Contraception and sexuality

Contraception has changed female sexuality. The possibility of sex without pregnancy is taken for granted by most women and facilitates sexual availability. Potential consequences to female sexual response are linked to the various contraceptive methods in use today. This is a comprehensive review article of existing literature that explores the impact of current contraceptive methods upon the female sexual response cycle with potential sexual dysfunction. The definitions and classifications of female sexual response and female sexual dysfunction are also reviewed. Combination estrogen and progesterone contraceptive products decrease testosterone and increase sex hormone binding globulin without consistent impact upon libido. Progesterone only methods can in small numbers decrease libido and cause vaginal dryness and dyspareunia. Bleeding irregularities contribute to vaginal dryness and vulvar irritation. In the postpartum period and during lactation, these changes are exacerbated. Overall, IUD users have no significant effect on libido. Female sterilization generally has a positive impact upon sexuality unless the woman has been ambivalent over the procedure. Barrier and natural family planning methods are neutral. The freedom of sexual activity without pregnancy must be balanced with known side effects, risks and benefits to sexual health. The impact of contraceptive methods upon sexual function is not often discussed with women prior to initiation of a selected method or at subsequent visits. It is important that as clinicians we recognize the impact of contraceptive methods to sexual functioning and counsel our patients appropriately.