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Try out PMC Labs and tell us what you think. Learn More. The overwhelming majority of sexual activity occurs during times when women wish to avoid pregnancy; contraception is expressly deed for non-procreative sexual activity. Investigating both negative and positive aspects of contraceptive practices represents a vital and understudied area for the contraceptive field [ 2 ]. For example, researchers attempt to improve condom de by developing more pleasurable latex and non-latex varieties [ 2 ].
A study of hormonal-based contraception for men that ignored effects on erectile functioning or orgasm would be regarded as incomplete, even invalid. Contraception may affect any of these sexual functions. Condoms and other barrier methods have direct effects on sensation and lubrication, whereas hormonal contraception could directly affect factors such as libido and orgasm as well.
In a study comparing approximately women using hormonal methods to a similarly-sized group using non-hormonal methods of contraception exclusively, researchers found that women using hormonal methods experienced lower levels of arousal, decreased sexual pleasure, fewer orgasms and more difficulties with vaginal lubrication, even when controlling for sociodemographic characteristics such as age, relationship status, sexual exclusivity status and children in the home [ 11 ].
Any method which inhibits ovulation and the mid-cycle increase in cervical fluid might impact some sexual experiences in as yet unknown ways [ 12 ]. Progestin methods that strongly suppress ovarian function and reduce endogenous estradiol could impact sexual functioning by contributing to vaginal dryness, especially in peri-menopausal women. Some recent contraceptive research benefits from use of the validated Female Sexual Functioning Index FSFI [ 13 ], which contains domains on desire, arousal, lubrication, orgasm, pain, and other sexual functions [ 14 — 17 ].
Contraception could also affect the sexual experience indirectly. Decreased pain and improved physical appearance could certainly improve sexual functioning, although positive effects remain unstudied. Some research also finds that hormonal contraceptive methods are associated with increased experiences of vulvar pain in some women [ 22 ]. For both personal and cultural reasons e. Such changes may reduce interest in sex and contribute to method discontinuation. On the other hand, some women may also appreciate the opportunity to refrain from partnered sexual activity at regular intervals.
Many women lose their arousal when the risk of pregnancy is present [ 24 ], especially when partners are not equally committed to pregnancy prevention [ 25 ]—although many men are also turned off by pregnancy risk [ 24 ]. The strong protection offered by highly effective methods may very well lead to improvements in sexual confidence and dis-inhibition see sterilization section , though empirical data on this issue are lacking. Weight changes should also be considered for sexual implications. Women are more likely to attribute weight gain to their contraceptive method than lifestyle factors [ 26 ], and some methods such as DMPA [ 27 ] and implants [ 28 ] have been associated with weight gain in some studies.
Moreover, how a woman feels about her weight, versus the amount of weight itself, tends to be more salient in terms of sexuality. Of course, clinicians concerned about the sexual aspects of contraception should focus on promotion of healthy body image with women in their care. Finally, we wish to include that users of hormonal methods in particular may be more likely to attribute any negative sexual changes to their contraceptive method rather than to their relationships, life stressors, health, or other external factors.
These negative mis attributions will nonetheless influence acceptability and use patterns. Without further study, we have no way of knowing how the various possible influences on sexual functioning may interact or overlap. Population-level research indicates that at least one in four acts of sexual intercourse in the U. The Gates Foundation recently released a call for proposals regarding the development of more pleasurable and appealing male condoms [ 43 ]. Growing research demonstrates that the ways male condoms feel sexually matter to women, too [ 44 ].
Some women dislike like the ways condoms diminish sensation [ 45 ], exacerbate vaginal dryness [ 29 ], or interrupt the sexual moment [ 45 ]. Research from both the United Kingdom [ 46 ] and the United States [ 47 ] demonstrated that women were less likely to use condoms when they experienced reductions in sexual pleasure and functioning compared to women with more positive condom experiences. In one cross-sectional survey of 5, adults in the US and Canada, women who reported that condoms diminished arousal were more likely than men to have had unprotected sex in the last twelve months [ 24 ].
Oral contraceptives OCs entered the cultural marketplace 50 years ago and are hailed as a key factor in facilitating the US sexual revolution [ 48 ]. Studies have explored if, and how, OCs affect sexual desire, enjoyment and functioning, and many of these studies have been reviewed elsewhere [ 12 , 18 , 21 , 22 , 49 , 50 ].
Unfortunately, the sexual impact of OCs remains poorly understood. Study methodology and quality varies widely and possible pathways of action are controversial. Further, the majority of studies on pill use and sexuality have been cross-sectional in nature for example, see [ 51 , 52 ] , an inherent limitation if one wants to understand the causal effects of the pill and changes in sexual functioning and enjoyment over time.
Most research on OCs and sexuality examines libido [ 17 , 21 , 50 ]. Oral contraceptives with estrogen reduce total and free testosterone, and decreased androgens are cited as a plausible biological mechanism for reduced libido in OC users [ 53 ]. A role for androgens is also suggested by studies showing transdermal androgens in various doses have improved sexual desire, arousal, orgasm, and other sexuality effects in women presenting with libido and arousal problems [ 54 ].
Researchers have explored the supplemental use of dehydroepiandrosterone DHEA to ameliorate the decline of adrenal and ovarian androgens during COC use [ 55 , 56 ]. Both and reviews assessed studies of OCs and libido and found reports of both increased and decreased libido with pill use [ 21 , 22 ].
Both reviews also noted the lack of high quality studies of this topic. A few randomized, placebo-controlled studies examined libido in OC users, but few meet current standards for high-quality reporting of randomized clinical trials CONSORT guidelines [ 61 ] , and of these studies are mixed. A well-conducted trial demonstrated a decrease in libido in COC users compared to placebo in a sample of women in Scotland higher baseline libido , but not in a sample of women in the Philippines lower baseline libido [ 62 ]. This study, like many other published observational studies, could not establish if OCs definitively caused the lower libido; yet it does highlight the importance of lowered libido to this sample of women and its effect on discontinuation.
Overall, while OC use does appear to be associated with diminished sexual desire in some women, it appears as if women experience positive effects, negative effects, as well as no effect on libido during OC use. Additional well-deed studies are needed to establish the independent, causal effects of OCs themselves.
Strong effects related to other factors may overwhelm changes related to OC use. A Cochrane review of the patch and ring [ 66 ] only identified two published studies with mixed that referred to any aspect of sexual functioning [ 67 , 68 ]; one found improvements in sexual functioning among ring users [ 67 ] while the other found increased reports of vaginal dryness and loss of desire [ 68 ].
Potential mechanisms for OC-mediated sexual effects i. The ring is unique as the only hormonal vaginal contraceptive. Data from clinical trials show most couples find it comfortable during sexual activity; for those who find it uncomfortable, the ring can be removed and replaced a few hours later without risking pregnancy. Women may hesitate to place a vaginal ring due to concerns about correct placement or discomfort; however, even women who do not use tampons or masturbate find the ring comfortable once placed [ 69 ].
Severy and Spieler suggest that contact between the penis, the ring, and the vagina or cervix may serve as a sexual stimulus to some couples [ 2 ]. One particular note should be made about sexual functioning and depot medroxyprogesterone acetate DMPA , or Depo. The treatment dose for sex offenders is considerably larger than standard contraceptive formulations — mg every 10 days versus mg every 12 weeks [ 70 ]; effects on sexual suppression in women are unknown. In contrast, a study of Chinese women found that injectables were not ificantly related to sexual functioning or overall quality of life [ 72 ].
The high efficacy of intrauterine contraception IUC is also likely to influence sexual enjoyment, but few studies document this or other sexual changes with IUC. Indeed, we wonder if strong user satisfaction with this method [ 73 — 75 ] is influenced at least in part by its facilitation of enjoyable sex, but few studies ask specifically about sexual satisfaction with this method when assessing acceptability.
Two studies reported sexual functioning improvements in women using this method [ 76 , 77 ], while other investigations have found no sexual changes, positive or negative, with IUC use [ 44 , 72 , 78 , 79 ].
Women who experience reductions in bleeding may sustain enhanced sexual functioning as a result and many women report a substantial reduction in menstrual bleeding as a major benefit of using the levonorgestrel IUD [ 80 ]. In turn, women who experience increased bleeding or cramping or unscheduled bleeding while using IUC may experience diminished interest in sex or may experience more discomfort when engaging in sexual activity.
Female and male sterilization for a large share of the US and global method mix. The bulk of studies on the sexual acceptability of vasectomy were conducted several decades ago, with most studies showing high sexual satisfaction among both sterilized men and their partners [ 81 , 82 ], but with others raising questions about the possible adverse sexual [ 83 ] and psychological [ 84 ] effects on men.
Among those respondents who did report consistent change, positive changes were 10—15 times as common as negative changes in sexual interest or pleasure. Sterilized women were ificantly more likely to experience extremely high levels of sexual satisfaction, relationship satisfaction, and sexual pleasure—perhaps due in part to diminished concern about unintended pregnancy.
These two studies should be reassuring for clinicians, women and their partners. Reason for optimism exists: a growing body of recent research considers sexual aspects of various contraceptive methods for women. It would be unwise to base understandings of the sexual side effects of contraception any one of the above studies alone, given differences and limitations in study de, study population, and method composition or mechanism [ 18 , 21 ].
One consistent finding of variability does emerge—women clearly vary in their sexual responses during contraceptive use, and we understand little about the reasons for this variability. Though such variability may be daunting for researchers, we nonetheless argue that contraceptive studies should systematically collect data on sexuality and sexual functioning. The above-mentioned Female Sexual Functioning Index, or FSFI, could be helpful in capturing domains relating to arousal, lubrication, orgasm, satisfaction, relationship closeness, and pain [ 13 ].
Along these lines, researchers should recognize that women may be more likely to attribute negative sexual changes to their contraceptive method rather than their relationships, mood, health, life stressors, or other external factors.
These negative mis attributions, whether causal or not, will nonetheless influence acceptability and use patterns. We also encourage an approach that taps into the sexual-improvement potential in contraceptive counseling, programming, and marketing [ 3 , 89 — 91 ]. What if clinicians and contraceptive marketers were to tout the potential sexual benefits of methods? Existing contraceptive advertisements portray women as empowered medical consumers but not as sexual agents. promote convenience, efficacy, and non-contraceptive benefits e.
It strikes us as odd that our culture uses sexual and erotic images to sell many consumer goods—but not to sell contraception, which is deed expressly for sexual activity. Along these lines, sexual and reproductive health clients could be well served by investigations of the feasibility and benefits of eroticizing of contraceptives. This trend can be seen globally in pleasure-centered sexual health promotion efforts, including the eroticization of safer-sex campaigns [ 91 , 92 ] see also thepleasureproject. The contraceptive field should follow suit. During preparation of this manuscript, Dr.
The authors wish to thank Cynthia Graham for her review of this material and insightful comments. Anne Cooper and Samantha Scholer provided sparkling research assistance. Thus, this particular part of the index might not be suitable for measures of contraception. No conflicts of interest nor funding sources need to be noted. Davis receives research support from Bayer Healthcare. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication.Woman wants sex Columbia
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