Female genital arousal in women using combined hormonal contraceptives

To correlate the sexual arousal and vaginal lubrication scores with free androgen index (FAI) and clitoral blood flow in women using different types of hormonal contraceptives (HCs) containing ethinylestradiol (EE), oestradiol valerate (E2V), 17β-oestradiol (E2), or estetrol (E4), combined with different progestogens having antiandrogenic properties.

One hundred and thirty-two women (age range 18-41) participated in the study. The Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale (FSDS) questionnaires were used to assess sexual function and sexual distress, respectively. Sex homnone-binding globuline (SHBG) and total testosterone (TT) were measured, and FAI was calculated. Translabial colour Doppler ultrasound was adopted to measure the pulsatility index (PI) of clitoral arteries.

Arousal and lubrication scores were lower in women on HCs with EE than in those using combined oral contraceptives (COCs) containing E2V, 17β E2, or E4. The lowest FAI percentages were achieved by women using combined hormonal contraceptives (CHCs) containing EE, while the highest ones were found in women using COCs with natural and native oestrogens. Sexual arousal and lubrication scores had a positive correlation with FAI. Finally, COCs with native and natural oestrogens produced lower PI values than CHCs containing EE. Moreover, clitoral artery PI values were negatively correlated with FAI, with a stronger negative correlation obsterved for COCs containing natural and native oestrogens conpared with those contanining EE.

Unlike what was observed in women who were using COCs containing E2V, 17 E2, or E4, a minority of those on CHCs with EE might experience decreased sexual arousal and vaginal lubrication.