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Happy with the method?: Sexual function changes in young women using contraception
Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.ORCID iD: 0000-0003-0755-1887
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Sexuality and contraception are closely linked topics. In theory, hormonal contraception use might affect female sexual function in both positive and negative directions. Some women experience and report adverse sexual function changes while they use hormonal contraception while others report no or positive changes. Questions of causality, the potential mechanisms of action, and how to counsel women reporting adverse changes have been a matter of debate but scientific consensus is lacking on the answers.

Material and Methods: The first study was a cross-sectional study with 1851 women, aged 22, 25 and 28 years, who answered a questionnaire regarding contraception use, positive and negative side effects, contraceptive counselling, and aspects of sexual function. The second study was a randomised double-blind placebo-controlled multicentre clinical trial. In this study we compared 102 women who used a combined oral contraceptive with 100 women who took placebo, regarding sexual function scores evaluated with the Mc Coy Female Sexuality Questionnaire. We measured testosterone level changes in serum and hair as a secondary outcome. The third study was a qualitative study in which we explored women’s experiences of the negative effects of hormonal contraceptive use on sexual function. We interviewed 24 selected women who had reported previous experiences of adverse sexual function changes while using a hormonal contraceptive method.

Results and Conclusions: Young Swedish women who used hormonal contraception, reported a negative change in sexual desire more than twice as often as women who used hormone-free contraceptive methods. A similar difference was seen between users of the levonorgestrel-intrauterine system compared with users of the copper-intrauterine device.

The experience of an adverse sexual desire effect, which the women thought was due to contraceptive use, was a strong predictive factor for reconsideration of the contraceptive method.

We found no change in the total score of sexual function during the use of a combined oral contraceptive compared with placebo. Sexual interest and lubrication which were two aspects of the total sexual function, were found to be negatively associated with the use of the tested combined oral contraceptive. Changes were small however, and the clinical relevance of these findings is therefore unclear. Furthermore, lubrication change did not persist following adjustment for change in self-rated depression scores.

The biologically active fraction of testosterone embedded in hair did not decrease during combined oral contraceptive treatment and no reliable associations were found between the induced serum testosterone level decrease and sexual desire changes. Women reporting negative sexual function effects while using hormonal contraception, described lubrication difficulties and decreased sexual desire associated with both contraceptive use and parts of the menstrual cycle. Associations became obvious with time and experience and consequently contraceptive choice became easier with age, experience, and better understanding, all of which we concluded could be facilitated by a responsive contraceptive counsellor.

Our findings indicate the need for further evaluation of sexual function changes in the selected group of women who seem to be susceptible to the use of hormonal contraceptives.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2019. , p. 81
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1713
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
URN: urn:nbn:se:liu:diva-161653DOI: 10.3384/diss.diva-161653ISBN: 9789179299682 (print)OAI: oai:DiVA.org:liu-161653DiVA, id: diva2:1367993
Public defence
2019-12-06, Berzeliussalen, Hus 463, Campus US, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2019-11-05 Created: 2019-11-05 Last updated: 2019-11-05Bibliographically approved
List of papers
1. Hormonal contraception and sexual desire: A questionnaire-based study of young Swedish women
Open this publication in new window or tab >>Hormonal contraception and sexual desire: A questionnaire-based study of young Swedish women
2016 (English)In: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 21, no 2, p. 158-167Article in journal (Refereed) Published
Abstract [en]

Objectives The aim of the study was to determine whether a decrease in sexual desire is more prevalent among women using hormonal contraception than among women using hormone-free contraception, and whether a decrease increases the risk of changing to another contraceptive method. Methods A validated questionnaire was posted to 3740 women (aged 22, 25 or 28 years) living in Sweden. Descriptive statistics were used to present the results; differences between groups were tested using χ(2) analyses. A multiple logistic regression model was used for analysis of possible confounders. Results The response rate was 50%. The majority (81%) of respondents used some kind of contraception, and 88% were generally satisfied with the method used. Regardless of the type of method, 27% of hormonal contraceptive users reported a decrease in sexual desire that they attributed to their use of hormonal contraception, whereas only 12% of women using hormone-free contraception reported a decrease in sexual desire (p<0.01). This twofold risk of a decrease in sexual desire was shown in the multiple regression analysis to be independent of age group, depression, BMI, educational level and parity. However, having a partner was found to be a factor of equal importance: women with partners experienced reduced desire twice as often as women without partners. The observed odds ratio for planning to stop hormonal contraception or to change to a different type due to reduced desire was 8.16 (95% confidence interval 6.65-10.1) among women who had had the same experience during a previous period of hormonal contraceptive use. Conclusions Women using hormonal contraception were more likely to experience reduced sexual desire compared with women using hormone-free contraception. Experiencing reduced desire was a strong predictive factor for women to change contraceptive method.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2016
Keywords
Cross-sectional study; Hormonal contraceptives; Intrauterine devices; Progestin; Sexual desire
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:liu:diva-126286 (URN)10.3109/13625187.2015.1079609 (DOI)000375025700007 ()26406399 (PubMedID)
Available from: 2016-03-22 Created: 2016-03-21 Last updated: 2019-11-05
2. A survey of young womens perceptions of the influence of the Levonorgestrel-Intrauterine System or copper-intrauterine device on sexual desire
Open this publication in new window or tab >>A survey of young womens perceptions of the influence of the Levonorgestrel-Intrauterine System or copper-intrauterine device on sexual desire
2019 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 21, p. 75-80Article in journal (Refereed) Published
Abstract [en]

Objectives: Few studies, with contradictory results, evaluate intrauterine contraceptives (IUC) and sexual function specifically. This study compares perception of sexual desire related to IUC use and aspects of sexual function in women who use the Lng-IUS with those using the Cu-IUD. Study design: A secondary analysis regarding IUC use based on a larger cross-sectional survey of contraceptive use in Sweden, conducted in 2013. In total, 153 IUC users (103 Cu-IUD and 50 Lng-IUS users) answered the questionnaire. The only inclusion criterion was intrauterine contraceptive use. Main outcome measures: Were self-reported sexual desire changes related to contraceptive method. We also analysed aspects of sexual functioning; sexual desire level, sexual activity, orgasm frequency, satisfaction with sex life and satisfaction of desire level. Results: A negative effect on sexual desire due to contraceptive method was reported by 28% of the Lng-IUS users and by 10.1% of the Cu-IUD users (p amp;lt; 0.05). Results were more marked after adjusting for age, body mass index, depression, parity, switching behaviour, and partnership (OR 5.0; CI: 1.8-13.8). The adjusted odds of reporting low sexual desire level (never or almost never feeling sexual desire) (OR 3.5; CI: 1.1-11.2) as well as low satisfaction with sex life (OR 2.7; CI: 1.2-6.3) was higher in the Lng-IUS group (adjusted for same confounders as above). Conclusions: The women in this study using the Lng-IUS more often report negative sexual desire effects of their contraception as well as lower sexual desire level compared with women using the Cu-IUD.

Place, publisher, year, edition, pages
ELSEVIER IRELAND LTD, 2019
Keywords
Contraception; Intrauterine contraceptives; Lng-IUS; Cu IUD; Sexual desire; Sexual function
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:liu:diva-161009 (URN)10.1016/j.srhc.2019.06.007 (DOI)000485335500013 ()31395237 (PubMedID)
Note

Funding Agencies|Region of Ostergotland

Available from: 2019-10-16 Created: 2019-10-16 Last updated: 2019-11-05
3. Sexual function and combined oral contraceptives: a randomised, placebo-controlled trial
Open this publication in new window or tab >>Sexual function and combined oral contraceptives: a randomised, placebo-controlled trial
Show others...
2018 (English)In: Endocrine Connections, ISSN 2049-3614, E-ISSN 2049-3614, Vol. 7, no 11, p. 1208-1216Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: The effect of combined oral contraceptives (COC) on female sexuality has long been a matter of discussion, but placebo-controlled studies are lacking. Thus, the aim of the present study was to investigate if an estradiol-containing COC influences sexual function.

DESIGN: Investigator-initiated, randomised, double-blinded, placebo-controlled clinical trial where 202 healthy women were randomized to a combined oral contraceptive (1.5 mg estradiol and 2.5 mg nomegestrol acetate) or placebo for three treatment cycles.

METHODS: Sexual function at baseline and during the last week of the final treatment cycle was evaluated by the McCoy Female Sexuality Questionnaire. Serum and hair testosterone levels were assessed at the same time points.

RESULTS: Compared to placebo, COC use was associated with a small decrease in sexual interest (COC median change score: -2.0; interquartile range (IQR): -5.0-0.5 vs. placebo: -1.0; IQR: -3.0-2.0, p = 0.019), which remained following adjustment for change in self-rated depressive symptoms B = -0.80 ± 0.30, Wald = 7.08, p = 0.008. However, the proportion of women who reported a clinically relevant deterioration in sexual interest did not differ between COC or placebo users (COC 18 (22.2%) vs. placebo 16 (17.8%), p = 0.47). Change in other measured aspects of sexual function as well as total score of sexual function did not differ between the two treatments.

CONCLUSIONS: This study suggests that use of estradiol-based combined oral contraceptives is associated with reduced sexual interest. However, the changes are minute, and probably not of clinical relevance.

Place, publisher, year, edition, pages
Bioscientifica, 2018
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:liu:diva-154597 (URN)10.1530/EC-18-0384 (DOI)000456843800012 ()30352399 (PubMedID)
Available from: 2019-02-21 Created: 2019-02-21 Last updated: 2019-11-05Bibliographically approved

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