“Frankly I would rather be gardening than having sex.”
Is this something you’ve ever thought or even said? If so, you are by no means alone. 40% of American women complain of low desire to have sex, and 81% of women have taken the birth control pill at some point in their lives. Is there a connection? Read on to find out.
At 19 I was prescribed the Pill, not for birth control, but rather so I could have a more regular period. Not only were my periods coming only two or three times a year but when they came, they were ferocious! The pain, oh the pain, the “stay home from work” cramps, the mood swings where I’d morph into someone I didn’t recognize, the “I’ve seriously gained 5lbs in two days!” bloating, along with many other undesirables.
This had been going on for a number of years and I decided I’d had enough already. After I relayed all of this to my doctor, she whipped out her prescription pad and sent me along my way. What I didn’t know back then was my troubles were all because of a sneaky hormonal imbalance, and the prescription I was holding would only mask the life-disrupting symptoms I was experiencing.
Fast forward to age 24. I had now been on the Pill for about five years and I still wasn’t happy. I know, I’m hard to please! All those teenage issues had pretty much disappeared but (there’s always a but!) they had been replaced by chronic yeast and urinary tract infections and a really blah sex drive (at 24!). There was a whole year where I had a UTI at least once a month and I remember thinking my low libido was a good thing because I couldn’t possibly handle another UTI or round of antibiotics. Good times!
Since that time I’ve learned a whole lot about the Pill and it’s effects (good and bad) on a woman’s body. I have conversations with women in their 20’s and 30’s almost every day about low desire for sex, pain during sex, vaginal dryness, chronic yeast infections, crazy mood swings and a general feeling that things just aren’t right “down there.”
Recently, I listened to a talk by a doctor named Andrew Goldstein. He spoke about how the pill controls our hormones and I was blown away by what he had to say. This guy is seriously the Pill God! He talked very specifically about why the pill causes a lot of these issues and I just had to share his pearls of wisdom with you!
Fact #1: Birth control pills are not a great idea for every woman.
Some women do very well on the pill but not all women are created equal. A pill that is good for one can be awful for another. This is because we all have different kinds of hormone receptors. According to Dr. Goldstein, some women have efficient receptors – kind of like the way a Prius sips gasoline, they just sip hormones. While others have inefficient receptors, similar to the way a Hummer guzzles gasoline, these women’s receptors need more hormones to function properly. Approximately 1/3 of women have Hummer receptors. I’m one of them and you might be too!
Here’s the deal: All birth control pills lower estrogen and testosterone in the body. They do this by suppressing the ovaries’ production of estrogen and testosterone. The estrogen in a pill is supposed to replace some of the estrogen that your body would be making but a low- dose pill (which is very popular nowadays) is not giving you back enough estrogen and every month you are running at a hormonal deficit.
So women who are Hummers, the ones who need tons of hormones to function optimally (moi!), don’t do well on the pill. Over time it causes their glands to not function, which in turn lowers libido, thins the vaginal tissues, and shrinks the clitoris and the labia. They develop vaginal dryness and pain during sex along with other issues.
Can we just talk about clitoral shrinkage for a second?! Are you gals as freaked out by that notion as I am? Find that hard to believe? There’s actually proof. Dr. Goldstein referenced a recent study done on the pill Yaz. He said they found that in just 3 months on Yaz, women’s labia minora decreased in size and the size of the clitoris decreased by 15%! Whoa!
Fact #2: Birth control pills can decrease your sex drive.
Hold on to your knickers ladies, I’m gonna get a little scientific here. Testosterone is the hormone responsible for your sex drive. The pill causes the liver to make a protein called Sex-Hormone Binding Globulin. SHBG binds to testosterone and makes it inactive. Therefore, when SHBG goes up in the body, it lowers the amount of free testosterone. Not good for your lovely libido. A woman not on the pill typically has a SHBG level of 20-30, but a woman on the pill can have a SHBG level of 200-300 and even up to 500!
A woman’s free testosterone level should be 0.8-1.0 but it dramatically goes down when SHBG levels are too high. Dr. Goldstein described a 27 year-old patient of his who had a free testosterone level of .01, which is 1/70th of what she was supposed to have! That is below the average levels of women in their 60’s! In some cases, the SHBG levels never return to their normal levels, yet doctors rarely if ever warn their patients of these consequences when prescribing the pill.
Fact #3: Birth control pills can cause dryness and painful sex, even if you’ve stopped taking them.
The vagina is a hormone-dependent organ, meaning that it needs adequate amounts of hormones in order to function properly. This is different for each woman – remember the Prius vs Hummer concept. Hormonal signals sent to the glands at the opening of the vagina cause them to produce something called mucin, a slippery lubrication that causes a woman to feel wet. Here’s the kicker: These glands depend only on testosterone to work. If a woman does not have enough testosterone in her body, these glands literally stop working, and she stops lubricating. Since the pill reduces the amount of testosterone in the body by a significant amount, there is decreased lubrication and ultimately painful sex for some women.
Remember the high SHBG levels I mentioned above? If SHBG levels stay high, testosterone stays low and this can take awhile to reverse. This is why women who develop pain during sex while on the pill, might continue to feel pain even if they stop taking it, because of the pill’s long term effects on SHBG levels and testosterone levels.
Okay that is enough gloom and doom for one post. Lucky for you, there are tons of things you can do to turn things around if you are dealing with anything I just described.
#1 You can get off the pill!
I know this is a scary prospect for many women but I personally think clitoral shrinkage is much more terrifying! Dr. Goldstein highly recommends the IUD and I highly recommend a natural birth control method called the Fertility Awareness Method. This involves taking your basal body temperature and observing your cervical fluid. I know this doesn’t sound too sexy but it has seriously changed my relationship with my body. If you want to know more, get your hands on my Ditch Your Birth Control Protocol and also check out the book Taking Charge of Your Fertility!
#2 Did you know 33% of US teens and 14% of all US women are taking oral contraceptives for reasons other than birth control?
There are a whole lot of unhappy hormones in this country. You can start addressing an underlying hormonal imbalance you may be dealing with by changing the way you see food. It may seem far-fetched, but every single bite you take affects your hormones and ultimately the health of your beautiful bod! Start by adding in leafy green vegetables. Kale, spinach, and swiss chard are all top 10’s in my book. Extra points if you eat them in at least one meal every day! If you want even more, consider my Fix Your Period 12-Week Program to jumpstart your hormonal health. This program will put you on track to seriously getting your va-va voom back ladies!
#3 If you are having issues with dryness and/or painful sex, here are some solutions.
- You should read my post on Julva, the dream cream for your vulva. It was formulated by my colleague Dr. Anna Cabeca, an OB/GYN, and it contains DHEA, a precursor hormone to estrogen and testosterone. It has worked miracles in many of my client’s sex lives! More lubrication, high libido, better sex! Here’s that post again. You can also get a free 7-day trial – just pay for shipping.
- Try a natural lubricant like SYLK. SYLK is the only moisturizing lubricant made from 100% purified natural New Zealand kiwi vine extract. If you give SYLK a try, you can get free shipping when you use coupon code PERIODGIRL
- Dr. Goldstein suggests speaking to your doctor about a local estrogen/testosterone combination gel (it should have a 10:1 ratio of testosterone to estrogen). It is typically applied to the vulva, in the vagina and on the clitoris. The reason for this is because the nerves in these areas are hormone-dependent, but much more testosterone dependent than estrogen dependent. Hence the reason for the 10:1 testosterone to estrogen ratio. Testosterone will help the lubrication issues and estrogen will help the pain issues. Please note, this is very individualized and you need to see your doctor to determine the prescription and the course that is best for you.
- DHEA is a hormone produced by the adrenal glands. It is a building block that provides the body everything it needs to make estrogen and testosterone and it is available over the counter in the US. According to Dr. Goldstein, there are clinical trials using DHEA intra-vaginally rather than estrogen and/or testosterone that are promising for the treatment of vaginal dryness. He says “It’s great because it gives the vagina the building blocks to make both of these hormones. It not only improves lubrication but it improves the quality of the mucus membranes, the health of the blood vessels and the health of the nerves.” Again, you should consult your doctor before taking any hormones.
- Another resource is Dr. Goldstein’s book When Sex Hurts: A Woman’s Guide to Banishing Sexual Pain. It is a fantastic resource if you want to learn more about Dr. Goldstein’s work.
I believe that good sexual health is your birthright. You need to fully live in your sexual self in order to fully live in all areas of your life.