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Are your birth control pills ruining your sex life? Maybe, experts say, but it’s complicated.
When comedian Whitney Cummings joined Rachel Bilson on the March 13 episode of the actor’s “Broad Ideas” podcast, both women shared that they’d never had an orgasm from sex until they stopped taking hormonal birth control pills.
Difficulty reaching orgasm or a decreased sex drive is not an uncommon experience, especially for women and those with female genitalia, said Dr. Elisabeth Gordon, a sexual health psychiatrist based in New York City. But the evidence that birth control causes these problems is mixed, she added.
Most people who take birth control pills won’t experience a change in their libido, while some see it increase and others see it decrease, Gordon said.
However, if you’re experiencing roadblocks during intimacy, there are ways to balance pleasure and protection, Gordon said.
Why would birth control pills ruin your sex life?
The way combination pills work — containing both progesterone and estrogen — prevents ovulation, said Dr. Alyssa Dweck, a gynecologist based in New York.
Not ovulating may mean that there is no hormone surge during a menstrual cycle that motivates someone to have sex so that the species can continue to reproduce, she added.
Another theory is that the pill with estrogen increases a protein in the liver that binds testosterone, meaning there’s less free testosterone in the bloodstream and, therefore, potentially less sex drive or more difficulty having an orgasm, Dweck said.
“There’s been a lot of controversy on this topic for years,” Dweck said. “I’ve been in the practice for 29 years and this has been a point of discussion all along.”
In general, if turning on a man takes a light switch, turning on a woman takes over mission control, Dweck said.
And that means that for many people, drive inhibition could be caused by a number of factors, she said.
Yes, birth control can alter desire levels, but the pregnancy protection it provides allows some people to engage in their sexuality with more freedom, Gordon said.
Who you’re attracted to on the pill may also be different than who you’re attracted to without the pill, so the partner you couldn’t keep your hands off of could become less attractive, Dweck added.
But stress in other aspects of life and past trauma can also make it harder to want and enjoy sex, Dweck said. In those cases, working with a mental health professional can be a good place to start.
The problem can also be physiological. It’s hard to want sex if you expect dryness or pain during intimacy, Gordon said.
That’s when it’s important to see a gynecologist, especially one with a focus on sexual health, Gordon said.
When it comes to sex, good communication is always a good idea.
Talking about excitement and pleasure can be especially sensitive, because the other partner may view 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 extremely difficult to accept. And we tend to take those things more personally than other kinds of conversations,” Mark said.
As with most relationship conversations, Mark recommended putting yourself at the center of the conversation and talking about your own experiences and intentions, rather than how you feel about the other person.
Your opening might sound like this: “I bring this up because I want to feel the best I can about our sex life, and I know we can feel good about our sex life.” So I just want to talk to you about some of these things.
Discuss the topic in a casual way to avoid sounding too important. It’s especially important to start the conversation in a positive environment — and not in the heat of the moment, she added.
For some people, a temporary break from medication can be helpful, Dweck said.
Taking a three-month break from the pill will help you see if the symptoms you’re experiencing are related to the medication, she added.
But that exploratory plan doesn’t work for everyone. Some people use birth control pills to treat other conditions, such as severe cramps, hormonal imbalances or acne, Dweck said.
It’s important to work with your health care providers to assess whether other birth control methods can provide the birth control, symptom management and sexual spark you’re looking for, she added.
“I think if it’s really affecting your relationship or your own well-being, it’s time to talk to your doctor,” Mark said.
For some people, medications may be 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 important thing to remember is that sexuality is individual and what works for one person may not work for the next person. Work with your medical and mental health providers to find what’s best for you, Mark stressed.
