The Science of Sexual Satisfaction
Hormonal birth control
Researchers debate whether hormonal birth control is associated with decreased sexual interest, but this doesn’t seem to be true for most people (20–22).
In a review on the relationship between sexual dysfunction and hormonal birth control, about 15% of combined oral contraceptive users reported negative sexual effects from their birth control, and this effect was primarily related to pills with lower doses of estrogen. Most people reported no change in sexual function, positive or negative (20).
For some people, the protection from pregnancy provided by hormonal birth control may improve their sexual experience by presenting them more peace of mind. In a randomized control trial, women prescribed either a combined oral contraceptive or hormonal vaginal ring reported improved sexual functioning in multiple categories as compared to women not on hormonal birth control after three and six months of use (21). Women on either contraceptive reported statistically less anxiousness while also reporting statistically more initiative, orgasms and orgasm intensity as compared to women not using hormonal birth control (21).
Some studies have found opposite results, though the results are less clear. In a study of over 1,000 women, researchers found that hormonal birth control users were statistically more likely to report negative sexual functions, including fewer orgasms and decreased arousal; however, the authors did not report the size of the differences between these categories when adjusted for important secondary factors, like age or whether the participant had a steady sexual partner, making it difficult to assess the extent of the change in light of other factors (22).
External factors
External factors, such as personal history or partner factors, can also influence a person’s sex life. These influences can be direct or mediated by factors such as depression or general health.
A history of abuse has been shown to be negatively associated with sexual function, though not for all women (4, 12, 23, 24). In one study, women who were sexual abused as children were more likely to report negative responses when discussing their sexuality or during arousal (23). Conversely, sexual assault, regardless of the gender of the attacker, was not found to be related to sexual dysfunction in one study of women who have sex with women (WSW), despite the fact that WSW are 2 to 3 times more likely to have been assaulted as compared to heterosexual women (24).
A person’s partner has a strong influence on their sexual experience. In the same study of Iranian women, more than 7 out of 10 women with sexual dysfunction reported that the cause of their dysfunction was related to interpersonal problems with their partner. More than 8 out of 10 reported that their dysfunction was caused by their partner’s sexual capabilities (5). Similarly, a study of Italian heterosexual women with sexual dysfunction found that the interest of a woman’s partner might more strongly affect her sexuality than any of her partner’s sexual dysfunction (25).
Women who have sex with women (WSW) sometimes experience different sexual effects than those who have sex with men. One study of over 1,500 WSW found many factors associated with sexual dysfunction, such as age, diabetes and menopausal status, were not related to sexual dysfunction (24). Although it’s possible that WSW somehow experience different physiological responses to these factors, the authors suggest that WSW participate in different forms of sex as compared to women who have sex with men, and these sexual activities are less affected by the side effects of diabetes or menopause (25). This idea underscores the subjectivity of sexual dysfunction research, and emphasizes that sexual dysfunction does not necessarily mean sexual dissatisfaction.
If you’re unhappy with your sexual function, consider reaching out to your healthcare provider. Sexual dysfunction is common, and it’s normal for a person to experience changes to their sexual function through their life.
Download Clue today to track how your physical and emotional symptoms affect your sexual life.
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