The Pill has become one of the most popular, and most effective birth control methods. But messing with your hormones can alter your sex life in positive and negative ways. Here's what you need to know, as a pill-taker or as the partner of one.
Illustration by Tara Jacoby
How the Pill Works
While the phrase "the Pill" seems to imply one particular pill, there are actually dozens of birth control pills on the market. Each one has different dosages of hormones that help the body prevent pregnancy. Most pills contain a combination of progestin and estrogen, while some contain only progestin. These hormones prevent your body from ovulating (releasing an egg from your ovary). With no egg, there's nothing to be fertilised, and no way for you to get pregnant. Huzzah!
But that's not all those hormones do — they can also have an effect on your sex drive, your emotions, and even who you're attracted to.
How the Pill Affects Sexual Desire
The Pill's relationship with sexual desire is complex. It's also, unfortunately, one of the least-researched aspects of potential side effects. Since the Pill changes your hormone levels, and hormone levels are also a component of sexual desire, it seems logical that the Pill would have an effect on sexual desire.
Unfortunately, sex drive isn't as simple as "more hormones = more horny" (I'm imagining a caveman loudly grunting that statement). There are an overwhelming number of factors that influence sexual desire, including other health issues, stress, ability, sleep, relationship dynamics, psychological attitudes towards sex, self-esteem, body image, and safety. But here are a few of the possibilities you might encounter.
Ways the Pill Might Decrease Your Sex Drive
Let's start with how the pill works biologically (with the caveat that I am not a doctor). Your ovaries, which the Pill essentially "shuts down", are also responsible for producing testosterone, a hormone that has been linked with sex drive. The Pill itself can lower levels of testosterone in a woman's body. It also forces the body into a steady-state of hormone levels, meaning you won't experience the usual spikes of testosterone during your cycle. If you've ever felt particularly horny before your period, that spike may have been the culprit. Estrogen can also increase levels of sex hormone-binding globulin (SHBG). SHBG attaches to testosterone and makes it biologically unavailable, further decreasing testosterone levels. Again, the relationship between testosterone and sex drive isn't fully understood, but lower testosterone levels may not be the greatest thing for a woman's sex drive.
The Pill can also drastically decrease the amount of lubrication your body creates. This can make sex uncomfortable or even painful. Some women associate getting wet with being turned on, so dryness can be interpreted as a psychological signal that she's not aroused.
Being on the Pill for a long period of time has also been associated with an increased risk of vulvar pain. When your girly bits hurt, sex does not seem particularly enticing.
Ways the Pill Might Increase Your Sex Drive
There are also a fair number of ways that the Pill might contribute to you to wanting or being open to sex more often, though. For example:
- Knowing you're safe from getting knocked up can be a huge relief. That sense of relaxation in and of itself can naturally increase your desire for sex. (Remember that while the Pill guards against pregnancy, it does nothing to protect you against STIs.)
- Some women use the Pill to skip periods entirely. If you're not comfortable having sex during your period (there's no need to be embarrassed, but some women don't like it), being on the Pill may give you more days where sex is actually a possibility.
- Being on the Pill typically means the end of menstrual cramping. Not having to deal with that pain may make you more open to sex.
- Some pills decrease acne. If you have serious adult acne, you know that it can make intimacy seem far too intimidating. More self confidence can make you feel more comfortable having sex.
Other Potential Sexual Side Effects of the Pill
Sex drive aside, the Pill can have other effects on your sex life:
- Spotting. Some women will experience mild to severe spotting while using the Pill. This is another case where discomfort with period sex can mean you're out of commission for a pretty significant amount of time. Mild spotting is normal, but moderate to heavy amounts of fluid should be checked out by your doctor. Ditto to spotting that goes on longer than a week.
- Partner choices. Some researchers speculate that the Pill changes the types of male partners you're attracted to. Our noses can sniff out the Major Histocompatibility Complex (MHC) genes in other people. These genes play a large role in healthy immune systems. Women prefer the scent of men whose MHC genes are different than theirs, since they would have children with healthier immune systems. When women are on the Pill, they're actually more attracted to men with similar MHC profiles. Terrifying thought for couples who met while the woman was on the Pill, isn't it?
- Emotional changes. The Pill can make you moody as hell. It's hard to have sex when you're weeping to the Sarah McLachlan SPCA commercial.
Of course, every woman will have different responses to the Pill, but these are pretty common responses.
How To Minimise the Pill's Impacts
If you're going to go on birth control pills, you need to explore different brands. Your body may respond far better to one pill than to another. Talk to your doctor, but it's generally a good idea to give each pill a 3-6 month test run.
If you're new to the Pill, try keeping a daily log for a month or two before you start. I know it sounds like a lot of effort, but it's a great way to keep track of the effects the Pill is having on you. Continue it for a month or two into taking the Pill, then switch to a weekly log for the next few months.
If you've taken the Pill for as long as you've been sexually active, you're less likely to notice the effects it's had on your sex life. You may want to consider take brief hiatuses to help get a sense of what your body's natural rhythms are.
How to Be a Good Partner to a Woman on the Pill
If your girlfriend or wife decides to start taking the Pill, your observations as an outside party can be invaluable in helping her figure out if it's working for her.
Of course, sharing your comments requires a little finesse. Saying, "you've been insane since you started taking those" isn't exactly going to win you any points. Before she starts taking the Pill, you may want to consider saying to her, "I've heard that the Pill can have a lot of side effects. If you think it would be helpful to you, I can try to see if I notice any changes." You may also want to discuss how you could share your observations with her, so she doesn't feel like you're springing unwelcome advice on her.
If there's something important that you do feel the need to bring up without your feedback having been solicited (for example, noticing a drastic change in her mood), try to broach the topic as sensitively as possible. Taking the Pill has an emotional charge for a lot of women, so you want to be respectful of the fact that it's her body. Be grateful that you don't have to deal with this crap!