Are your birth control pills ruining your sex life? Maybe, experts say — but it's complicated.
When comedian Whitney Cummings joined Rachel Bilson during the March 13 episode of the actor's "Broad Ideas" podcast, both women shared that they had never had an orgasm from sex until they stopped taking hormonal birth control pills.
Difficulty reaching orgasm or a lowered sex drive is not an uncommon experience, especially for women and people with female genitalia, said Dr. Elisabeth Gordon, a sexual health psychiatrist based in New York City. But the evidence on whether birth control causes those problems is mixed, she added.
Most people taking birth control pills will not experience any change in their libido, while some will see it go up and others will see it go down, Gordon said.
If you are experiencing roadblocks to during intimacy, however, there are ways to balance pleasure and protection, Gordon said.
What it may be doing to your body
Why would birth control pills mess with your sex life?
The way combination pills work — with both progesterone and estrogen — prevents ovulation, said Dr. Alyssa Dweck, a gynecologist based in New York.
Not ovulating might mean not having the surge of hormones in a menstrual cycle that motivates someone to have sex so the species can keep reproducing, she added.
Another theory is that the pill containing estrogen increases a protein in the liver that binds testosterone, which means there is less free testosterone in the bloodstream and therefore potentially less sex drive or more difficulty with orgasm, Dweck said.
"There's been a lot of controversy about this subject matter for years," Dweck said. "I've been in practice (for), like, 29 years, and this has been an issue of discussion for that entire time."
Where to start
Generally speaking, if turning on a man takes a light switch, turning on a woman takes mission control, Dweck said.
And that means that for many people, the inhibition of drive could be caused by some degree of many factors, she said.
Yes, birth control may change desire levels, but the pregnancy protection it offers allows some people to engage in their sexuality with more freedom, Gordon said.
Who you are attracted to on the pill could also be different than who you are attracted to off of it, so the partner you couldn't keep your hands off of could become less appealing, Dweck added.
But stress in other aspects of life and previous trauma may also make it harder to want and enjoy sex, Dweck said. In those cases, working with a mental health professional may be a good place to start.
The problem could also be physiological. It's hard to want sex when you are anticipating dryness or pain during intimacy, Gordon said.
That's when it's important to see a gynecologist, particularly one with a focus on sexual health, Gordon said.
Talking to your partner
When it comes to sex, good communication is always a good idea.
Talking about arousal and enjoyment can be especially sensitive, as the other partner may take the lack of desire as a criticism, said Dr. Kristen Mark, a professor of sexual health education at the University of Minnesota Medical School.
"Sexual criticism ... can be particularly, like, tough to take. And we do tend to take those things more personally than we might other types of conversations," Mark said.
As with most relationship conversations, Mark recommended keeping yourself centered in the conversation and making it about your own experiences and intentions, rather than about how you feel about the other person.
Your opening could sound like this: "I'm bringing this up because I want to feel as good about our sex life as I can, and I know that we can feel great about our sex life. So, I just want to talk to you about some of these things."
Broach the subject in a casual manner to avoid it sounding like too big of a deal. It's especially important to bring up the conversation in a positive environment — and not in the heat of an argument, she added.
What works for one may not work for another
For some people, a temporary break from the medication might be helpful, Dweck said.
Pausing the pill for three months could allow you to see if the symptoms you are experiencing are tied to the medication, she added.
But that exploratory plan won't work for everyone. Some people use birth control pills to manage other conditions, like severe cramps, hormone imbalances or acne, Dweck said.
It is important to work with your health care professionals to assess whether other birth control methods could offer the contraceptive protection, symptom management and sexual spark you are looking for, she added.
"I think that if it's really impacting your relationship or your own well-being then it's time to talk to your doctor," Mark said.
For some people, there may be medication available to increase sex drive.
Seeing a sex therapist is often helpful for these issues, but not everyone has access to these professionals, Gordon said.
The main thing to remember is that sexuality is individual, and what works for someone may not work for the next person. Work with your medical and mental health providers to find what is best for you, Mark emphasized.
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