A vast percentage of women on the pill complain of a loss of sex drive. The scientific evidence and wealth of testimony is there, so why don’t we see this as a serious problem? Camilla Ackley asks, why don’t we care about the female libido?.
There is a joke I believe will be familiar to most women who have ever taken the pill as a contraceptive measure, the punch line of which is that its efficacy comes mostly from the fact that you cannot get pregnant if you never want to have sex. Ha, ha.
It was a joke that I stumbled across mainly when, six months into being on a progesterone only pill, I frantically searched the internet to find answers about why I had all of a sudden become utterly uninterested in sex.
The realisation that something had changed dawned slowly, expanding over a time period so wide I could no longer brush it away as, ‘stress’. My boyfriend at the time was understanding and kind but ultimately disappointed and a little hurt. It was impossible to explain it had nothing to do with him, that something had changed in my own body. Men are so often ill-equipped to understand how small shifts and changes in female hormones brought on by the pill can have huge effects, so it was not an easy point to get across. It was even harder to live with the uncertainty of whether it was a permanent shift. But at the heart of it was not how it made the men in my life (past, present or future) feel, but how it made me feel. My body was not cooperating with my own feelings, and to feel alienated from your own body is never a positive experience.
I had heard the rumours and speculation that the pill causes a loss of libido, but when I asked my doctor at university, they brushed it away. Insignificant, or insufficient evidence – or worse, a loss of sex drive was at least better than having a baby. The startling nature of the choices on offer went over my head at the time; have no libido (or have some other common side effect, like depression) or have a baby. Despite protestations of various doctors and nurses I spoke to at the time, the science is there. There are legitimate and very real reasons that the pill may decrease libido. Perhaps most obviously is the now accepted fact that the pill is linked to a higher rate of depression and anxiety, mental health issues that very often decrease the urge to have sex. Antidepressants taken to combat those problems are also well known to decrease libido.
The links between hormone-based contraceptives, specifically the pill, and a woman’s sexuality are many, and often not explained to women starting their contraceptive journey. The pill is touted as a miracle solution, when in reality, every option comes with a leaflet full of side effects, always sold as ‘better than getting pregnant!‘
“The pill is touted as a miracle solution, when in reality, every option comes with a leaflet full of side effects, always sold as ‘better than getting pregnant!”
Women’s health practitioner Maisie Hill explains that the pill can often dry and thicken the cervical fluid that usually acts a natural lubricant. This in itself can make sex painful for women – something reported by a third of women, but never discussed beyond the ‘first time’ pain which is falsely sold as entirely normal. On a hormonal level, the pill can cause the liver to produce more of SHGB (sex hormone binding globulin) which binds to testosterone, an essential hormone in a healthy libido, changing its shape and rendering it useless. As if those two weren’t enough, suppressing our cycles means we don’t get the natural testosterone and oestrogen peak in our menstrual cycle that usually makes us horny af. If you combine this hormonal shift, with the fact that 1 in 3 women find sex painful, it’s no wonder the female libido takes a hit. Maisie herself has experience with the problem, “I wrote my depression and lack of libido off as being a teen”. She quickly came off hormonal contraceptives when she realised that natural planning was a viable option, and soon noticed a positive shift in mood and sex drive.
I made the same choice, as a last ditch attempt to fuel some fire. Slowly but surely, it has come back and sex is ultimately a much more comfortable experience, but as Maisie points out, “for some women it can take years to start to feel normal again as their cycles return and hormones build up to efficient levels.” I regret not listening to my own body sooner, but the pressure to be on long term hormonal contraception was overwhelming.
The final blow Maisie delivered when I spoke to her? “The Pill makes the clitoris smaller.”
“The Pill makes the clitoris smaller.”
It can feel awkward to start to tell people that your libido has done a runaway – especially when so many women are gaslit into believing it’s all their imagination – but it is not something rare among young women exploring hormonal contraception.
Nikki, co-founder of the organic Tampon company Ohne, experienced the same problems. Having spoken to her doctor about fears of returning onto the pill, which she felt decreased her sex drive and made her depressed, she was told it was likely to be all in her head. “I decided to try it out, and stayed on the pill for about a year. My sex drive decreased again but it happened very slowly over a period of about 6 months so it took me a really long time to realise that it had changed. At this point, I went back to my GP and said what I was feeling. He basically told me that all pills have side effects, and that unless I was willing to go on a stronger version (with a different estrogen progresteron mix) I would have to suck it up and decide whether one bad side effect was bad enough to try another pill that might have more side effects.”
So many of the women I spoke to for this story discussed taking their pill for years after they noticed a decrease in libido because they thought it may have all been in their head, a rhetoric repeated to them over and over about an entire host of female health problems. Consider Endometriosis, a women’s health problem that often goes as long as 7 years without being diagnosed, despite repeated complaints of symptoms directly associated with the condition.
“Consider Endometriosis, a women’s health problem that often goes as long as 7 years without being diagnosed, despite repeated complaints of symptoms directly associated with the condition.”
Perhaps it seems like a small trade to make for a childless existence for those who want it, but so much of the blasé attitude regarding a pill related loss of libido seems to stem from the misunderstanding that women aren’t as sexual as men. It is a fallacy that dips its toes into so many interactions between men and women, from cases like this to jokes about husbands constantly pestering their wives for sex. Women typically do want to have sex, and more often than not just as much as men.
The idea that women have intrinsically lower libidos is wildly outdated, and the idea that society sees it as normal for men to have high sex drives and seek out sex, but that it still isn’t okay for women to do so, is incredibly problematic. It fuels slut shaming language and rape culture, and leads to women not being believed when repeatedly complaining of problems like a loss of sex drive.
The psychological effects are just as significant; I spent months wondering whether I had misunderstood my own body my entire life. Maybe this was the real me? Maybe I just wasn’t that into sex? It’s a rhetoric I’ve heard repeated over and over by female friends on the pill, those who have realised and come off and those who are still lost and left feeling alienated. The strain it can put on our sexual relationships is enough cause for concern, as Nikki notes “Looking back I can definitely say that my lack of sex drive did have an effect on my last relationship”. Reflecting on my own experience, waiting for my hormones to return to normal and freshly single, I was terrified of entering a new relationship in case nothing got better and I couldn’t find someone else who understood me.
The problem is vast, and complicated; ultimately the pill is not perfect, and never has worked for every woman. Natural planning is certainly gaining in popularity, but with it comes a lack of security. The choice women are forced to make when it comes to their bodies and pregnancy almost constantly place them between a rock and a hard place and the onus is always placed on us to take the responsibility for contraception. The pill in itself has not been developed further for over 60 years, and was given to women only after men complained of depression and, you guessed it, low libido. Gaslighting women into accepting this situation is what lies behind the stagnated research into better alternatives; how can we complain, make noise and demand change if we are consistently taught to question the legitimacy of our symptoms? How do you listen to your body, when we are told we are constantly misunderstanding it?
We can take matters into our own hands and go hormone free (or trial and error until we find something that works for our bodies, which can take years), but the problem of contraception won’t be resolved until the world of medicine listens to women when they speak, and the world as a whole stops treating female sexuality as some lesser entity than our male counterparts. It isn’t just about the lack of sex, it’s about every doubt and insecurity that stems from a dramatic change in your body’s function, and the emotional distress when others urge you to first doubt your own feelings, emotional and physical. It causes a devastating disconnect, and one that can simply be solved if we realise that a woman has a pretty good understanding of her own body and mind.
** It is always worth speaking to a doctor when you’re considering changing contraceptive methods, or coming off contraception, especially if you take the pill to manage other health problems/ symptoms. Some forms of contraception are not medically suitable for some women to take. Remember to use protection responsibly always (unless you’re trying to conceive), and rubber up if you’re having sex with someone who you aren’t sure has been checked for any STI’s.
Illustration: Mariel Abbene