Annals of Obvious: Sexual Side Effects of Birth Control Are Complicated

I do not shy away from discussions of how hormonal birth control can cause a reduction in desire (among other, more acutely disagreeable side effects) in some patients--indeed, I experienced it myself. But I wanted to add a few points to the debate about this research. Jezebel posted* on a German study on the sexual side effects of birth control and here is my take.



First, this study's sample is large but very homogenous--every participant was a German medical student. The authors say: "Although this [homogenous sample] simplifies interpretation for this specific group, the results cannot be applied to broader populations."



Secondly, the researchers specifically examined whether different preparations of pills had disparate effects on the Female Sexual Function Index (FSFI) scores of participants, and there was no difference between pills that had androgenic or anti-androgenic progestins nor was there a dose-response relationship among pills that had low-, medium- or high- doses of estrogen ethinylestradiol. This doesn't necessarily mean that hormonal contraceptives don't affect sexual desire and function--indeed, we know they do--but it means that there is a more complex problem that has yet to be solved. From the researcher's conclusion:

"According to our online investigation, neither androgenic or antiandrogenic progestins in OCs nor the EE dosage in the OCs used significantly influenced sexual function in German medical students. Oral contraceptive users, however, did have lower FSFI scores than users of nonhormonal contraceptives or no contraception at all. These results could be explained by two alternative hypothesis: (1) The difference in FSFI scores between users and nonusers of OCs is not due to biological actions of the steroids but due to differences in psychosocial variables (personality, relationship, sexual script, etc.) between the two groups. (2) The difference in FSFI scores may indicate that even small dosages of steroids have a direct influence on the sexual response of women. This effect would then not be dose or type dependent. We will need further studies to understand these interactions better and to clarify which hypothesis holds true."

I'm inclined to go with hypothesis #2, but we have yet to see research proving it true. Further, I would caution casual readers of research to be wary of the measurements taken in this study because while the researchers declare no conflicts of interest and the research itself was not funded by any pharmaceutical company, there is tremendous bankroll behind the effort to zero-in on Female Sexual Dysfunction is and create profitmaking drugs to treat it.



This paper seems transparently critical of hormonal contraception's role in female sexual desire (and for that I applaud it) and function but there is a real risk in the medicalization of women's sex lives. Women respond to and enjoy sex in a variety of ways and save for the very few who have real, diagnosable, treatable dysfunctions, I implore those who comment on this type of research to keep in mind that putting weight behind the specter of "female sexual dysfunction" will not necessarily help women--it will line the pockets of pharmaceutical companies interested in exploiting women's insecurities.



You can read extensive critique about the invention of Female Sexual Dysfunction at the New View Campaign founded by one of my heroes, Dr. Leonore Tiefer.

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Annals of Obvious is an occasional series wherein Julie Sunday reads popular research articles in full because nobody else does.





*And also, they headlined it "No Shit"--methinks somebody is reading HTHSIT and stealing story ideas.