Comparison of Androgens in Women with Hypoactive Sexual Desire Disorder: Those on Combined Oral Contraceptives (COCs) vs. Those Not on COCs

Abstract

Introduction Approximately one out of four sexually active women in the United States uses some form of hormonal contraceptive method because they provide the most effective reversible method of birth control available. However, little attention has been paid to possible adverse effects of combined oral contraceptives (COCs) on sexual functioning. Aims The aim of this study was to examine the potential effects of COCs on women with hypoactive sexual desire disorder (HSDD). It was hypothesized that female patients with generalized, acquired HSDD on COCs have lower androgen levels than those not on COCs. Methods The patients were healthy premenopausal women with HSDD, aged 22–50 years. Subjects had a history of adequate sexual desire, interest, and functioning. Participants were required to be in a stable, monogamous, heterosexual relationship and were screened for any medication or medical or psychiatric disorders that impact desire. The patients met operational criteria for global, acquired HSDD. The 106 patients were divided into two groups: those on COCs (N = 43) and those not on COCs (N = 63). A two-tailed t-test comparison was made between the two groups comparing free and total testosterone and sex hormone-binding globulin (SHBG). Main Outcome Measures The main outcome measures are the differences between the two groups comparing free testosterone, total testosterone, and SHBG. Results These patients with HSDD on COCs had significantly lower free and total testosterone levels compared with those who were not on COCs. The SHBG was significantly higher in the group on COCs compared with those who were not on COCs. Conclusion The result of this study suggests that COCs in premenopausal women with HSDD are associated with lower androgen levels than those not on COCs. Further research is required to determine if low androgen levels secondary to COCs impact female sexual desire.

A multivariate analysis of the factors that influence the modification of sexual desire in oral hormonal contraceptive (OC) users

“…Hutchison [20] and van Lunsen and Laan [1] state that the increase in the binding globulin of sexual hormones produces similar responses. Warnock et al [21] and other authors [9,22] refer to the fact that changes in sexuality are due to gestagens and the antiandrogenic effect of estroprogestatives, with estrogens playing a lesser role in the modification of sexual desire in women, although van Goozen et al [15] do not agree with this proposal.…”

To study hypoactive sexual desire disorder in a fragile X carrier female successfully treated with local testosterone application

“…4 The relation between serum testosterone level and lack of libido has not been proven yet. However, research findings show that testosterone, together with estrogen, is believed to be involved in the sensations perceived by the brain to be sexual.…”

Sexual Activity during Pregnancy in Childbirth and after Childbirth

“…Relaxin, for example, causes epithelia cells in the vagina to enlarge and vaginal circumference lumen to increase, and this subsequently might cause a decrease in vaginal sensitivity [20]. Recent studies also suggest that hormones cause symptoms of diminished clitoral sensation, orgasmic disorders that may last up to six months postpartum and lack of libido [21]. Some authors [22][23][24] correlate diminished sexual desire with sex hormone alterations, but there are no valid studies so far to prove their major impact on women's sexuality during pregnancy [21].…”