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Are the birth control pills ruining your sex life? Maybe, say experts – but it’s complicated.
When comedian Whitney Cummings joined Rachel Bilson during the March 13 episode of the actress’ “Broad Ideas” podcast, both women shared that they had never orgasmed from sex until they stopped taking hormonal birth control pills.
Difficulty achieving orgasm or decreased 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 these problems is mixed, she added.
Most people who take the pill won’t experience any change in libido, while some will see it go up and others will see it go down, Gordon said.
If you experience roadblocks during intimacy, however, there are ways to balance pleasure and protection, Gordon said.
Why will birth control pills mess with your sex life?
The way the combined pill works — with both progesterone and estrogen — prevents ovulation, said Dr. Alyssa Dweck, a gynecologist based in New York.
Not ovulating could mean not having a surge of hormones in a menstrual cycle that motivates someone to have sex so the species can continue to reproduce, she added.
Another theory is that the estrogen-containing pill increases a protein in the liver that binds testosterone, meaning there is less free testosterone in the blood and therefore potentially less sex drive or more difficulty orgasming, Dweck said.
“There’s been a lot of controversy on this topic for years,” Dweck said. “I’ve been in practice (for), about 29 years, and this has been a matter of discussion the whole time.”
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 can be caused to some degree by many factors, she said.
Yes, birth control can change desire levels, but the pregnancy protection it offers 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 off it, so the partner you couldn’t keep your hands off may become less appealing, 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 such cases, working with a mental health professional may be a good place to start.
The problem can also be physiological. It’s hard to have sex when you expect dryness or pain during intimacy, Gordon said.
That’s when it’s important to see a gynecologist, especially one focused on sexual health, Gordon said.
When it comes to sex, good communication is always a good idea.
Talking about arousal and pleasure can be especially sensitive, since the other partner may take a lack of desire as a criticism, said Dr. Kristen Mark, professor of sexual health education at the University of Minnesota Medical School.
“Sexual criticism … can be particularly, like, hard to take. And we tend to take those things more personally than other kinds 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 how you feel about the other person.
Your opening might sound like this: “I’m bringing this up because I want to be as good with our sex life as I can be, and I know we can be good with our sex life. So I just want to talk to you about some of these things.”
Broach the subject casually to avoid sounding like too big a deal. It is especially important to start the conversation in a positive environment – and not in the heat of an argument, she added.
For some people, a temporary break from the medication may be helpful, Dweck said.
Stopping the pill for three months can allow you to see if the symptoms you’re experiencing are related to the medication, she added.
But the exploratory plan won’t work for everyone. Some people use birth control pills to manage other conditions, such as severe cramps, hormone imbalances or acne, Dweck said.
It’s important to work with your healthcare provider to assess whether other birth control methods can offer the birth control protection, 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, then it’s time to talk to your doctor,” Mark said.
For some people, there may be medications 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 most 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 emphasized.
