The Latest on Birth Control Pills and Women’s Libido

In the U.S. in 2018, birth control pills were the most popular form of contraception, used by almost 10 million women. The Pill has consistently been the most popular method since 1982.

Oral contraceptives have been the subject of more than 44,000 research publications, but fewer than 100—less than one-half of 1 percent—have dealt with their impact on women’s libido and sexuality. Some show no effect or greater desire and improved sexual functioning, but most show diminished libido and increased risk of sexual problems.

How "The Pill" Works

Most birth control pills contain female sex hormones estrogen and progesterone (progestin). Formulations vary and, over the past 50 years, dosages have diminished. But whatever the formulation, the hormones in the Pill tinker with women’s pituitary hormones to suppress ovulation.

In addition, the Pill decreases ovarian production of androgens, the female form of testosterone that ignites sexual desire. Most women produce more androgens than necessary for fully functional sexuality, so despite Pill-induced suppression, most women still synthesize enough androgens to maintain libido and sexuality. But if women have low levels, to begin with, the Pill could reduce androgens to a level that might suppress women’s libido.

Sexual Effects Pro, Con, and Equivocal

The Pill has many effects that may increase erotic interest and improve sexual function. When used properly, it’s highly effective, eliminating anxieties about unintended pregnancy. The Pill also reduces premenstrual distress, menstrual cramping and bleeding, and risk of endometriosis and uterine fibroids. Family planning resources, notably Contraceptive Technology, the bible of birth control, emphasize the Pill’s pro-sexual effects, saying that at most 5 percent of Pill users report sexual difficulties. But with 10 million users, that 5 percent comes to 500,000 women with libido/sex problems. In addition, the substantial majority of recent research shows that many women experience modest-to-major declines in sexual desire and function:

• German researchers surveyed 2,612 female medical students. Among Pill users, 37 percent reported at least one sign of female sexual dysfunction, more than seven times the proportion suggested in Contraceptive Technology.
• Swedish investigators surveyed 3,740 women in their twenties. Among those taking the Pill or using other hormonal contraceptives (injected, implants, patches), 27 percent reported decreased desire.
• Lithuanian researchers started 40 women on the Pill and 40 others on non-hormonal contraceptives. Three months later, the Pill-users reported significantly lower libido and sexual arousal.
• Much research shows that women who don’t take the Pill have cyclical increases in sexual desire around ovulation midway between periods. This makes evolutionary sense. Most women are more interested in sex around the time intercourse is most likely to result in pregnancy. Belgian researchers tracked 89 couples. The Pill users showed no mid-cycle spike in libido and less frequent intercourse.
• The news isn’t all bad. Czech researchers reviewed 36 studies from 1978-2011, involving 13,673 women. Among Pill users, 22 percent reported more desire while 15 percent reported less. But that 15 percent is three times the proportion mentioned in Contraceptive Technology.

The Upshot

What should we make of this? For women plagued by PMS, severe cramps, endometriosis, fibroids, or heavy menstrual bleeding, Pill-induced relief may well enhance lovemaking. But for many other women, a growing body of research shows deflated libido and impaired sexual function.

If you take the Pill or are considering it:

• Understand that it may produce a wide range of sexual effects.
• Be sensitive to your own reactions. Disregard friends and clinicians who say, “The Pill doesn’t do that.” Actually, almost any sexual effect is possible.
• Consult an expert. Family doctors can prescribe the Pill, but if you notice any changes in your sexual demeanor, you might consider consulting a family planning or Planned Parenthood clinician who is probably more familiar with the nuances.
• Over time, continue to focus on your reactions. In some women, the Pill’s sex-impairing effects may take a year or more to develop.
• If the Pill’s disadvantages outweigh its advantages for you, choose another contraceptive. With proper use, many are equally reliable and do not interfere with sexuality. Counselors at family planning clinics or Planned Parenthood can discuss the pros and cons of all methods.