The birth control pill, or oral contraceptive pill (OCP), which is made of synthetic hormones, became the first “lifestyle” drug prescribed to women for personal, family-planning reasons rather than for an illness. Approved for use in 1960 by the FDA and originally prescribed only to married women, it quickly became the most widely used medicine in the world. At least 500 million women have used the pill at some time in their lives, frequently for decades at a time. For many women, the pill was liberating. But is it really?
What doctors are seeing now are the unintended effects, temporary or irreversible, that the pill has had on women’s bodies. Changes have been made to OCPs over the years to decrease troublesome side effects, but studies remain controversial about the full array of problems, with politics often interjected into a scientific discussion. What problems, then, are patients presenting to their medical doctors? Is it safe for young girls to get on the pill? To answer these questions, let’s first review the vaginal anatomy and how the pill works.
The vulva is the woman’s external genitalia. The vagina is the internal muscular tube known as the birth canal. But actually, the vagina and vulva comprise three distinct areas: the outer vulva, the vulvar vestibule, and the vagina. The vulvar vestibule is the small area of skin immediately outside of the vagina. Many women who report vulvar pain actually have localized pain called vestibulodynia only in the vulvar vestibule. The vulvar vestibule is androgen dependent. The vestibule’s tissue contains the glands that release mucin, the vagina’s natural lubrication, which is released during sexual stimulation and intercourse. The “on/off switches” for these glands are known as the androgen receptors. Moisture problems, vaginal dryness, or a lack of mucin can arise if there are problems with the androgen receptors or with a lack of an androgen called testosterone, both resulting in vestibulodynia.
How OCPs Cause Vestibulodynia
Most OCPs contain two synthetic hormones – estrogen and progesterone. The different brands of OCPs only vary in the amount of estrogen and the type of progesterone. OCPs use these two hormones to inhibit the body’s release of follicle stimulating hormone (FSH) and luteinizing hormone (LH) to prevent pregnancies in three ways. First, they prevent ovulation. Second, if ovulation occurs, they thicken cervical mucus to prevent sperm from reaching an egg. Third, if fertilization occurs, they thin the uterine lining to prevent the fertilized egg from implanting. Two inadvertent side effects occur due to the inhibition of FSH and LH:
- Without FSH or LH, the ovary’s natural production of testosterone decreases, resulting in fewer androgen receptors being activated. This results in decreased mucin production and less vaginal lubrication.
- OCPs’ synthetic hormones are metabolized in the liver, which causes the liver to increase its release of a protein called Sex Hormone Binding Globulin (SHBG) that binds to testosterone. Once these proteins bind to testosterone, the testosterone is unable to activate the androgen receptors.
The ultimate result of these two side effects is that available androgen is reduced by 75%, having a significant impact on mucin production. When there is less mucin, there is more vestibulodynia, or localized pain in the vulva vestibule. Additionally, with a decrease in the body’s own hormones, there is diminished blood flow to and shrinkage of the vulvar vestibule’s tissues. This causes thinning of the vaginal tissue resulting in dryness, tearing, infections, and vestibulodynia.
Low Sex Drive in Women
Testosterone is an androgen that is the dominant hormone in men. Although women have far less testosterone than men, it has an equally important role for women. Testosterone affects a woman’s energy, sex drive, and feelings of well-being. As OCP use increases production of the protein SHBG which binds to testosterone, more and more testosterone becomes ineffective. Therefore, women on the pill often experience a lower sex drive because of less free testosterone. While OCPs can be used intentionally to decrease free testosterone for treatment of acne and excessive hair growth, it also can cause a lower sex drive.
For many women, being on the pill is a medical necessity. The hormone pill is indicated for treatment of excessive or long periods that can lead to anemia, for acne that can be psychologically and physically scarring, and for endometriosis that can cause debilitating pain, among others. It is important for a woman with any indicated medical condition to discuss alternatives with her doctor before simply stopping the pill. Women who use OCPs for birth control and have pain with intercourse or low sex drive should discuss alternatives with their doctor before stopping so that unintended pregnancy does not occur.
Unfortunately, simply stopping the pill does not always reverse the problematic side effects, and, without intervention, women can continue to suffer with low libido or pain with sex until they have proper medical intervention. For women suffering from vestibulodynia, a thorough evaluation by an expert medical doctor specializing in female sexual health is paramount. There are other disorders that can cause the same symptoms, and it is important to have proper diagnosis for proper treatment. Tests, hormone levels, blood work, examination, and an extensive medical history are necessary to determine the cause of the pain and the best course of treatment.
Does the Pill Actually Castrate Women?
To answer our initial question, does the pill castrate women, the short answer is yes. Some women lose the ability to produce healthy, functioning levels of hormones due to inadvertent side effects of OCPs. Hormonal creams and alternative birth control methods may be needed indefinitely. The pill is thought to be sexually liberating, but in fact it can be sexually restraining. The risk only increases for younger, teenaged women, who could suffer from this condition for decades. This information and scientific data should be known not only by women seeking birth control but also by their health care providers, many of whom do not know about this connection of OCPs with vestibulodynia and low sex drive.
While not all women who take birth control pills will have vulvar pain, many women will. And once this condition begins, it usually requires medical treatment. If you suffer from vestibulodynia, Dr. Katherine Williams, who earned her fellowship from ISSWSH and founded the Southern Institute for Women’s Sexual Health, can help you and other women who have complex pelvic and vulvar pain disorders. Sex should never hurt. For more information, visit www.siwsh.com, call (985) 871-0707, or email firstname.lastname@example.org.
There is hope. Please don’t suffer in silence any longer.
Goldstein, A. T., MD, Krapf, J., & Belkin, Z. (2014, June). Do Oral Contraceptive Pills Cause Vulvodynia? Time to Finally End the Controversy. Retrieved April 19, 2017, from http://pelvicpain.org/professional/blog/ipps-blog/june-2014/do-oral-contraceptive-pills-cause-vulvodynia-time.aspx
“A Brief History of Birth Control in the U.S.” Our Bodies Ourselves. N.p., 14 Dec. 2013. Web. 23 Apr. 2017. <http://www.ourbodiesourselves.org/health-info/a-brief-history-of-birth-control/>.