Most women have no idea that taking birth control pills can cause pelvic pain and painful sex. There has been some controversy on the subject, but I am not here to argue a point. Instead, I want to share about my own experience. I know for a fact that oral contraceptives were one of the primary causes for my pain.
There is a detailed article by Dr. Andrew Goldstein on the IPPS blog which I will be referring to throughout this post. (The Dr. Oz blog also provides a good summary of the same article if you’re interested in checking it out.) What prompted this article last year was a genetic study that Dr. Goldstein and others completed which identified why some women are more susceptible to the damaging effects of birth control pills.
How birth control pills can cause pelvic pain:
Oral contraceptives signal your body (specifically your pituitary gland) to stop producing normal levels of specific hormones which support ovulation. This reduction also signals your body to reduce other hormones, like estrogen and progesterone, which are important for your sexual health. “But don’t birth control pills contain estrogen and progesterone?” you may be thinking. That’s true, but they are synthetic versions which means they don’t match your body’s natural hormones perfectly.
Compounding this lack of natural estrogen, progesterone, and other important hormones called androgens is the increase in Sex Hormone Binding Globulin, or SHBG. When the synthetic hormones in birth control pills are processed through your body (your liver, specifically), they cause an increase in your body’s production of SHBG. This is bad because SHBG attaches itself to sex hormones and makes those hormones inactive. Thus, even if you had sufficient amounts of sex hormones in your body, they are no longer working to keep you sexually healthy.
Birth control pills affected my own sexual health in a couple of ways. The first and most obvious way was by reducing my libido. I had a lot of other factors going on that made me not very interested in sex (namely the fact that it was painful). But, at a biological level I didn’t have a healthy amount of hormones to set any desire in motion. The second way was less obvious to me at the time, but had the most significant impact. The reduction in fully functioning hormones left my vestibule red, atrophied, and painful to the touch. Think about what happens to a flower petal that is no longer connected to its life-giving source of water—it wilts and shrinks, the soft surface becomes dry and fragile, and the vibrant color begins to fade. Similarly, the very part of me that was created for sexual pleasure was causing me great pain because it didn’t have the life-giving source of hormones it required to be healthy. I didn’t recognize these symptoms at the time, and neither did my doctors. It wasn’t until I saw a sexual health specialist that I learned about the importance of hormones and just how big an impact taking birth control pills had made on my sexual health.
Why some women are more likely to develop pelvic pain from birth control pills:
The article I mentioned earlier describes why some women are more affected by oral contraceptives than others. The authors completed a genetic study on women who were on oral contraceptives, both those who experienced vestibulodynia and those who did not. The study found that women who experienced pain had less efficient androgen receptors than those who did not experience pain. The article provides a great analogy to describe the effect of oral contraceptives on women with inefficient androgen receptors.
Take two groups of women. The women in the first group all drive Hummers (a gas guzzling huge SUV) and the women in the second group all drive a Prius (a very fuel efficient compact car). Now if there is plenty of gas to go around, both groups of women have no problems driving as much as they want. But, if there is a gas shortage, then the women who drive a Hummer will run out of gas well before the women who drive a Prius. Women with long androgen receptor gene are “driving a Hummer” and there is a gas shortage caused by taking [oral contraceptive pills].
I have no doubt that if a similar genetic test was completed on my own blood, it would find that I am also “driving a Hummer” as described in the analogy.
Another contributor mentioned in the article is the age you were when first starting birth control pills. Some studies have shown that starting early significantly increases the chances of vestibulodynia. One study found that women who started before 17 years of age were 11 times more likely to develop vestibulodynia compared to women who had never taken birth control pills, and another study found a likelihood of 9.6 times. I fall into this category because I was on and off birth control pills since I was about 16. I had irregular periods and every doctor’s answer to that was simply to put me on oral contraceptives (no matter that every kind I tried gave me excruciating menstrual cramps).
Doctors don’t always know what’s best for sexual health:
In my personal experience, I have found that doctors prescribe oral contraceptives like candy—even a dermatologist’s first answer to acne is to recommend that you go on the pill. When I was on hormone treatment to undo the havoc that oral contraceptives had wreaked on my body I went back to the dermatologist for help with my acne (this can be a side effect to testosterone treatment, depending on the dosage). Even when I explained that I had stopped birth control pills because of the negative effects on my body, the doctor still told me that the pill was my best option. More recently, I saw a new OBGYN for an unrelated complaint and during her information gathering I mentioned the irregularity of my periods. I wasn’t seeing her to address my irregular cycle, but she immediately began pushing me to try oral contraceptives. I emphatically told her that I strongly disagreed with the use of birth control pills due to their significantly negative effects on my body, but I could tell by her demeanor that she thought I was being melodramatic.
The bottom line:
I may have climbed up on a bit of a soapbox, but the bottom line is that you deserve to know the risks of taking oral contraceptives as well as your other options for birth control. First, you should be aware that not all birth control pills are created equal. The article by Dr. Goldstein describes some of the differences between medications and even mentions a few types that are especially effective at increasing SHBG and making sexual hormones inactive. (Of course with my luck, I just so happened to have been on one of the pills he mentions during the early years of my marriage.) Second, you should know that intrauterine devices, or IUDs, can be a non-hormonal approach to birth control. Although I have never personally used one, I do have friends who have found them to be very effective.
Please know that it is not my goal to convince you that all oral contraceptives are bad for you or that you should never take them. I fully acknowledge that many women can take birth control pills without any noticeable impact to their sexual health. My true goal is that you will be better prepared to research your options and not let your doctor pressure you into something that may not be best for your overall wellbeing. And if you do decide to try oral contraceptives, please pay close attention to your body. If you notice your libido decreasing or your vestibule start to change, recognize that this is not normal and could be 100% due to the pill you are taking. And if your doctor is unsupportive or uneducated in these very real risks of birth control pills, get a second opinion.* The longer you stay on oral contraceptives that are negatively impacting your sexual health, the harder it becomes to reverse their effects. But it is possible to reverse their effects—I can say so from personal experience. So whether you have been, currently are, or plan to take them in the future, know that birth control pills can cause pelvic pain. And also know that when sex hurts there is hope!
*I can personally vouch for Dr. Irwin Goldstein at San Diego Sexual Medicine. Likewise, Dr. Andrew Goldstein at the Centers for Vulvovaginal Disorders in Washington, DC is another leader in sexual medicine and the author of the article titled “Do Oral Contraceptive Pills Cause Vulvodynia? Time to Finally End the Controversy.”