The   changes   in   desire   and   sexual   satisfaction   during   hormonal contraceptive(HC)  use   are   important   elements   that   might   relate   to acceptability, compliance and method continuation. Little is known about the influence of combined hormonal contraceptive on sexual functioning. Sexual side-effects have been reported in women taking HC, although no consistent pattern of effect exists to suggest a hormonal or biological determinant⁽¹⁾.  Sexual desire most   likely   represent   a   complex   and   idiosyncratic   combination   of biological, psychological,and social effects.  Overall, Literature data show that women experience positive effects, negative effects, as well as no effects on libido during HCs use^{( 2,3,4,5 )}. Moreover, current pill-users seem to discontinue for low libido less frequently than did users of higher dose pills⁽⁶⁾.

In the past years an important trial reported evidence that mood and sexual desire are dissociable and suggested that HCs can have direct effects on women’s sexuality.  Therfore, the negative effect on sexual interest found in this study was not just a result of HC induced negative mood changes⁽⁷⁾.

Furthermore, a population survey conducted among   1466   women   who   used   different   methods   of   birth   control (oral contraceptives, intrauterine devices, condoms, natural family planning, sterilization) indicated that combined oral contraceptives (COCs)  and sterilization has less negative impact on physical and psychological functioning than the other methods used⁽³⁾. This   evidence   is   in   contrast   to   what   the   general   public   often believes. Nevertheless, with the introduction of oral contraceptives very low-dose ethinylestradiol (EE), sexual disturbances due to vaginal dryness and low desire, is a problem which comes up often⁽⁴⁾.

A recent study evaluated the effects on vaginal   dryness, sexual   desire   and   sexual   satisfaction   of   the   hormonal contraceptives low-dose EE(20μg EE/100μg levonorgestrel(LNG) versus very low dose (15μgEE/  60μg gestodene or vaginal ring containing 15μg EE/120μg etonogestrel).

After   three   cycles,30.4%  of   the   participants   taking   oral contraceptive containing very low-dose EE,reported vaginal dryness;  while the same problem was reported in 12.7% of the COC-low dose EE and in 2.1% of the women using the contraceptive vaginal ring. In the meantime, the highest rates of negative impact on sexual well-being were reported by COC 15μg EE users and this data may be related to falling free testosterone levels.

In addition, this study reported a rate of discontinuation of 22.3% with COC low-dose EE, 30.4% with COC very low-dose and 11.7%  with vaginal ring⁽⁸⁾. 

Indeed, cycle control and sexual satisfaction seem to be good indicators of treatment adherence and continuation; although studies on the effects of sex-steroids on female sexual behaviour have not yelded conclusions. Many reports have been established that sexual desire,in women depends on androgen levels^(2,4,6,8). 

But,  there are reports that progestins with antiandrogenic effect in COCs do not affect sexual desire. In human population,sexual behaviour is not determined so simply by the level of sexual steroids. The difficulty arises from the complex interaction among different factors influencing female sexual function as sexual relationship type, menstrual   irregularities, vaginal   dryness, partner   attraction   and   sensitivity, culture, economic status as well as life-style.

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Rosa Sabatini and Raffele Cagiano
Department of Obstetrics and Gynecology
Department of Pharmacology General Hospital Policlinico-University of Bari, Italy
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REFERENCES

1.   Schaffir J.  (2006).  Hormonal contraception and sexual desire:a critical review. J.Sex Marital. Ther, 32(4), 305-14.
2.   Davis A.R., Castano P.M. (2004). Oral contraceptives and libido in women. Annu.Rev.Sex.Res,15, 297-320.
3.   Oddens,  B.J.  (1999). Women’s satisfaction with birth control:a population survey of physical and psychological effects of oral contraceptives,intrauterine   devices,condoms,natural   family   planning,and sterilization among 1466 women. Contraception, 59(5),277-86.
4.   Sanders S.A., Graham C.A., Bass J.L., Bancroft J. (2001). A prospective study of the effects of oral contraceptives on sexuality and well-being and their relationship to discontinuation. Contraception, 64,51-8.
5.   Caruso S., Agnello C., Intelisano G., Farina M., Di Mari L., Cianci A. (2004).  Sexual behavior of women taking low-dose oral contraceptive containing 15μg ethinylestradiol/60 μg gestodene.Contraception,  69,  234- 7.
6.   Bancroft J., Sartorius N. (1990). The effects of oral contraceptives on well-being and sexuality.Oxf. Rev. Reprod.Biol,12, 57-92
7.   Graham C.A.,  Sherwin B.B.  (1993). The relationship between mood and sexuality   in   women   using   an   oral   contraceptive   as   a   treatment   for premenstrual symptoms. Psychoneuroendocrinology,18(4),273-81.
8.   Sabatini R.,  Cagiano R.  (2006). Comparison profile of cycle control, side effects   and   sexual   satisfaction   of   three   hormonal   contraceptives. Contraception,74, 220-223. 
9.   Bjelica A.,  Kapamadzija A.,  Maticki-Sekulic M.  (2003). Sex hormones and female sexuality. Med.Pregl, 56(9-10),446-50.