Q: I’m a 22 year old woman and have almost entirely lost my sex drive. I am in the mood for sex perhaps once every two months, and even then it takes me a long time to get my body into a state of arousal that makes intercourse possible [all the plumbing and hardware works fine then, though.] This is a huge departure from the past, where I have consistently had a very strong sex drive. But about three years ago, my sex drive rapidly dwindled and disappeared over a period of a few months. My low sex drive is causing me to fear intimacy [because it could lead to sex, which feels like a dreaded, somewhat painful chore], which is destroying my relationship. I have no desire for anyone at all, and have even stopped masturbating. I have read that oral contraceptives are increasingly being shown to have a negative impact on sex drive in studies. I have my annual gynecology exam soon and am wondering what other options might work for us – condoms are not an option for my boyfriend for very real reasons. What can we do? Thanks.
A: Great question. We get some version of this question regularly, which basically boils down to: is it true that oral contraceptives [the birth control pill] and other hormonal birth control are linked to low desire among women? If so, what other options are available for couples that want to have sex but don’t want to become pregnant?
First, it is true that hormonal contraception has been linked with low desire among women. That said, we need significantly more research to understand the why and the how and whether there are certain brands of birth control pills [or other types of hormonal contraceptives] that are less likely to cause sexual side effects than others. There isn’t much funding available for this type of research – which is a shame given how many couples it impacts.
As for options, condoms are an option for many couples but some don’t feel they’re the right choice for them. If size is an issue, the couple might consider looking for smaller or larger sized condoms that will be comfortable for him. If he’s had emotionally difficult experiences related to condom use [say, perhaps he was molested as a child and the sexual experiences involved an adult man who was wearing a condom] he may find it helpful to meet with a counselor or therapist to talk about any issues that are currently interfering with his life.
Intrauterine devices [IUD] are an option. While there are hormonal IUDs available there is also a non-hormonal IUD available and people may find it helpful to talk with their healthcare provider about the IUD as an option. It’s more expensive in the short-term but if individuals are not planning to become pregnant for a long time, if ever, it may be a very good option to consider.
If any boyfriend can reliably – and I mean, very reliably – ejaculate when he wants to and hold off until he’s ready [i.e., if he can easily control the timing of his ejaculation] then withdrawal, or more commonly referred to as, “pulling out,” is another option to consider. It’s less effective than hormonal birth control but it’s more effective at preventing pregnancy than many people believe.
Various natural family planning methods are yet another option that may interest sexually active people. They don’t involve taking hormones; however, they’re most effective when health educators and/or nurses or doctors walk people through the most reliable ways to tell when they are likely to conceive and when they are very unlikely to conceive. True, it means that some days of the month may be days they decide to skip sex so as not to become pregnant but frankly it sounds like right now there are far more days that they’re skipping, or rather avoiding, sex because of their feelings related to low desire.
Finally, although low desire is not necessarily “in their head,” they expressed ways that this frustrates them and is getting in the way of their relationship. This can become a difficult cycle, full of challenging relationship dynamics. Meeting with a sex counselor or therapist [find one through sstarnet.org] may be helpful.
Dr. Debby Herbenick is a sexual health educator at The Kinsey Institute and author of Because It Feels Good: A Woman’s Guide to Sexual Pleasure and Satisfaction, Read My Lips: A Complete Guide to the Vagina and Vulva, The I Love You More Book, and Great in Bed. Find our blog, sex information, podcasts and archived Q&A at www.KinseyConfidential.org. Follow us on Twitter @KinseyCon and follow Debby at @mysexprofessor.
