downside. And a very significant downside is, ironically, the fact that the pill can significantly lower sex drive!
Recent research published in the January 2006 issue of the Journal of Sexual Medicine found that birth control pills significantly decrease circulating levels of testosterone, a hormone that is strongly associated with optimal sexual functioning. The result is diminished sexual interest, sexual arousal, initiation of sexual activity, and also sexual enjoyment. Since I’ve seen this for years in many (but not all) patients on the pill, I was very happy to learn of this new research, which confirms that the pill’s effect on libido is "not all in a woman’s head!"
Birth control pills are comprised of potent synthetic estrogens (for example, ethinyl estradiol) and synthetic progestins (for example, norethindrone) that diminish the levels of follicle stimulating hormones (FSH) and luteinizing hormone (LH), two pituitary hormones. This results in the metabolic suppression of ovarian function, including both the suppression of ovulation and testosterone production!
In addition, OCs also cause a marked increase in the production of sex hormone binding globulin (SHBG) in the liver. (This is the main binding protein for sex steroids.) The higher the SHBG levels, the more hormones are "bound" and unavailable for biologic effects on tissues. In the recent study on the pill’s effect on testosterone, researchers found that SHBG levels were four times higher in pill users than in those who had never used the pill. This means that although a woman taking OCs produces testosterone in her body, it’s unavailable for normal uses such as stimulating her sex drive.
Even more worrisome is that SHBG levels remained elevated in women for at least six months after they stopped taking the pill, after which the study was concluded. No one knows how long this effect lasts, but researchers are concerned that prolonged exposure to synthetic hormones induces gene-imprinted and increased gene expression of SHBG in the liver in some women who have used the pill.
Dr. Claudia Panzer, an endocrinologist in Denver, Colorado and the lead author of the study, was quoted in a press release issued on January 3, 2006. She said, "It is important for physicians prescribing oral contraceptives to point out to their patients potential sexual side effects, such as decreased desire and arousal, decreased lubrication, and also increased sexual pain. Also if women present these complaints, it is crucial to recognize the link between sexual dysfunction and the oral contraceptive, and not to attribute these complaints solely to psychological causes." (For more information, contact Blackwell Publishing.) I certainly agree with Dr. Panzer!
Spiritual and Holistic Options
Of course there are many causes of decreased sex drive. From what I’ve seen, the most common for women in their childbearing years is lack of sleep! Couples need to make time for each other, too. That’s why I love the new country music song by Reba McIntyre called "Love Needs a Holiday," about a couple who takes a weekend away to rediscover each other. To listen to a clip, please visit the Reba McIntyre Official Web site. Here are tips for putting some sizzle in your sex life—whether you’re on the pill or not.
- If you’re on the pill, it agrees with you, and you like it, I recommend you stay with it. Just be sure to take a good multivitamin/mineral, rich in the B vitamins. The hormones in the pill change a large number of metabolic functions in your body, including putting increased pressure on the liver to metabolize those synthetic hormones. When you take a good multivitamin/mineral regularly, you provide your body with the materials it needs to do its job well!
- If you’re on the pill and you’re worried about whether to continue with it, I recommend you stop taking it. But be sure you’re willing to "make friends with your fertility" and know exactly how to prevent or achieve pregnancy at will.
- Use your brain to turn yourself on! The brain is the biggest sex organ in the body. Newer research on sex drive and menopause has found that the most important factor in ensuring an optimal sex drive is the ability to turn yourself on with your own thoughts. This includes deciding to feel sexy. That’s right. When a woman knows how to use her own mind to arouse herself, she is far more apt to have a satisfying sex life—with herself or with a partner.
Let me suggest an exercise I learned from Laura Bushnell, author of the delightful book Life Magic: The Renowned Psychic Healer Shares Her 7 Keys to Finding Your Power and Living Your Purpose (Miramax-Weinstein, 2005). Imagine that there is a giant mirror over your head that broadcasts how you feel to the world. Write the following on that mirror in red lipstick: "I am an irresistibly sexy woman. I am magnetically attractive to pleasure now!" Visualize that mirror over your head wherever you go. The more you practice this, the more sexually fulfilling your life will become.
Consider reading novels or renting movies that contain sexual content to help you get in the mood. For movies, I recommend Two Moon Junction, Dangerous Beauty, and Delta of Venus. For books, you can’t beat Valley of the Horses by Jean Auel or Outlander by Diana Gabaldon. Of course Kathleen Woodiwiss writes some good steamy romance novels too, just not as sophisticated.
- Plan for pleasure. Most people operate under the erroneous belief that sex is supposed to be spontaneous, and that there is something wrong with your sex life if you plan for it. Nothing could be farther from the truth! If you want to have a good sex life, you have to pay attention to it. What we pay attention to expands. That means making time for arousal and sex, even if it means jotting it in your Day Timer! (By the way, that includes making time for self-pleasuring, too!)
- Take advantage of your natural sexual cycles. The menstrual cycle is designed so that your libido peaks during two phases: the three-day period surrounding ovulation, and, ironically, just before the onset of menses—proof to me that sex is about far more than just procreation. It’s also re-creation in the finest sense of the word. During ovulation, the body produces more testosterone, which increases sex drive, and it produces potent pheromones that waft into the air and make you more sexually attractive to others. To read further research on pheromones, please visit the Athena Institute or Love Scent. (Hint: You can also help nature along with some purchased pheromones!)
But you don’t need to ovulate to experience sexual arousal. As I said before, your brain is set up to do a fine job of this for a lifetime—long after you’ve stopped ovulating.
- Give yourself a "tune and a lube." There are times in every woman’s life (for example, after childbirth, after chemotherapy or illness, or during menopause) when vaginal dryness can decrease sexual pleasure. For many women, all that is necessary to slide through these dry spells is a little lubrication.
For some women, non-hormonal lubrication is not enough. They require the effect of estrogen, which thickens the vaginal and outer urethral tissues as well as the covering of the clitoris—that lovely little organ that has 8,000 nerve endings and whose sole purpose is for pleasure. All that is necessary is a dab of estrogen cream (available by prescription) on the clitoris and/or in the vagina daily for a week, then twice per week thereafter. There is no substantial increase in blood levels of estrogen when you use the cream this way. I recommend you use the lowest dose necessary (the amount of cream needed is about the size of a penny). It takes a week or two to estrogenize vaginal and clitoral tissue, so you have to use it daily. But after that twice a week is all that’s necessary. Regular vaginal stimulation, in and of itself, also helps keep vaginal tissue resilient.
Some women will want to use systemic hormone replacement because in some (not all) it can help sex drive. If so, use bioidentical hormones and consult my book The Wisdom of Menopause for more information!
When it comes to sex—or anything else—each of us is unique. What works for one woman won’t work for another. And that includes the birth control pill. One thing I’m absolutely clear on, having spent a lifetime of study in this area, is that we are sexual beings by nature. Our sexuality is part of our spirituality. Allowing the life force from our sexuality to course through us is one of the most sublime experiences we are capable of in a human body. So take my advice. Embrace this aspect of your body and enjoy this part of your life in your own unique way!
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Last updated: August 21, 2009