Heather was thirty-one when she first came to my office for help to locate her sexual desire. Her sandy blonde hair had an angled cut that came right below her chin. She walked in, sat down in the office chair right up against my clinic desk, and looked directly at me and said, “Tell me Susan, do women ever really want it?”

As she asked me that question, I took a quick breath as I registered what she was telling me—that she did not experience sexual desire, and that possibly she never had. Even though her particular medical situation has presented dozens upon dozens of times in my office since her visit in 2003, I will never forget the striking directness of her question.

Heather told me she’d never felt interest in being sexual. She did not think about sex or look forward to it. She never had. She otherwise had a very satisfying life. She was attracted to her husband. She found him to be exceptionally good-looking and manly.

Heather was healthy. She had no medical conditions. She was on no other medication besides the pill. Her life was busy and she enjoyed it. Mostly she stayed home with their three school aged kids, and she assisted her husband in his CPA practice part-time. Their daughter was eleven, and their twins (a boy and a girl) were nine. All of her children were well adjusted.

Her contraceptive history revealed that she had gone on the birth control pill in her late teens before becoming sexual. She was on birth control when she married her husband, and she had stayed on birth control pills until she wanted to get pregnant. She stopped to get pregnant and then started again when she stopped breastfeeding. She did this again for the second pregnancy when she had the twins. She had gotten pregnant quickly each time. At the time of her visit she was back on the pill.

Although highly effective at preventing pregnancy, birth control pills and other hormonal contraceptives are not always sex friendly. They can dampen sexual desire and reduce vaginal lubrication during sex, which can cause intercourse to become painful.

Research shows that while most women on the pill report no change in desire, some report more sexual desire, while others report less. I see those women who have less.

Here’s why some women see their desire drop. Hormonal contraceptives (including the pill, the patch, and the ring) prevent pregnancy by blocking ovulation, so that surge in hormones that comes with ovulation no longer happens. If you are used to experiencing a spontaneous interest in sex mid-cycle, you may notice that it is no longer there after you start using a hormonal contraceptive.

Also, hormonal contraceptives lower the testosterone level in your body. Testosterone, which is the primary hormone associated with sexual desire in both men and women, is produced less by your ovaries when you are on hormonal contraceptives. Also, the estrogen you are taking causes a liver protein called Sex Hormone-Binding Globulin (SHBG) to be increased. This protein binds up your testosterone, making the testosterone that you do have less available for your cells to use. Lowering your testosterone can land a blow to your sexual desire. It also can decrease lubrication, sensation, arousal, and weaken orgasm—all the feel good parts of sex. The Ortho Evra Patch, the NuvaRing, and also the newer, lower, twenty microgram estrogen birth control pills create even more binding up of testosterone than the older versions of the pill that had thirty or thirty-five micrograms of estrogen.

Heather’s blood tests confirmed her testosterone levels were below normal and she had an elevated SHBG level. I explained to Heather that this is a side effect of using the pill and it did not mean something was wrong with her.  

After our visit Heather decided to try going off of the pill to see what she experienced. Nine months later, she came in and reported that she had started feeling cyclical sexual desire about seven months after stopping the pill. This pleased her. She could finally relate to wanting it.

She never went back on the pill. Since both she and her husband were satisfied with their three children, he got a vasectomy.

Their sex life expanded. She continued to desire him, especially mid-cycle. She discovered a newfound appetite for exploration and discovery. They got creative in their lovemaking—they were sexual in the middle of the day and in different rooms of the house, they bought sex toys, and experimented with anal intercourse. They became far more open with each other and felt more connected.

Heather told me feeling sexual desire has made her feel normal. She’s no longer missing out! She finally felt part of the club of women who have desire and enjoy sex. She did not realize how much she had felt like an outsider before.

Some contraceptives don’t block ovulation or lower testosterone; these include the barrier methods—condoms, diaphragms, and also the PARAGARD® IUD (Copper-7). There is always the vasectomy option for your partner, or a permanent method for you, if you both are sure you don’t want any more children.

Not everyone is a candidate for these methods. Your medical history, your risk of pregnancy, and your personality all should be factors in your choice.

If you notice a drop in libido within a few months of starting any hormonal contraceptive, explore your options with your health care provider. The list of possible problem birth control methods includes the progestin only contraceptives like the Depo-Provera shot, the mini pill, and the implants in your arm, as a small percentage of women users may have lower libido and vaginal dryness with these as well. There is no perfect contraception, as each has its plusses and minuses.

If you do need contraception and your situation requires you to use a hormonal contraceptive that blocks ovulation or lowers your testosterone, there are remedies that can counterbalance those negative effects. Also, some birth control pills are found to be friendlier to your sex life than others.

This is an excerpt from Fanning the Female Flame-How to Increase Your Sexual Desire (Without Changing Partners).