Oral Contraceptives and Female Sexual Dysfunction
A recent survey published by The National Center for Health Statistics revealed that 64.9% of the female population in the United States used some form of birth control on a regular basis. While forms of birth control vary from oral pills, implantable methods (IUD’s), barrier methods or sterilization, oral contraceptives were the most commonly used method of birth control for women ages 15 to 49 (excluding sterilization/hysterectomy). Oral contraceptives, or birth control pills, are frequently used in traditional American medicine to prevent pregnancy, normalize menstrual cycles, manage ovarian conditions such as PCOS, or mitigate menstrual cycle related symptoms. Unfortunately for many patients, the use of oral birth control may have long-term, undesired side-effects, one of the most common being sexual dysfunction.
Most oral contraceptives contain two active synthetic hormone derivatives; a progesterone, such as norethindrone, and an estrogen, such as ethinyl estradiol. These products are non-bio-identical, meaning they interact with the same receptor sites as human hormones but are not molecularly the same, and therefore may interact differently with human tissue than the hormones they are meant to replace. Use of these hormones results in neuro-endocrine suppression of the communication loop between the hypothalamus, pituitary, and ovaries (HPO-Axis), that is responsible for regulation of sex hormone production, follicle production, ovulation and menses. In short, oral contraceptives reduce or stop the patient’s normal ovarian function.
Oral contraceptives may mitigate symptoms of the loss of natural progesterone and estrogen production by replacing them with synthetic hormones, however, there is no additional provision for the loss of patients’ endogenous production of testosterone from the ovaries. Patients may maintain some low level of testosterone output, sourced primarily from the adrenal glands. Unfortunately, oral birth control also raises the livers production of certain proteins, like sex hormone binding globulin (SHBG), that when bound to testosterone renders it unable to interact with cellular receptor sites. The combination of suppression of natural testosterone output from the ovaries and increased output of SHBG leaves women on oral contraceptives with a chronic deficiency of free, or usable testosterone.
Low testosterone impacts women with a myriad of negative side effects; fatigue, lethargy, depressive symptoms, compromised lean muscle mass, loss of bone density, metabolic dysfunction, exacerbation of inflammation, and sexual dysfunction. Testosterone has a multifaceted influence on female sexual response. It is largely responsible for regulation of libido and sexual excitation, but also plays a critical role in regulation of genital tissue health. The erectile tissue of the clitoris as well as vulvar vestibule are regulated by Testosterone. Long term deficiency of testosterone can result in loss of libido, atrophy or loss of sensitivity of the clitoris, and reduced vestibular function. Vulvar vestibular dysfunction often results in vestibulitis, or inflammation of vestibular tissue near the vaginal entrance, a common cause of dyspareunia, or painful intercourse for female patients. Long-term testosterone deficiency without correction will often result in progressive worsening of these conditions.
Luckily, there is help available! Patients with a history of long term oral contraceptive use or non-OCP use related testosterone deficiency can help resolve sexual dysfunction with bio-identical testosterone replacement. Additional modalities of therapy, such as localized testosterone application, or PRP (protein-rich-plasma) rejuvenation therapy, can significantly improve the health clitoral and vulvar vestibular tissue, resulting in a more satisfying sex life and improved quality of life.
Author: Joseph Matovich