ORIGINAL RESEARCH—WOMEN's SEXUAL DYSFUNCTION: Impact of Oral Contraceptives on Sex Hormone‐Binding Globulin and Androgen Levels: A Retrospective Study in Women with Sexual Dysfunction

Boston University, Boston, Massachusetts, United States
Journal of Sexual Medicine (Impact Factor: 3.15). 12/2005; 3(1):104 - 113. DOI: 10.1111/j.1743-6109.2005.00198.x
Source: PubMed

ABSTRACT Introduction.  Oral contraceptives (OCs) have been the preferred method of birth control because of their high rate of effectiveness. OC use, however, has been associated with women's sexual health complaints and androgen insufficiency. OC use is associated with a decrease of androgen ovarian synthesis and an increase in the production of sex hormone-binding globulin (SHBG). There have been limited studies assessing SHBG values after discontinuation of OC use.Aim.  To retrospectively investigate SHBG levels before and after discontinuation of OC use.Main Outcome Measure.  Sex hormone-binding globulin values were compared at baseline, while on the OC, and well beyond the 7-day half-life of SHBG at 49–120 (mean 80) days and >120 (mean 196) days after discontinuation of OCs.Methods.  A total of 124 premenopausal women with sexual health complaints for >6 months met inclusion/exclusion criteria. Three groups of women were defined: (i) “Continued-Users” (N = 62; mean age 32 years) had been on OCs for >6 months and continued taking them; (ii) “Discontinued-Users” (N = 39; mean age 33 years) had been on OCs for >6 months and discontinued them; and (iii) “Never-Users” (N = 23; mean age 36 years) had never taken OCs.Results.  Sex hormone-binding globulin values in the “Continued-Users” were four times higher than those in the “Never-User” group (mean 157 ± 13 nmol/L vs. 41 ± 4 nmol/L; P < 0.0001). Despite a decrease in SHBG values after discontinuation of OC use, SHBG levels in “Discontinued-Users” remained elevated in comparison with “Never-Users” (N = 26; P < 0.0001 for >120 days).Conclusion.  In women with sexual dysfunction, SHBG changes in “Discontinued-Users” did not decrease to values consistent with “Never-Users.” Long-term sexual, metabolic, and mental health consequences might result as a consequence of chronic SHBG elevation. Does prolonged exposure to the synthetic estrogens of OCs induce gene imprinting and increased gene expression of SHBG in the liver in some women? Prospective research is needed. Panzer C, Wise S, Fantini G, Kang D, Munarriz R, Guay A, and Goldstein I. Impact of oral contraceptives on sex hormone-binding globulin and androgen levels: a retrospective study in women with sexual dysfunction. J Sex Med 2006;3:104–113.

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    • "While each contains items that quantify general sexual desire, not one contains an item specifically about desire for (nor indeed about arousal, lubrication or orgasm during sex with) the woman's main sexual partner. Furthermore, even though several questionnaires contain items relating to partner-focused sexual satisfaction, which is likely correlated with desire, these items are often subsumed within global sexuality scores or in desire subscales which also incorporate general sexual desire (e.g., Panzer et al., 2006; Wallwiener et al., 2010). "
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    ABSTRACT: It is now almost two decades since the idea that partner preference might be influenced by OC use was first proposed (Wedekind et al., 1995), but this rapidly growing body of evolutionarily informed research has been overlooked by contraception practitioners ingeneral (Cobey&Buunk,2012),andbythoseworking on psychosexual effects of hormonal contraception in particular (Burrows et al., 2012;Davis&Castano, 2004; Pastor et al., 2013; Schaffir,2006). Itmaybe that something as apparently esoteric as individual preferences for partners is simply viewed with skepticismor clinical researchersmaybeunaware of it.Eitherway,we hope this Letter will stimulate researchers to incorporate these contextual perspectives when investigating these effects in future, and that this may ultimately lead to more informed discussion between practitioners and users about their contraceptive choices, and better understanding by users of the potential consequences for their sexual relationships.
    Archives of Sexual Behavior 06/2013; 42(8). DOI:10.1007/s10508-013-0126-9 · 3.53 Impact Factor
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    • "OCs decrease serum testosterone levels by decreasing ovarian testosterone production and increasing hepatic sex hormone-binding globulin (SHBG) production. SHBG serum levels may remain increased months aft er women withdraw OCs (Panzer et al. 2006; Sitruk-Ware et al. 2007). In the present series, women who previously used OCs presented better FSFI scorings. "
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    ABSTRACT: The present study aimed at assessing sexuality after hysterectomy using the Female Sexual Function Index (FSFI). A telephone survey was conducted among women 1 year after a hysterectomy for benign cause. The FSFI and a general questionnaire containing personal and partner sociodemographic data were applied. A total of 100 sexually active women participated. Bilateral oophorectomy was performed among 41%. Upon survey, 63% were on hormone therapy (HT) and 2% on psychotropic drugs. Regarding the partner (n = 100), 32% abused alcohol; 11% had erectile dysfunction; 67% premature ejaculation and 11% were unfaithful. Total FSFI score was 19.4 ± 3.6 (median 19.8) and for the domains: 3.2 ± 0.9 (desire); 3.2 ± 0.9 (arousal); 3.1 ± 0.6 (lubrication); 3.1 ± 0.7 (orgasm); 3.5 ± 1.1 (satisfaction) and 3.2 ± 1.2 (pain/dyspareunia). All women displayed sexual dysfunction (total FSFI score ≤ 26.55). A total of 53% presented FSFI scores equal to or below the calculated median for the series. Logistic regression determined that among women who had had a hysterectomy, male premature ejaculation was related to an overall poorer female sexual function (lower total FSFI scorings), whereas sometime oral contraceptive use decreased this risk. Age (female or male) and male sexual dysfunction were factors related to lower individual FSFI domain scores.
    Journal of Obstetrics and Gynaecology 02/2012; 32(2):180-4. DOI:10.3109/01443615.2011.634035 · 0.60 Impact Factor
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    • "Use of exogenous opioids is associated with HSDD and orgasmic difficulties [40]. The impact of oral contraceptives on sexual functioning is controversial , although the weight of evidence suggests that negative effects may occur, but only in a minority of women [41] [42]. Of course, this conclusion is limited by the nature of the studies that have been done. "
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    ABSTRACT: Hypoactive sexual desire disorder (HSDD) is defined as a deficiency or absence of sexual fantasies and desire for sexual activity that causes marked distress or interpersonal difficulty. The dysfunction cannot be better accounted for by another psychiatric disorder (except another sexual dysfunction) and must not be due exclusively to the physiological effects of a substance or a general medical condition. HSDD occurs in approximately 1 in 10 adult women in the USA and its prevalence appears to be similar in Europe. A number of potential causative and contributory factors to low sexual desire have been identified, reflecting the interplay among hormonal, neurobiological, and psychosocial factors. One theory is that sexual desire is controlled in the brain by a balance between inhibitory and excitatory factors. In general, dopamine, estrogen, progesterone, and testosterone play an excitatory role in sexual desire, whereas serotonin, prolactin, and opioids play an inhibitory role. It is hypothesized that decreased sexual desire may be due to a reduced level of excitatory activity, an increased level of inhibitory activity, or both. A greater understanding of the complex pathophysiology of HSDD would improve the identification and management of women for whom low sexual desire is a concern.
    International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 04/2010; 110(1):7-11. DOI:10.1016/j.ijgo.2010.02.014 · 1.56 Impact Factor
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