Can birth control cause painful vaginal insertion/intercourse?

Megan is a 23-year-old female who has been using oral contraceptive (OC) since she was 16 years old. She has always experienced painful intercourse, so her gynecologist referred her to pelvic floor physical therapy. She has recently discussed stopping oral birth control because she wants to “see what happens with her hormones” and was curious if her birth control had any impact on her painful intercourse.

The short answer to Megan’s questions is maybe. We know that oral contraceptives can negatively impact some individuals’ sexual desire and libido while having no effect or increasing others. A 2017 review of the available research found that oral contraceptives could potentially cause dyspareunia, or painful intercourse, due to increased risk of vestibulitis (inflammation at the vaginal entrance) and vaginal dryness.1 The risk of this developing is greater when prescribing oral contraceptives (OCs) to adolescents and when the use exceeds 2 years. Birth control that contains drospirenone and ethinylestradiol or gestodene and ethinylestradiol are preferred as these are less likely to cause female sexual dysfunction according to the available research.1-2 While this review found some evidence that OCs can cause and worsen female sexual dysfunction in reproductive aged women, the evidence is limited based on the available research.1 

The reason why OCs should be prescribed to adolescents with careful consideration is that their bodies are still developing, and hormonal changes can impact develop. A study performed in 2014 found evidence that adolescent female rats who were treated with progesterone had increased genital nerve development or hyperinnervation.3 Increased nerves means increased sensitivity and this could explain why some women develop vestibulodynia (pain at the vaginal opening). The study also suggested that estradiol may reduce symptoms by decreasing the progesterone-induced hyperinnervation.3

Another study looked at 30 women who developed vestibulodynia while taking combined hormonal contraceptives as compared to 17 women who did not.4 The women who did develop pain were found to have lower free testosterone and were found to have a change at a receptor gene on the X chromosome. This means that some women may be more genetically predisposed to developing pain than others while on birth control.4 

If you have noticed a reduction in comfort with intimacy after starting birth control or if you have a history of painful intercourse and birth control use, it may be worthwhile to discuss the possible correlation with your medical provider. This may mean a change in birth control. Also, medical providers who prescribe birth control should be conducting a thorough sexual history prior to prescribing oral contraceptives to assess sexual function and better compare changes that occur with use.1 If you are experiencing painful intimacy, don’t be surprised if your pelvic floor therapist asks questions regarding your cycle and birth control to determine possible contributing factors. And remember, there are many wonderful options to address painful intimacy and increase comfort, so don’t lose hope! If you feel like you have tried everything, please reach out to your local pelvic floor therapist and schedule an evaluation to make sure nothing has been missed, especially in regards to the nervous and musculoskeletal systems in the pelvic and surrounding areas.

Written by Jordan Schmidt, PT, DPT

References

1. Lee JML, Low LL, Ang SB. Oral contraception and female sexual dysfunction in reproductive women. Sex Med Rev 2017; 5:31-44.
2. Lee, J. J., Tan, T. C., & Ang, S. B. (2017). Female sexual dysfunction with combined oral contraceptive use. Singapore medical journal, 58(6), 285–288. https://doi.org/10.11622/smedj.2017048 
3. Liao, Z., & Smith, P. (2014). Persistent Genital Hyperinnervation Following Progesterone Administration to Adolescent Female Rats1. Biology of Reproduction, 91(6),

Goldstein, A. T., Belkin, Z. R., Krapf, J. M., Song, W., Khera, M., Jutrzonka, S. L., Kim, N. N., Burrows, L. J., & Goldstein, I. (2014). Polymorphisms of the androgen receptor gene and hormonal contraceptive induced provoked vestibulodynia. The journal of sexual medicine, 11(11), 2764–2771. https://doi.org/10.1111/jsm.12668