EFFECTS OF HORMONAL CONTRACEPTION ON FEMALE SEXUALITY: OUR EXPERIENCE IN A SAMPLE OF USERS

Objective: investigate sexual function and distress in a cohort of young women using different types of combined hormonal contraceptives for at least 3 months in a real-life setting. Our secondary objective was to explore the usefulness of a psychometric tool assessing cues for sexual desire in contraceptive counselling. Methods: We recruited a sample of healthy fertile women (n°=155) between 15 and 35 years age requesting combined hormonal contraception (CHC) to prevent pregnancy. To enter the study, nulliparous women should be at their first prescription of hormonal contraception and should be willing to fill in a series of questionnaires to assess sexual function and behavior. The psychometric sexual testing was performed through: 1- Female Sexual Functional Index (FSFI) 2- Female Sexual Distress Scale-Revised (FSDS-R) 3- Cues for Sexual Desire Scale (CSDS). Results: sexual function measured by using the total FSFI score in 6-month CHC use showed no significant change in the total FSFI score and in the majority of FSFI domains, with only sexual desire barely significantly lower at 6° month in comparison to baseline and 3° month. Age and BMI were not significantly correlated to sexual function at baseline. No differences were evident in women according to their menstrual pattern before assuming CHC. The total FSFI score before and after 3 months of CHC use showed that the clinical picture was highly variable with many women remaining stable and some displaying positive or negative changes. The rate of FSD was slightly lower as compared to baseline, being present in 31.6%. Analyzing FSFI scores it was noticed that 72.9% of the patients following 3 months of CHC use remained in their FSD category. In addition, in 15.5% of our study sample FSD remission was evident following CHC, whereas in 11.6% CHC had a detrimental effect on sexual function by inducing FSD. We found that sexual distress measured by FSDS-R was superimposable in women tested at baseline as compared to 3 and 6° month of use. Around a third of the sample was above the cut-off to define sexual distress at baseline. The clinical picture was highly variable with many women remaining stable and some displaying positive or negative changes as it was described for Total FSFI score. The rate of FSD was slightly lower than at baseline, being present in 27.7%. Considering FSDS-R scores, 78.6% of the patients following 3 months of CHC use remained in their distress category. In addition, in 14.3% of our study sample distress remission was evident following CHC, whereas in 7.1% CHC had a detrimental effect on sexual distress. Following 3 months of CHC use analyzing the type of estrogen, the dose of EE, the route of administration and the type of progestogens we did not find any significant differences analyzing both the FSFI and the FSDS-R scores. Interestingly, emotional bonding and romantic cues measured by the CSDS were slightly but significantly affected by the use of CHC following 3 months. Moreover, lower scores for emotional bonding cues were evident following 3 months of CHC use in those women reporting a worsening of sexual function, especially when there was a change of FSFI category which became dysfunctional. Conclusions: The studies performed so far are conflicting although it seems that only a minority of women experience sexual function changes. Nonetheless this issue deserves attention due to the large number of CHC users and considering that each women should have the right to enjoy their sexuality and experience pleasure from it. So far, there are no absolute recommendations, however these possible sexual side effects should always be considered and, if present, a therapeutic approach should be started.