Birth control and sex drive
A common belief about hormonal birth control is that it lowers a person’s sex drive by lowering their level of testosterone, or because it makes the body think that it’s pregnant.
Your doctor or healthcare provider might say that hormonal birth control doesn’t usually affect your sex drive.
Here’s why it’s tricky
This is a hard question to answer. Studying sex, libido (sex drive), and sexual pleasure is complicated. Our sex drive and sexual pleasure are impacted by our physiology, psychology, societal expectations, and the interactions between these domains. In addition, we still don’t have a great understanding of the female sexual anatomy or female orgasm.
There is a lot of research to pore through about sex and birth control, and not all of it is in agreement. (As a species, we’ve gone to the moon, but we still don’t agree about whether the G-spot exists.) Here’s what you should keep in mind.
When using a hormonal birth control option or an intrauterine device (IUD), a person’s sexual experience may be impacted, positively or negatively, by:
their underlying physiology, like their levels of circulating hormones and their sensitivity to changes in these levels
the type and levels of hormones in their birth control
how a form of birth control impacts the body’s production of hormones (does it suppress ovulation?)
their cultural expectations for sex and sexual pleasure
their partner(s), their relationship(s) with their partner(s), and their partner(s)’ thoughts about birth control
what types of sex they enjoy
their feelings towards the positive side effects of birth control
the severity and level of importance they put on the negative side effects of birth control
their feelings on the risks of engaging in sex without birth control (i.e. unintended pregnancy, sexually transmitted infections) (1,2).
Then, there’s the specific ways in which each of the above categories impact sex. Researchers and health care professional divide sexual complaints into four main categories:
Desire (or libido), which refers to interest in sex
Arousal, which refers to the physical changes, such as lubrication, and emotional changes people experience when thinking or participating in sex
Physical pain (3-6)
When making decisions about birth control, it’s important for you to think through what factors are important for a good sexual experience to you, and which are less important.
If a form of birth control decreased your desire or sex drive, but improved your orgasm experience, would you consider this method to have a positive, negative, or neutral impact on your sex life?
If your method of birth control gives you unpredictable periods and tender breasts, but protects you almost 100% from unintended pregnancy, would the benefits outweigh the negatives for you?
We can’t go through all of the side effects of each form of birth control here, but these are things to keep in mind when reading through the following research.
Also, even if a method “on average” has no impact on people’s sex lives according to research, some people may still experience improvements or detriments to their sex life. The “average” experience isn’t everyone’s experience.
Using an app like Clue to track your method of birth control and symptoms can help with communicating your needs to your healthcare provider.
Here’s what the research says about each type of birth control.
Combined hormonal contraceptives and sex
Combined hormonal contraception (CHC) is a category of birth control that includes the combined-hormone pill (i.e. oral contraceptives or the pill), the vaginal ring, and the hormonal patch. These forms of birth control contain a form of estrogen and a progestin (a synthetic progesterone). CHC works by suppressing ovulation and thickening cervical mucus (7).
The pill (various brands)
Studies into the effect of combined pills on sexual functioning do not all agree with one another. Most studies have found no impact or improved sexual functioning among users of the pill (1,2).
In a 2013 review of studies published since the 1970s on the pill and sexual function, researchers found that more than 6 in 10 people using the pill had no changes in libido, more than 2 in 10 had an increase in libido, and about 1 in 10 did report a decrease in libido (2).
Different formulations (chemical make-ups) and regimens (the number of days a person takes a hormone-pill vs no pill or a placebo-pill) may impact sexual functioning (1,2). Pill regimens that have more hormone-containing pill days than the common 21-hormone/ 7-placebo pills may be more likely to improve sexual functioning (1,2). Lower amounts of estrogen may cause more changes to sex drive than higher amounts (this is called a dose-response relationship).
In the 2013 study, all people using pills with the smallest dose of estrogen available (15 micrograms), reported having a decreased libido, while people using pills with higher doses of estrogen reported mostly no change or an increase in libido (2). The number of people using low-dose pills was small—only 140 people—so it’s difficult to say if these results are generalizable to everyone.
Some studies have looked at more than just libido.
A 2016 randomized control trial examined how people using one formulation of the pill differed, sexually, from people using a placebo (i.e. a pill that contains no drug) in seven areas of sexual function (8). They found that people in the pill group were more likely to report decreased sexual desire, arousal, and pleasure (8).
However, decreased arousal and desire did not seem to mean less sex, or less good sex. Both groups reported about the same number of “satisfying sexual episodes” and the same scores for questions about orgasm (8).
One way CHCs may negatively impact sex drive is by lowering the level of testosterone in the body (1,2,8,9). Lower testosterone is thought to decrease sex drive, but the relationship between testosterone and sex drive is not well understood (1,2,9). People with abnormally high levels of testosterone, such as people with PCOS, don’t necessarily have higher libido (2,10); however, people with consistently low libidos sometimes benefit from testosterone supplementation (2,9,11).
In a 2016 randomized trial, researchers found that people using the pill had lower testosterone levels than they did at the beginning of the study, and lower levels than the placebo group at follow-up (8).
Despite this difference, testosterone levels were not associated with any differences in sexual function (8), suggesting that the lower testosterone may not be the cause for the reported difference.
The ring and the patch
The hormonal vaginal ring and patch are less studied than the pill.
One review study found that users of the ring were three times more likely to report vaginal wetness and less likely to report vaginal dryness, as opposed to people using the pill. Both pill and ring users reported improved sexual functioning, including higher scores on sexual pleasure and orgasm, as compared to people using non-hormonal methods (12).
In a randomized control trial where people were assigned to the combined pill or the ring, both pill and ring users reported higher sexual functioning at 3 and 6 months (13).
One potential benefit that the combined pill, the ring, and the patch all share is that they can be used to skip menstrual periods (14). It is safe to not have a period when on birth control, so a person who doesn’t like having sex during their period could use these methods to increase the number of potential sex days in their life. (Though it’s totally safe and normal to have sex during your period too.)
Certain types of CHCs, extended use (for example, packs that have 24-day hormone pills), and continuous use (for example, packs that have people using hormone-containing pills for a few months) can also reduce the frequency of menstrual migraines and negative premenstrual symptoms (14), which may improve a person’s mood and overall sex life.
Progestin-only contraceptives and sex
The pill (e.g. “mini pill”)
Progestin-only pills are pills that only contain progestin (so they don’t contain estrogen). They work primarily by thickening cervical mucus (15).
Very few studies have looked at sexual function among progestin-only users.
In a study where participants used combined pills, progestin-only pills, and the vaginal ring for 3 months each, people reported higher sexual interest during the 3 months that they used the vaginal ring as compared to either pill type (16). Researchers also found that the types of birth control affected participants’ testosterone levels. This relationship was modified by genetics, specifically the sensitivity of androgen receptors, or the proteins on cells that “read” androgens, in each participant (16) (testosterone is a type of androgen).
In a study that included participants from Scotland and the Philippines, the progestin-only pill had no impact on sexual interest or activity at four months in comparison to a placebo (17). Interestingly, the combined pill had a negative impact on sex for participants from Scotland, but not for participants from the Philippines (17), suggesting that physiology and/or socio-cultural experiences may impact birth control acceptability.
The shot (e.g. Depo-Provera)
Progestin-only injectable contraception or “the shot,” sometimes better known by the brand names Depo-Provera/DMPA and Noristerat, is a form of contraception that only contains a progestin. It’s given as an injection (shot) every 8 or 12 weeks, depending on the type. These methods work by suppressing ovulation and thickening cervical mucus (15).
There is not much research on the impact of injectable contraception on sex drive.
One study in the United States found that after six months of use, people using DMPA were 2 to 3 times more likely to report that they were “lacking interest in sex” than people using the copper IUD, which does not contain hormones (18).
In a study conducted in Kenya, about 1 in 10 people using DMPA reported “reduced libido” during 6 months of use (19) and 2 out of 15 people who stopped using DMPA reported reduced libido (19).
DMPA doesn’t necessarily have a negative effect on everyone, though.
In the Kenya study, there was no average change in “sexual interest” or “arousal”, and the average scores for “enjoyment” and “orgasm” increased (19). (It should be noted, though, that it’s not clear if these scores included scores of the people who discontinued the study prior to six months. Excluding these people would improve scores.)
Another study among adolescents age 14-17 found no differences in reported sexual interest between users of DMPA, users of combined pills, and people who didn’t use hormonal methods (20). A study among adults reached similar conclusions (21).
One benefit of the shot that might improve a person’s sex life is that it doesn’t require taking a pill every day or using a condom to prevent pregnancy—someone only needs to worry about birth control method every 8 to 12 weeks. The shot can also reduce menstrual bleeding and migraines (14), which may increase the number of days a person wants to have sex.
Implant (e.g. Nexplanon)
The contraceptive implant (e.g. Implanon, Nexplanon) is a device that contains only progestin. It’s placed in the upper arm. The implant works by suppressing ovulation and thickening cervical mucus (22). It lasts for up to three years, but it can removed before four years if desired.
Less than 1 in 20 people using the implant report a decrease in libido, though estimates vary (23-27).
In one study, users of the implant were more likely to report that they lacked interest in sex as compared to users of the copper IUD (18). Despite this, few people discontinue using the implant due to lost libido (23-28).
One study reported improved overall sexual functioning and improved sexual satisfaction after 3 and 6 months with the implant (28). This suggests that the implant may negatively impact a small number of users’ sex lives, but for the majority it either improves or does not change their sex lives.
The implant may improve someone’s sex life by reducing the stress of worrying about unintended pregnancies. The implant is the most effective form of birth control (29), with only about 1 in every 2,000 users experiencing an unintended pregnancy during 1 year of use. The implant also tends to reduce menstrual pain (14).
Hormonal and Copper IUDs
There are two types of IUDs: hormonal and copper. The hormonal IUDs (e.g. Mirena, Kylena, and Lilleta) release a progestin, which thickens cervical mucus and sometimes suppresses ovulation (22). The copper IUDs (brand names include Paragard) interferes with sperm function (22).
Both devices are placed into the uterus and can last for between 3 and 10 years, depending on the specific device. An IUD can be removed at any time if a person doesn’t want to use it anymore.
In general, hormonal and copper IUDs users report that their method of birth control has no impact on or improves their sexual satisfaction (30-33).
One study found that 9 out of 10 people using either type of IUD had no change in libido and 3 out of 10 reported increased sexual spontaneity (30).
The hormonal IUD has also been associated with more sexual desire, decreased sexual pain, and lower levels of sexual dysfunction, compared to function before using the IUD, or compared with people not using contraception (31,32).
Like the implant and the shot, IUDs are a great choice for people who don’t want to think about their birth control every day. IUDs are also one of the most effective forms of birth control. Only 1 out of 500 people using the hormonal IUD become pregnant in 1 year of use. For the copper IUD, 4 out of 500 using the copper IUD become pregnant in 1 year of use (29). Although hormonal IUD users may initially experience prolonged or abnormal bleeding, the hormonal IUD tends to decrease menstrual bleeding and menstrual pain after a few months of use (14), which may improve a person’s sexual experience.
What to do if you think your birth control is negatively affecting your sex life
Choosing a birth control method isn’t a lifelong commitment. Even if you decide to use the implant or an IUD, you can always have them removed before they expire.
If you’re otherwise happy with your method, you may want to consider if other things going on in your life, such as stress or your relationship(s) with your partner(s), may be causing your changes in sexual function as opposed to your birth control. If you’re new to starting a method, you could consider waiting a few months to see if your body adjusts to your new method of birth control. However, it’s 100% your decision as to when to stop using a method. You don’t have to wait to change methods if you don’t want to.
Whether you’re using birth control or not, you can use Clue to track both your sexual frequency and sex drive. Tracking can help you make an informed decision about starting, stopping, or switching methods of birth control.
Download Clue today.