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Anyone visiting their primary care physician will be asked, “Are you also on hormonal birth control?” Anyone who goes to a therapist may get these questions: “Are you depressed? Have you lost all desire for sex?” On closer inspection, these factors might be more intimately intertwined than many in the medical and psychological fields realize.

While 2016 and 2017 studies from the University of Copenhagen made international headlines by finding connections between hormonal contraception use and increased risk for depression and increased risk for suicide, the sad truth is that this information was really nothing new. As evidenced by transcripts from the 1970 Nelson Pill Hearings, doctors and researchers have been voicing concerns about the Pill and its impact on women’s mental and emotional health since use of the Pill became widespread in the 1960s.

Recently, it seems that lowered libido has also been another hot topic of discussion when it comes to birth control, but again, the evidence for it is really nothing new. The reasons behind birth control’s effects on libido are not entirely understood, but it is suspected that the Pill’s testosterone-lowering effects could be the culprit behind why some women experience decreased sex drive while on the Pill. Although women need much less testosterone than men, proper testosterone levels are crucial to a woman’s libido. Lowered testosterone may have other effects that ultimately lead to lowered libido, from shrinking a woman’s clitoris and changing the vascularization of her vulvar tissue (which in turn leads to less frequent desire for sex, less frequent orgasms during sex, and pain during sex), vaginal dryness, and depression (which also has a way of dampening libido).

Difficult realities

Unfortunately, these mental and emotional health effects of the Pill are all too often downplayed in the medical community. Some doctors may be reticent to ascribe a woman’s issues with libido to her use of the Pill, citing studies that indicate that, on the whole, women have a “mixed bag” of sexual reactions to the Pill. Instead of encouraging women to try other family planning options, many doctors simply prescribe another drug, this time in the form of antidepressants. Of course antidepressants come with their own side effects, one of which is lowered libido. For women on both the Pill and antidepressants, the quest to resolve the libido problem can feel like a vicious cycle.

Depression and libido are of course incredibly complex issues in their own right, and some women may experience either or both conditions wholly unrelated to their use of hormonal contraception. Libido, in particular, is incredibly difficult to measure, as a variety of factors contribute to sexual desire. But for the women who experience lowered libido and/or depression as a direct result of their use of prescription drugs, it’s fair to say we can do better to offer solutions that help them reach their health potential.

Perhaps the greatest irony in all of this is that the birth control Pill has long been hailed as the tool for women’s sexual liberation, the very thing that is meant to make women more available for sex—but it’s also the very thing that may be causing them to desire sex less and less.

It’s just another reminder of why suppressing fertility with birth control isn’t necessarily a sign of female progress. 

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