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Sexual function and combined oral contraceptives: a randomised, placebo-controlled trial
Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för mikrobiologi och molekylär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Diagnostikcentrum, Klinisk kemi.
Department of Women’s and Children’s Health, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden.
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2018 (Engelska)Ingår i: Endocrine Connections, ISSN 2049-3614, E-ISSN 2049-3614, Vol. 7, nr 11, s. 1208-1216Artikel i tidskrift (Refereegranskat) 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.

Ort, förlag, år, upplaga, sidor
Bioscientifica, 2018. Vol. 7, nr 11, s. 1208-1216
Nationell ämneskategori
Reproduktionsmedicin och gynekologi
Identifikatorer
URN: urn:nbn:se:liu:diva-154597DOI: 10.1530/EC-18-0384ISI: 000456843800012PubMedID: 30352399OAI: oai:DiVA.org:liu-154597DiVA, id: diva2:1290600
Tillgänglig från: 2019-02-21 Skapad: 2019-02-21 Senast uppdaterad: 2019-11-05Bibliografiskt granskad
Ingår i avhandling
1. Happy with the method?: Sexual function changes in young women using contraception
Öppna denna publikation i ny flik eller fönster >>Happy with the method?: Sexual function changes in young women using contraception
2019 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
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.

Ort, förlag, år, upplaga, sidor
Linköping: Linköping University Electronic Press, 2019. s. 81
Serie
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1713
Nationell ämneskategori
Reproduktionsmedicin och gynekologi
Identifikatorer
urn:nbn:se:liu:diva-161653 (URN)10.3384/diss.diva-161653 (DOI)9789179299682 (ISBN)
Disputation
2019-12-06, Berzeliussalen, Hus 463, Campus US, Linköping, 13:00 (Svenska)
Opponent
Handledare
Tillgänglig från: 2019-11-05 Skapad: 2019-11-05 Senast uppdaterad: 2019-11-05Bibliografiskt granskad

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