The debate about the effect of the combined oral Pill on a woman’s sex drive has raged ever since it became available in the early 1960s. I was one of the first doctors to prescribe them in general practice and most of the women who were given them told me that their libido was improved. This was probably because before then my patients had been terrified of becoming pregnant and this worry had dominated their sex lives.
More careful analysis carried out by the Royal College of General Practitioners in 1974 suggested that oral contraceptives quadrupled the number of women admitting to their GPs that they were suffering from a lack of sexual drive. Later analysis of these figures suggested that some of the increase was probably because collecting the prescription for the Pill gave patients a chance to talk to their doctor about their sex lives.
Since the Royal College’s report there has been a mass of studies on the effect of the Pill on sexual drive. The general view is that the Pill may increase libido, decrease it, or leave it unaltered — not a useful conclusion for someone who, like you, finds that they have little sex drive.
However, there is no doubt that in a minority of women the loss of libido is a sideeffect of taking the Pill — but just how big this minority is is uncertain. Until now the accepted opinion has been that the libido will return to its previous level once the Pill is discontinued. However, the recent research that you refer to in your letter seems to indicate that in some women the libido doesn’t pick up once the Pill has been abandoned.
And it is not true to say — as is often said — that an appetite for sex in women varies as much as an appetite for food because hunger will eventually prevail in the starving. Libido varies in a woman’s life according to her age. It is usually low when she is a teenager and in her early twenties (as you are), usually increases in the late twenties and thirties, and varies enormously after the menopause.
Pregnancy decreases the sex drive in many women but increases it in a minority.
Giving birth and breast-feeding usually reduce it. Sexual drive even varies throughout the month. It tends to be greatest around the mid-cycle, at the time of ovulation, and some studies suggest that it is also greater in those not taking the Pill just before a period.
The range and number of factors affecting libido is so great that it is impossible to define a normal female response. However, it is true that it is usual for young women, whose sexual response is still developing, not to be hugely interested in sex. Not unnaturally, these women wonder if the Pill is responsible.
A woman’s sex life is more dependent on her emotions than is a man’s. Her approach to sex may have been as much determined by the warmth and physical demonstrations of love between her parents, as well as between her parents and herself in her childhood household, as by her later hormone levels. A woman’s ability to feel at ease with a man, so that her sexual inhibitions may be abandoned and her desires given free rein, is as likely to be related to her feelings of a sense of security as to her levels of oestrogen or androgen.
It would be a good idea to try different types of combined Pill. Their side-effects vary, but if none suits you and there is no improvement in your libido, it might be worthwhile switching to another method of birth control. Before you consider anything of the nature of an IUD you would need to be in a long-term monogamous relationship as the device does not protect against sexually-transmitted infections. Have a chat with your doctor.
There is a problem but it’s not the one that you are worrying about. You are suffering from a nervous condition caused by over-exposure to under-investigated scientific research. Your symptoms probably started in May when the New Scientist published an article stating that the Pill curbs the production of testosterone in the ovaries and raises levels of a substance called sex hormone-binding globulin (SHBG). Because testosterone, the hormone responsible for libido, attaches itself to the SHBG protein, the more SHBG there is in the body, the less biologically active testosterone there is to trigger arousal in the brain.
So far, so scientific, but on its own it is not exactly the kind of copy that would elevate the blood pressure of a healthy 23-year-old. That was down to the people at New Scientist who are trained to give turgid chunks of biology media teeth. By the time they were finished with it, the Pill story had acquired a truly attention-grabbing headline: “Can the Pill dull a woman’s desire for ever?” It had everything going for it; universal relevance, vague but gravely damaging consequences, and the potential to cause enormous controversy. Needless to say it was swiftly picked up by the national media and the story then began to morph into a series of increasingly alarmist headlines.
The Independent sat on the fence with “The Pill may cause permanent loss of sex drive”, and The Times Online delivered a tongue-in-cheek “Not tonight dear — I’ve been taking the Pill”, but soon Life Style Extra had upped the ante with “Pill blamed for wrecking women’s sex lives”, and finally, the Daily Mail stated categorically in a front page headline: “Pill can ruin sex drive permanently”. One has to wonder what the Daily Mail expected to happen when it declared that tablets taken daily by millions of women would permanently destroy their sex drive. The panic that ensued inevitably gave rise to several thousand costly “doctor reassurance appointments”, but a closer analysis of the study revealed that the authors suggested only a “possibility” of a link between the Pill and long-term loss of libido.
The original research was carried out by Irwin Goldstein and Claudia Panzer, of Boston University, on 125 young women who attended a sexual dysfunction clinic; 62 were taking oral contraceptives, 40 had previously taken them; and 23 had never taken them. The team measured levels of SHBG in the women every three months for a year, and found that in Pill users they were seven times as high as in women who had never taken them. Levels had declined a bit in women who had stopped taking the Pill, but remained three to four times as high as in those who had never taken it.
Before anyone decided to turn that information into a doom-and-gloom headline they should have taken a couple of essential issues into account. First, all the women involved were recruited from a sexual dysfunction clinic, which is a bit like asking 125 people who hate chocolate if they fancy a bar of Dairy Milk. Second, women produce only one tenth the amount of testosterone that men do and scientists have not determined how significant its influence is on female libido because sexual response in women is so contextual. In other words, it is who you are shagging, not how many hormones you make, that matters most.
Finally, since its inception in the early 1960s the Pill has been taken by billions of women around the world and although they have had many complaints about it, low libido hasn’t been one of them. As a rule, women tend to be more perceptive and querulous than blood samples, so I think you can rest easy. If the Pill had a negative impact on female libido, we’d all know about it already.
OVER TO YOU
Do you have a sexual dilemma for Suzi Godson and Dr Thomas Stuttaford? Send your e-mails to body&soul@thetimes.co.uk or write to Body&Soul, The Times, 1 Pennington Street, London E98 1TT. The authors regret that, although your letters are much appreciated, they cannot respond personally.
