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Post written by guest blogger, Jenny Higgins, PhD, MPH, Associate Professor, University of Wisconsin; Director, Collaborative for Reproductive Equity
We tend to think of contraception as a medical versus a sexual good. Most studies of contraceptives, as well as most public health programs and clinical care, tend to de-eroticize family planning and focus almost entirely on efficacy, safety, and non-sexual side effects. This “pleasure deficit” stands in contrast to both current and in-development contraceptive methods used for male-assigned bodies. For example, most people implicitly recognize that male condoms reduce sensation and pleasure for people with penises, and that this sexual side effect can discourage condom use. Comparatively, we give little lip service to how women’s* sexuality, including sexual pleasure, may be affected by contraceptive use.
However, at its core, contraception allows women to engage in penis-in-vagina sex without the occurrence of unwanted pregnancy. In fact, many scholars have written about the advent of the pill as ushering in the sexual revolution of the 1960s. Women who wanted to avoid pregnancy could engage in penis-in-vagina sex with much more security, and thus increased sexual disinhibition and enjoyment. But given widespread cultural discomfort with women’s sexuality, one of the ways that family planning advocates garnered more widespread support for modern contraceptives was to promote it as a medical product that advanced health rather than improve women’s sex lives.
Contraceptives have come a long way since the 1960s. However, the pleasure deficit lives on. Sexuality is still largely overlooked as a reason women might continue or discontinue their method.
A few scholars, including myself, have engaged in research to better understand the ways that contraceptives affect women’s sexual experiences. These studies have clearly established that some women experience reductions in sexual pleasure and wellbeing while using contraceptives. Granted, most of these studies have taken place in the United States and Europe, and work is still needed to document how women in a variety of other cultural settings experience their contraceptives from a sexual perspective. But the existing research does give strong clues that the association between contraceptive use and women’s sexual pleasure and wellbeing is very likely to shape method satisfaction and use over time.
For example, in one U.S. study by Stephanie Sanders, Cynthia Graham, and colleagues, women who reported declines in sexual functioning (that is, orgasm, libido, arousal, and other physiological domains of sexuality) were more likely than any other group to discontinue combined oral contraceptives within the first six months of use. My research collaborators and I have also found that women who experience increases in vaginal bleeding, as well as side effects such as breast tenderness, headaches, or bloating, are—understandably—more likely to report declines in their sexual wellbeing and to discontinue their contraceptive method. Excitingly, we have also found that contraceptives can help improve women’s pleasure and wellbeing. In fact, a greater proportion of new contraceptive users seem to experience side benefits due to their method.
For example, in qualitative studies, we have documented that if women are confident that their contraceptive method is effective, they are more likely to feel like they can “let go” during sex. These women indicate that contraceptive methods can minimize “that little voice inside your head”—that is, chronic worry that one might be or become pregnant. These qualitative studies have also shown that methods that help enhance spontaneity (compared to, say, condoms or withdrawal) can also enhance people’s sexual experiences. That said, condoms play a critical role in both STI and pregnancy prevention across the world; moreover, some women report liking the ways that condoms make sex less messy.
We are currently undertaking what we believe to be the largest longitudinal study of new-start contraceptive users and their sexual experiences. Findings show great promise in terms of establishing that contraception can improve many women’s sex lives. The project involves over 3,500 family planning clients who started an FDA-approved, reversible contraceptive method of their choice at the beginning of the study. We’ve tracked a number of sexual outcomes over time—for example, people’s sexual functioning, sexual satisfaction, and overall rating of their sex life. While a sizable proportion report no contraception-related changes to their sex lives, almost half (48%) reported that their new method had made their sex life better in the first month of use; 19% reported it had made their sex life worse. Those reporting sexual detractions were most likely to have experienced increased bleeding and physical side effects (headaches, breast tenderness, bloating). People reporting sexual improvements were more likely to have experienced decreased vaginal bleeding and minimal side effects.
Perceived sexual effects were similar across methods, but compared to oral contraceptive users, patients initiating IUDs and implants were slightly more likely to report positive effects than those using oral contraceptives. That said, I want to underscore that a variety of methods may meet people’s sexual needs. Contraception is an under-appreciated part of women’s sexuality during the reproductive years, when women may spend decades engaging in penis-in-vagina sex but don’t want to be pregnant. As such, contraceptive researchers and product developers should consider sexual satisfaction when designing new methods.
* In this blogpost, I focus on people who identify as women and who could also get pregnant (that is, cisgender women), particularly since most cultures disdain women’s sexuality far more than men’s. However, we greatly need more research and programs focused on the contraceptive needs of transgender and gender-nonconforming individuals.