Friday, February 22, 2019

Loss of Libido – The ultimate irony

Loss of Libido – The ultimate irony

The pill's dark secret
By Valerie Nahmad
From the Chicago Tribune
Special to the Tribune
July 16, 2003

Two months ago a New York woman called her gynecologist to find out whether
her birth control pills were ruining her sex drive.

It would be the ultimate irony. Could medication created to liberate women
be the cause of her yearlong struggle with a waning libido? Could the pill
really reduce sex drive?

Turns out it can.

"I called my gynecologist and she said 'Oh yeah, that's a side effect,' "
said the woman, who is 24 and did not want her real name used. "It was like
she expected it--I couldn't believe she never mentioned that it could

The woman's gynecologist is just one member of a larger scientific community
that routinely downplays a problem that's serious enough to make the pill's
list of side effects, but not serious enough to merit much attention in
research labs. The exact cause is unknown and the issue is rarely discussed,
but it is a medical fact that oral contraceptives can cause sexual
dysfunction in women, often in the form of decreased libido, vaginal dryness
and painful intercourse.

The issue has been studied only twice since the pill's appearance in
American markets 40 years ago. Research is so insufficient that doctors do
not know which pills are more likely to cause sexual dysfunction, which
patients are more likely to suffer from it or how to best treat it. Doctors
speculate that the effect is triggered by the pill's manipulation of various
hormones, including testosterone, estrogen and progesterone, but they cannot
say for sure.

"It's pretty shocking there's so little research," said Cynthia Graham,
clinical assistant professor of gender studies in the department of
psychiatry at Indiana University and director of graduate studies at the
Kinsey Institute for Research in Sex, Gender and Reproduction in
Bloomington, Ind. "There's been a real neglect in this area."

Dr. Michael Eisenberg, an obstetrician and gynecologist in Buffalo Grove,
agrees. "Many women and many physicians are not well versed in women's
sexuality," he said. "It should be addressed--sexuality is very important to
the human condition and women routinely rate it very highly in quality of
life factors."

Fine print on page three

Unfortunately, the issue of sexual dysfunction is not addressed in
scientific studies about the pill. What is addressed is its potential role
in increasing the risk for heart attack, blood clotting and breast cancer.
These and other vital concerns are bolded, boxed and graphed at the
beginning of contraception packaging.

But, buried, for example, on page three of the patient information packet
for the oral contraceptive Ortho Tri-Cylen, between advisory precautions and
administration directions, is a 20-item list even thorough users could
easily overlook. Item 18 on the list--"the following adverse reactions have
been reported in users of oral contraceptives and the association has
neither been confirmed nor refuted"--reads "changes in libido." This
seemingly inconsequential effect may be surprisingly significant to the
everyday lives of many women.

An estimated 16 million women take oral contraceptives, which works by
releasing synthetic hormones into the bloodstream to prevent the ovaries
from releasing eggs. Yet, U.S. government surveys indicate that as many as
29 percent of these women switch medications or discontinue use within one
year of beginning treatment. Sexual dysfunction may be a leading cause of
this dissatisfaction, according to a 2000 study conducted at the Kinsey

The study followed 79 women in sexually active relationships and found that
emotional and sexual side effects were the best predictors of
discontinuation and switching. Fifty-nine percent of the women switched
pills or discontinued use within one year. Of these women, 87 percent cited
decreased frequency of intercourse and/or spontaneous sexual thoughts,
difficulties with arousal and negative mood changes as cause of
dissatisfaction. The sample size is small, but the results are compelling,
according to Graham, one of the study's lead researchers.

"There is enough research to indicate that a subgroup of women suffer from
adverse sexual side effects as a result of oral contraception," Graham said.
"We can't pin down numbers or percentages, but they are there. There just
isn't enough research to answer any more questions."

A 1995 study

Other than the Kinsey project, there has only been one study specifically
addressing the issue.

A 1995 placebo-controlled, double-blind study involving 150 women from
Manila, Philippines, and Edinburgh, Scotland, compared the hormonal effects
of different chemical types of oral contraceptives. The study found varying
effects among the women, ranging from decreased libido to improvements in
mood. Researchers offered no concrete findings about cause, effect or
prevalence, but concluded that oral contraception can cause sexual
dysfunction in some women.

"I probably see it in about 5 percent of my patients," confirmed Debra
Kenward, an obstetrician and gynecologist in Miami. "It's not real common,
but it's not something to ignore."

But researchers have largely ignored it. Graham attributes this neglect to
several factors, most notably funding, gender bias and stereotypical
thinking. Concerning funding, drug companies are not particularly interested
in conducting research that could potentially discourage women from taking
the pill, particularly when gender stereotypes tend to diminish the
importance of the issue.

"Women's sexual interest is often viewed as less important than men's,"
Graham explained. "There is this belief that it won't have as big an
influence on relationships because men traditionally initiate sex."

This stereotype is further proved by the fact that studies on the male
contraceptive pill, which is still in development, are researching potential
effects on libido and erectile function, she said.

"Sexual side effects might be a trivial effect compared to blood clots,"
explained Graham. "But they're not trivial when you're discussing a woman's
relationships and moods, and her and her partner's relationship

Graham acknowledges that the issue is difficult to study because of the risk
of pregnancy with placebos and the subjectivity of self-reporting, but she
insists effective studies can be performed.

"There are more difficult areas that have been researched," she said. "I
think there is just a general reluctance to accept that there are some
negative effects of the pill."

Benefits and drawbacks

Indeed, there are several benefits to oral contraception, most notably its
role in liberating women from pregnancy concerns.

It also is believed to reduce premenstrual and menstrual symptoms, lessen
the severity and frequency of acne, protect against osteoporosis and reduce
the risk of endometrial and ovarian cancers.

Unfortunately, like many medications, the pill has its drawbacks as well as
its benefits. Doctors can offer little concrete treatment advice for women
suffering from sexual dysfunction as a result of the pill.

Eisenberg emphasizes the difficulty in isolating the pill as the sole cause
of sexual dysfunction.

"The whole idea of libido and sexuality is so multifactorial, you can't
necessarily ascribe it specifically to any one factor," he explained, noting
that decreased libido could be caused by thyroid, depression, medication or
several other conditions. "Sexual function and dysfunction are perhaps the
supreme example of a blending of mind and body," he added. "It's hard to
separate one from the other. But, sexual dysfunction is a problem and I
think it has some solutions to it."

Typical recommendations include switching pills or experimenting with a
different form of contraception, such as injection, patch or IUD. Sex
therapy is also an option. Kenward says it's most important that women speak
with their doctors.