Did you know that birth control pills can cause pelvic pain?

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, andbirth control pills can cause pelvic pain - when sex hurts there is hope 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. Continue reading

Interview with Sex Therapist Dr. Rose Hartzell (Part 1)

interview with sex therapist Dr. Rose Hartzell - when sex hurts there is hopeI recently had the honor of interviewing Dr. Rose Hartzell, PhD, EdS, CHES, LMFT. She is the resident Sex Therapist at San Diego Sexual Medicine, the premier center for sexual health, and is responsible for addressing the sexuality, relationship, and intimacy concerns of individuals and couples who attend the clinic, many of whom suffer from sexual pain.  Here are some of the insights she shared.


1.  What made you decide to become a sex therapist?

I took a roundabout way of getting there.  I started off as a sex researcher and then realized that, although doing research was interesting, I found that a lot of people would come to me with questions.  I decided that I really like helping people better.  Research is helping people, but helping people as a therapist is more one-on-one, or two-on-one.  So I went back to school and while I was working on my PhD I added a Masters and then an EdS in therapy.

On a more global level, I like talking to people about things that they can’t talk about with anyone else.  Sex is something that is really important to people, but often times they have difficulty talking about it.  And for some reason God granted me the gift of feeling comfortable talking about sex, so I like to help other people feel more comfortable talking about it and have more satisfying sex lives.

2.  You are part of the team at San Diego Sexual Medicine. What type of work do you do there? How does your role fit into the larger goal of the center?

Here at San Diego Sexual Medicine we take a bio-psycho-social approach or a holistic perspective.  The kind of people I see here is usually different than the average sex therapist would see because a lot of times the people that we see here are people that have a physical component. So I often see people who have some type of physical issue that has affected them psychosocially.  My role here is for both men and women, to help them to see how whatever happened to them (erectile dysfunction, low sexual desire or whatever it is) is impacting themselves and their relationships, and how to get what they want out of their sex lives.

I have been working in this office for four and a half years and I love my job.  I can’t think of anything cooler.

3.  How does sex therapy differ from other types of psychotherapy or counseling? Continue reading

Being comfortable with your doctor

I have learned just how important it is to be comfortable with your doctor. I think we all want to have a doctor that we are comfortable with, but we often don’t put it high enough on our requirements list. We focus on their knowledge and experience, maybe the convenience of their office location and whether or not they accept our health insurance. While all of those are important considerations, I believe that being able to connect personally with your doctor is just as important. I’m not saying you need to be best friends or go out for coffee after your appointment. What I am saying is your doctor needs to listen to you, and you need to feel heard when you speak to him or her. Your doctor needs to be able to empathize with you and not discount your feelings or jump to a diagnosis without fully exploring your experiences. Your doctor should never make you feel stupid, ashamed, or uncomfortable in any way.

comfortable with your doctor - when sex hurts there is hopeBeing comfortable with your doctor is especially important when dealing with something as personal as sexual pain. I may be worse than most, but I think all of us have some degree of discomfort in discussing intimate topics. We keep them guarded and typically discuss only with those we trust—that is precisely why they are called intimate! Thus you need to feel comfortable to be able to explain all of the details of your pain, including exactly where it hurts and when Continue reading

Get a second opinion

get a second opinion - when sex hurts there is hopeNavigating the healing process of something as complex as sexual pain can be extremely difficult and often overwhelming. One of my biggest pet peeves when it comes to painful sex is how the number one word of advice you will find online is simply to talk to your doctor. On the surface that seems like perfectly good advice, but what happens when your doctor doesn’t know what to do? Or worse, what happens when your doctor tells you there isn’t anything wrong, implying that it is all in your head? My response, get a second opinion—or third or fourth or fifth, as the case may be. Continue reading

Another leg of the journey (this is my story…part 6)

I was able to have sex without pain for the first time ever!  I should be jumping for joy by now, right?  Not exactly.  Although I knew it was actually possible to have pain-free sex, this was a very rare occurrence.  I like to describe it as occurring only when all the stars were aligned.  In reality, I was still experiencing pain at least 90 percent of the time.

I say “when all the stars were aligned” because everything had to work perfectly in order to avoid pain.  I had very low libido and if I wasn’t at the perfect arousal level before entry and remaining throughout, it would become extremely painful.  The worst pain I would experience actually came on about an hour after sex.  My pelvic floor muscles would basically start to spasm and I wouldn’t be able to sit, sleep, or do much of anything without experiencing severe pain.  Of course the fear of bringing on this pain only added to my libido and arousal problems.

So, with the goal of increased libido in mind, my urologist referred me to an endocrinologist who did more tests.  Unfortunately, she wasn’t much help since her focus was really on reproductive disorders (she diagnosed me as having Polycystic Ovarian Syndrome based on the fact that I had irregular periods even though none of her tests actually supported this*).  Fortunately, my physical therapist recommended I visit a specialist in San Diego who is a leader in sexual medicine and he was able to address the missing piece in my healing puzzle.

This new specialist didn’t waste any time in setting me out on the next leg of my healing journey.  He explained how important hormones are to our bodies’ health and how specifically our sexual organs are affected when they are out of balance.  My testosterone levels were very low and my sex hormone binding globulin (SHBG) was through the roof, resulting in extremely low free testosterone.  I started on daily hormone therapy and began seeing amazing changes.  I hadn’t even realized that my vestibule wasn’t supposed to be red or that my labia were half the appropriate size until everything began to heal.

Not only did my libido improve, but everything wasn’t painful to the touch anymore.

*What is especially ridiculous about this diagnosis is that many of the symptoms of PCOS are due to high levels of testosterone.  Yet, my correct diagnosis that came later actually showed that my libido and arousal issues were specifically because my testosterone, especially my free testosterone, was so low!