The Pill and Pain During Sex

coc
combined-oral-contraception
pain-during-sex
the-pill

#1

I recently came off the combined pill after 12 years due to migraines. Ever since I first became sexually active, I’ve been on it and so I didn’t know my body without it. Sex was always very painful for me - sometimes it would be bearable but other times I just couldn’t do it. I was prescribed anaesthetic gel (what an insult) and vaginal dilators over the years, was told it was “nerve pain” and basically left thinking I was defective and that there was nothing that could be done.

I’ve been off the pill for 3 months and I finally know what sex is supposed to feel like. I actually enjoy it now instead of just enduring it. Interestingly, it seems that research has been conducted in this area and there are a number of mechanisms by which the pill causes this kind of pain and yet this information is not being used in practice.

I wanted to know if anyone else has experienced this? The reason I really started thinking about and looking into this is that the first woman I found who had also come off recently had the exact same experience as me. This must be more common than we’re being led to realise and something needs to change in clinical practice. Has anyone else noticed that their ability to have pain free sex is affected by their contraception?


#2

Hello @LucyAndTheSky

Interestingly there was an editorial about ‘The Pill and Women’s Sexuality’ in the British Medical Journal last week

It doesn’t say much except that little is known about this and it is a neglected topic for research. It talks about interest in sex but not pain. It suggests that some women experience a decrease in interest in sex when starting the pill and that this may relate to a decrease in testosterone levels.

https://www.bmj.com/content/bmj/364/bmj.l335.full.pdf

It would be really interesting to know whether anyone else has experienced pain during sex while on the pill.

Many thanks

Paula


#3

I started the pill on September 2017. After 6 months, my boyfriend and I were trying to have sex and I had to totally stop because it was so painful, probably from dryness which caused friction. The next day, it became very itchy and so I went to the doctor’s and they had diagnosed me with thrush and gave me treatment (oral tablet). I also switched to nexplanon because I thought it wouldnt make me as sensitive/dry but i haven’t seen much of a difference. After the thrush treatments, it was fine for 2 weeks but the symptoms came back. I think the dryness of my vagina led to friction and the thrush would come back so quickly (sometimes after a week)! This repeated for a long time, I am on a suppression therapy now for thrush and sex seems normal again. I have to take the oral tablet every week and my bf has been treated too. We use organic water based lube (By the company YES) and every few days, I’ve used their vaginal moisturiser which seems to be working as I get very wet during sex.

I feel that there is very limited knowledge on the effects of vaginal dryness from the pill/implant, if I had known they were connected I would have tried a different method of contraception. Sticking with nexplanon for now because I’ve not had any other problems.


#4

Hello, so happy to hear others talking about this! I experienced pain during sex on synthetic birth control, although I was using the Nuva Ring. The pain did not have to do with the physicality of the Nuva Ring–it was exactly the chafing feeling others describe–like an abrasion. I was also given a dilator and told it might be psychological, but when I went off of it this past May, sex became pleasurable again in no time. I’m very much hoping that this becomes a highlighted issue for women on or considering the pill, as it’s just as important for women to enjoy sex as men!

Also related, coming off of birth control is a crazy ride in itself, and I also wish I’d known more about that before choosing to go on the pill. I’m grateful that we women have the option to control our reproductive fate, but sad that the pill is not given with more counseling about the risks and damage it can do to our physiology, as well as expected struggles coming off.


#5

Hello @LucyAndTheSky, @churros and @andrea

Thanks for you comments - we ran an instagram story on the pill and pain during sex. I have put all the comments below.

Main points seem to be:

Some people get vaginal dryness on hormones and this can make sex more painful.
Some people get irregular bleeding on contraception and this can be embarrassing - this also works the other way around - so some people have no periods and can like the fact that they never have sex and bleeding at the same time.

Here are the actual comments

Would be interested to know what you think. Particularly @LucyAndTheSky - has this helped your contraceptive decision making?

Many thanks

Paula

Q: Has your contraception affected your enjoyment of sex?

  • Yes it has caused dryness and oversensitivity.
  • Yes, it started when I was on the pill, switched to nexplanon but the pain is still there. (Nexplanon = contraceptive implant)
  • Yep, Mirena coil killed my orgasms and libido. But being sterilised has massively improved it with no risk of pregnancy. (Mirena coil = hormonal IUD)
  • Dryness which then leads to friction.
  • The implant means I can be on my period for a long time. I can still have sex, I’m just very self-conscious.
  • Implant caused spotting/bleeding constantly making me very self conscious and anxious during sex.
  • Contraception seems like an incredibly unjust and sexist enterprise.
  • Yes! Had the implant since I hit puberty ‘til a month ago, 6 years in total! Horny AF now.
  • The Mirena coil led to painful sex, vulvodynia ruined sex for life I now fear it, devastating. (Vulvodynia = chronic pain syndrome that affects the vulva area, symptoms include a feeling of burning and irritation).
  • No
  • Yes, I have no interest in sex and because of suspected endometriosis, I find it very painful. (Endometriosis = conditions where tissue similar to the lining of the womb starts to grow in other places, such as ovaries and fallopian tubes)
  • Turned off easier during sex
  • Progesterone based contraception killed my sex drive completely
  • I’m on the mini pill Cerelle caused dryness! And certain positions r painful now if the penis hits the side of my vagina. (Cerelle = progesterone-only pill)
  • Made it a bit better because boobs were huge which lifted self esteem
  • Yes I had the depo injection and it made sex impossible and excruciating #vaginaldryness. (Depo injection = contraceptive injection)
  • I’ve got the bar and it’s been making me bleed constantly the last 8 months so yay. (The bar = contraceptive implant).
  • My coil threads were too long and would hurt my partner, getting them shortened was a huge fight.
  • First time I started taking the pill I got a bartholin cyst. It’s still here! (Bartholin cyst = fluid filed sac at entrance of vagina).
  • It didn’t for the first few years but then it got increasingly worse, so I switched pills.
  • At the start my libido was very high, after a month my libido was the lowest of the low.
  • My first implant stopped my periods for 2 years so I could enjoy casual sex like a cis man. (Cis =cisgender, a person whose sense of personal identity and gender corresponds to their sex at birth)

#6

Hi Paula,

Thanks for running this topic on the Instagram page, I saw the comments in the SH:24 account’s stories and was amazed to see how many women have reported effects on their sexual function.

Thank you also for sharing the BMJ paper - the responses are also particularly interesting. One researcher cites a study that saw depressive mood incidence increase from 10% to 44%, while others agree that this is a hugely under-researched area.

I had already made my contraceptive decision (to go without anything at all) but if I had known all of this earlier, I would probably have come off the pill much earlier and saved myself a lot of uncomfortable examinations and low self-esteem as a result of thinking I had some kind of incurable “pelvic pain”. I also wish I had been equipped with the empirical evidence before my last appointments at the sexual health clinic in Balham, where I was rather forcibly directed towards taking the POP. I left with a prescription that has sat in the back of my wardrobe gathering dust. I am still planning on writing them a strongly-researched and worded letter.

Another fascinating review (which unfortunately is not open access for those without university library services) can be found here:
https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1743-6109.2012.02848.x

The particularly relevant section (for me anyway) discusses the influence of oral contraceptives on the incidence of vestibulodynia:

> Several studies have found that COCs increase the relative risk of developing pain in the vulvar vestibule (provoked vestibulodynia, vestibulodynia) by four- to ninefold [33–35]. Furthermore, Bouchard et al. found that the likelihood of developing vestibulodynia was highest in women with the longest duration of pill use and in those women who initiated use of COCs at a young age [34]. Berglund et al. surveyed 172 women age 12–26 regardingtheir sexual habits, and questioned them specifically on vulvar pain. They found that one-third of women reported pain during and/or after intercourse and having used oral contraceptives for more than 2 years was a risk factor [36]. In a study comparing COC users vs. nonusers, Bohm-Starke et al. found that COCs increased sensitivity (mechanical pain threshold) in the vestibular mucosa [37]. The authors concluded that COC use may predispose women to vestibulodynia. There are also reports of women on COC with vestibulodynia who have had resolution of their pain when the pill was discontinued and SHBG and free testosterone levels were normalized [38]. Alternatively, others have not found an association between COC use and vestibular pain. Lee et al. assessed genital sensation in low-dose (20mg EE) COC users and COC nonusers [39]. They found no difference in vestibular pain thresholds among the COC users vs. the nonusers. Edgardh and Abdelnoor assessed risk factors for vestibulodynia in a case control study of 45 women. They found that nulliparity and bacterial vaginosis were risks factors, and oral contraceptive use was not [40].

This review was conducted in 2012, meaning that the research has been underway for many more years. Why was this information not available to the sexual health practitioners who treated me when I reported unbearable pain during sex? I have had some very positive experiences with sympathetic and caring staff, as well as less-positive experiences with those who made me feel defective and who did not respect my decision to stop using contraception - but in all cases, the knowledge just was not there. I feel like I’ve lost 10 years to painful sex, which has inevitably impacted my relationships and sex life.

How can we change this?

Other interesting individual studies demonstrating the impact of oral contraceptives on sexual function:




#7

Many thanks @LucyAndTheSky

If I get a chance over the next couple of days I will try to do a plain English summary of these papers.
I did invite the author of the BMJ article to do a post on the forum but have not heard back yet.

Thanks again.

Paula


#8

Thank you Paula.

I’ve also found this post by some of the researchers involved in those studies which presents things in plainer English:


#9

Wow - this is really interesting.
I might drop a line to the clinical effectiveness group at the Faculty of Sexual and Reproductive Health Care to see whether they are interested in mentioning it in their next clinical guidance document.
Many thanks

Paula