Blog of the Society for Menstrual Cycle Research

Footloose and Pharmaceutical-Free?

October 26th, 2012 by Elizabeth Kissling

Guest Post by Holly Grigg-Spall, Sweetening the Pill

At the West Coast Catalyst Convention for sex-positive sex-educators I was listening to a talk on definitions of sexual health when the birth control pill was brought up. I’d spent much of the event feeling desperately vanilla and so was pleased to be discussing something other than strap-ons and lube. The most popular forms of contraception – the hormonal kind – had been notably absent from all discussion that weekend.

Toys in Babeland window display, Photo by Joaquin Uy // CC 2.0

The speaker told the group that the pill is the leading cause of low libido and pelvic pain. She explained that studies had suggested the impact on libido could be permanent. The reaction of the audience was immediate and urgent – questions were fired out and it became clear that this information was news to most. A number of audience members seemed genuinely shocked. “What’s the science behind that?” one woman asked, but the speaker said she didn’t know.

Although the convention’s attendees had an intimidating level of knowledge when it came to sexual technique and sex toys, I discovered that once I mentioned I was there to develop a book and a documentary on hormonal contraceptives, many repeated the usual disinformation about birth control methods.

The speaker was right – the birth control pill is a leading cause of lowered sexual desire and pelvic pain. It’s also known to cause loss of lubrication, vaginitis, and vulvodynia. Other hormonal contraceptives such as the Depo Provera injection, implant, ring and Mirena IUD have been seen to have similar consequences. In fact, Dr. Andrew Goldstein, director of the U.S.-based Centers for Vulvovaginal Disorders and one of the foremost vulvodynia experts in North America, blames an increase in complaints of this kind on third generation low-dose pills.

The study the speaker referred to was conducted by Dr. Claudia Panzer of Boston University and it did suggest some women may see a permanent effect on their testosterone levels, and so their level of desire. There have also been studies on these methods impact on frequency and intensity of orgasm, showing both to be decreased. Not to mention the 50% of women who will experience general negative mood effects that surely impact on their interest in sex. Many, many other studies have shown a clear negative effect on libido whilst using hormonal contraceptives. So many that it’s become something of a joke to roll eyes over the “irony” of prescribing a pill for pregnancy prevention that stops you wanting to have sex anyway.

At a convention dedicated to the celebration of sexual pleasure, I was surprised to see this information received with such confusion. A sex-positive attitude is becoming synonymous with “set it and forget it” long acting hormonal methods of contraception. But it struck me that sex-positive advocates should be the biggest fans of fertility awareness methods. Here’s why:

  • The love of barrier methods. Never have I seen such all-out enthusiasm for condoms, nor such in-depth knowledge of brands, styles and types. Did you know that you can get them in black and that that’s sexy, not creepy? If you practice fertility awareness then barrier use only during your fertile phase has been shown to be 98.2% effective at preventing pregnancy. If you choose to use a condom every time you have sex then add spermicide and fertility awareness and you have a highly effective form of birth control. If you’re single or a swinger or just want to use condoms all the time then doubling-up with hormonal birth control is overkill that could be doing your health and well-being harm in the long term.
  • Libido peaks at ovulation. If sex-positive becomes synonymous with long-acting hormonal methods like Mirena and Implanon then women will be forgoing the time of the month when they most want to have sex. Suggesting women avoid sex during their fertile time  could be considered cruel and unrealistic – however having a good reason to skirt “penis in vagina” sex  in favor of another kind might not be so bad. Being sex-positive is about exploring your sexuality and not adhering to mainstream models – fertility awareness demands you think outside of the box (pardon the pun) once a month. Knowing about your cycle’s peaks and troughs also allows you to understand you don’t have to be “on” all the time. If you don’t feel like having sex one week, there’s no need to dash to buy out the Pleasure Chest to rectify the situation.
  • Looking for worry–free, no-strings, uninterrupted sex? Then what’s more confidence-boosting and anxiety-relieving than knowing for sure because your own body tells you so that you’re definitely not fertile and can not get pregnant? Sure, you can get this reassurance with Mirena or Implanon – but you might also get the side effects of depression, anxiety, and low libido so that would defeat the purpose. You can choose to have the sex with your date on the day you know you’ll only need to worry about whether to call him three days or five days later.
  • Using hormonal contraceptives messes with our instincts when it comes to physical attraction. It makes sense if you think that all of our five senses are meddled with when we stop the body’s hormone cycle like sense of smell and acuity of touch. It’s not very sex-positive to disregard these biological signals that provoke our physical response to our partner. Attraction isn’t just about pheromones but they do play their part.
  •  Being sex-positive should be about more than knowing what gets you off. Body literacy through cycle awareness can help you keep healthy physically and emotionally. Good sex doesn’t occur in a vacuum. If you feel good (and you don’t have a deadline, the dishes are done, and your cell phone stops ringing…) then having good sex will come easier (again, pardon the pun). If being sex-positive is about respecting your body and feeling no shame, then why shut down your body’s integral hormone cycle?
  • If your’re sex-positive why would you want to submit to the pharmaceutical and medical industry when it not only thinks that it’s okay to make contraceptives for women that kill libido (and won’t make contraceptives for men for the very same reason) but also can’t wait to diagnose women with “sexual dysfunctions” in order to create a market for a female Viagra – as illustrated in the great documentary ‘Orgasm Inc.’?

Fertility awareness advocates could also learn from the sex-positive community and market the methods to more than just those in long-term partnerships or marriages. Single women are the fastest growing demographic in the US. There’s a monogamy backlash underway and people are choosing new relationship models. We need to democratize the knowledge. I hope that in years to come I will never again have to hear a self-described sexuality expert ask “what’s the science behind that?” or, as I heard at Catalyst Con from another expert using the Nuvaring, “I don’t have a period so where does all the period blood go?”

5 responses to “Footloose and Pharmaceutical-Free?”

  1. Laura Wershler says:

    Thanks for summarizing the many and varied reasons I’ve been putting forward for decades on how fertility awareness and body literacy can enhance our sexuality. I’ve always resisted the argument that FAM only works for women in committed relationships. This outdated idea assumes that single women don’t have the agency to resist sexual activity when they are fertile, or the savvy to effectively use barrier methods when they are fertile, or the sexual communication skills to negotiate non-penetrative sex when they are fertile. I agree that sex-positive devotees should be the biggest proponents of body literacy and fertility awareness.

    How the issue of reduced libido does not register for the millions of women using hormonal birth control methods is a mystery to me. But unintended pregnancy and abortion are such hot button issues in the U.S. you can understand how politically correct it has become to advocate for pounds of prevention when an ounce would do, no matter what the cost to women’s sexuality, health or well-being. I believe that if teens and women had body literacy and knew more about the science behind the ill effects of hormonal contraception they’d start saying “NO” to these drugs and device-based methods. Maybe then, finally, mainstream sexual and reproductive health-care clinics and providers would open their minds to providing information, support and services to use barrier and FA methods effectively and confidently. They are not doing so now. But I imagine that most doctors and contraceptive counselors would be horrified at the prospect: “We can’t have that!”

  2. Lara Catone says:

    I greatly appreciate your perspective on this post. I am someone that straddles the women’s health/sex positive worlds as a yoga teacher, birth doula and somatic sexologist. I have been in contact with Kate and look forward to supporting your documentary. Well stated article and I am answering your call for bridging this gap!

  3. Good work of letting women know about the effects of various contraceptives, Holly.

    Sorry for my belated comment.
    I just realized that you put Mirena and Implanon in the same category. I think it is important to know that DepoProvera and Implanon, like ordinary combined hormonal contraceptives but more so, act to suppress our own hormones. However, Mirena (and I’m not advocating it except for heavy flow) although it is an IUD with a synthetic progestin hormonal portion, the hormone primarily works locally to thin the uterine lining.

    Just to keep women’s contraceptive options clear (-

  4. Dr John Pryse-Davies and I worked out why progestin based contracpetion caused depressive mood changes and loss of libido in the 1960s. There are free British Medical Journal papers at Search grant ec.
    The enzyme monoamine oxidases increases in activity at the end of a normal cyle but there is high activity for most of the time a progestin is taken. Most depression and loss of libido occurred with progestins given with no or low doses of estrogens. Monoamine inhibitor drugs are used as antidepressants.

Readers should note that statements published in Menstruation Matters are those of individual authors and do not necessarily reflect the positions of the Society as a whole.