“I went to my OBGYN to ask about non-hormonal birth control. (The Pill basically ruined my sex drive.) She pushed the Pill and the Nuva Ring, and said that condoms have a 15 percent failure rate. I don’t like that she was pushing hormonal birth control. Is it possible for hormonal birth control to lower your desire, and if I don’t want to use it, what’s my best, and safest, bet?”
To hear Dr. Glickman's advice,
Unfortunately, yes, birth control pills can lower libido. There are at least a couple of reasons for that. First, the Pill inhibits the production of androgens by your ovaries, including testosterone. While ovaries don’t produce as much testosterone as testicles do, it’s still an important part of women’s sexual arousal. The Pill also seems to increase the production of sex-hormone binding globulin (SHBG). SHBG binds to testosterone, which further reduces the amount of it that you have available. On top of that, an article published in the 2006 Journal of Sexual Medicine found that some of these changes may last for quite a while after you stop taking the Pill. Some women report that the NuvaRing has similar effects, although others don’t have any change in their libidos and others actually have an increase in sex drive.
15 percent is a bit higher than many estimates for condom failure rates, but part of why it’s hard to pin down more precisely is that many of the reasons for condoms not working is user error. Here are some tips on reducing the odds of that happening. And since each brand of condom is a bit different, this page has lots of advice for finding the right one for you.
Even though condoms aren’t 100 percent effective at preventing pregnancy, they go a long way towards lowering your risk for sexually transmitted infections. But if your focus is on contraception rather than STI prevention, there are some other options. Intrauterine devices (IUDs) are a lot more effective and safer than is popularly believed. They are currently available with or without hormones, although it’s worth noting that the level of hormones that end up in your system is a lot lower than what you get from the Pill and the non-hormonal IUDs can cause heavier menstrual bleeding or cramps.
Unfortunately, most of the more effective forms of contraception either include some form of hormones or are irreversible. The only other way to avoid pregnancy is to keep sperm from coming into contact with the ovum. Obviously, condoms do that, but if you want other options, you might want to check out cervical caps which have about a 10 percent failure rate if you’ve never given birth vaginally and a 25 percent failure rate if you have. (You can reduce that with a spermicide.) You could also check out the vaginal contraceptive film, a strip of spermicide that you insert into the vagina where it melts and provides up to three hours of protection. It also turns out that withdrawal is more effective than was previously thought, with an 18 percent pregnancy rate. Since these other approaches are clearly less effective than implants, the Pill or other hormonal methods, a lot of people use more than one. Condoms plus cervical caps or condoms plus withdrawal improves your odds a lot.
I’d really like to see some other forms of birth control that don’t mess with women’s hormones; so many women report having all sorts of side effects. There are some gel products being developed that will (hopefully) be effective as both contraception and STI preventatives and at least some of them are working their way through clinical trials. So eventually, there will be something better for you but in the meantime, I hope this helps.