How You’re Ruining Your Sex Life, Part II: The Pill

(Part 3 of a series on great married sex.  Parts 1 and 2 can be found here and here.)

If the United States ever considers dropping the motto “In God We Trust,” it might consider replacing the phrase with “Better Living Through Chemistry.” Americans are among the world’s most heavily medicated people, with millions taking over-the-counter and prescription drugs for everything from heartburn to depression to birth control.  Now, as a cancer survivor and someone who lives with chronic illness, I’m not one to complain about modern medicine – I’ve depended on it for both my survival and my quality of life.  But I’m also familiar with the drawbacks … and one of the most common is sexual dysfunction.

When it comes to spoiling the bedroom magic between married couples, two of the most notorious offenders are also two of the most commonly prescribed medications: hormonal contraceptives in the form of pills, shots, patches, rings, implants and IUDs – used by roughly one out of five women of childbearing age – and selective serotonin reuptake inhibitors, the most common class of antidepressant, prescribed to one out of every ten Americans (disproportionately middle-aged women).

First, an important disclaimer regarding SSRIs: Obviously, if you’re on an anti-depressant, there’s a reason for it, and it’s not the kind of thing that should ever, EVER be stopped without talking to your doctor. So don’t.

But, and you knew there was a ‘but’ coming, many people are unaware that SSRIs can often kill libido and reduce or even eliminate physical sexual pleasure, leaving men unable to perform in bed and women unable to climax (the clinical term for this is anorgasmia). This can be a nasty surprise, especially as the patient’s mood stabilizes only to find that his or her sex life is now nonexistent.

For the significantly clinically depressed, the dangers of leaving their illness untreated may very well justify the negative side effects of these medications. But severe sexual dysfunction – particularly when the cause is not well understood and anticipated by a couple in advance – can also be a marriage killer … which won’t exactly help a person who is already suffering from depression. 

If you or your spouse are undergoing pharmaceutical treatment for depression, make sure you are both educated and on the same page about the chemical explanation behind any apparent lack of interest or performance capability between the sheets, so that neither of you takes it personally or lets resentment build. You may also want to speak to the prescribing doctor about things that can be done to mitigate this particularly unhappy side effect – sometimes doctors can prescribe a second drug or alter the dosage of the first in order to get patients back to a normal sex life. 

Now, moving on to “The Pill” – or more accurately, all hormonal contraceptives.  

Hormonal contraceptives are a double edged sword – on the one hand, they’re intended to free a woman up to have sex whenever she wants it, with reduced fear of unwanted pregnancy.  On the other hand, they can reduce some women’s libidos so severely that they become uninterested in sex, making the pill seem rather pointless.

According to the contraceptive- and abortion-tracking Guttmacher Institute, 80 percent of sexually active women have used oral contraceptives, with about 18 percent of women of childbearing age currently on them at any given time.  Add those to the number of women who opt for injectable, implantable, or insertable hormones, and you’ve got about one out of every five women whose bodies have been chemically altered, fooled by hormone levels into thinking they’re in early pregnancy – which as anyone who has been pregnant can tell you, is not a time of wanton sexual desire, what with the weight gain, moodiness, sore breasts, vaginal dryness, gastrointestinal issues, and all. 

Aside from the unpleasant side effects of early pregnancy – which are well-mimicked by the pills, by the way – the result of all that hormonal tweaking is a drop in or elimination of testosterone. We may think of testosterone as an exclusively male hormone, but women have it, too. It gives us our aggression and libido, and spikes in the middle of our cycles to coincide with ovulation. 

For those interested in seeing the human race survive, that’s just smart design – it ensures that women’s desire for sex peaks right when they are most fertile. But if their bodies have been fooled into never ovulating, they’ll never experience that spike in desire. They can go months or years without ever really feeling “in the mood.”  When they consent to do it anyway, they may have trouble becoming physically aroused, requiring artificial lubrication not just to make sex enjoyable, but to prevent it from being downright painful.

If there’s a recipe for a more perfunctory sex life, I’m unaware of it.

Worse yet? There are significant health risks associated with hormonal birth control, including blood clots, stroke, increased risk of certain cancers and even death.

But here’s the good news about oral contraceptives: Aside from rare cases when it is used off-label to treat debilitating conditions that may justify the risks and side effects – they are always optional. Pregnancy isn’t a disease, after all, but even for those who have serious reasons to avoid pregnancy, there are safer, more natural and more effective ways to lessen the chances of conception. 

The Catholic Church has been ahead of the curve on this one.  The Church has for decades promoted what it calls Natural Family Planning, or “NFP” to track a woman’s reproductive cycles and limit sexual intercourse to those days when a pregnancy would be almost impossible – almost, they say, because anything is possible with God, but NFP, used correctly, boasts better than a 99 percent effectiveness rate – that makes them more effective than any hormone-only contraceptive method and far better than the much-maligned, seemingly perpetually broken condom. 

NFP is not to be confused with the old “rhythm method” – a long-defunct calendar-based approach based on outdated and misinformed science. In contrast, NFP uses a combination of current modern medical knowledge and often, technology, to monitor individual reproductive cycles, which can vary wildly from woman to woman – and even from cycle to cycle for each woman. There are several different “methods” of NFP, each designed to suit the needs of women based on their bodies, their personal preferences, and their lifestyles. A few of the most popular:

1. Sympto-thermal. This method is great for science geeks who love data and charts, or women who need the maximum information about their cycle for diagnostic or fertility purposes. Arguably the most cumbersome of the methods, it requires plotting a daily early-morning temperature reading on a graph, plus keeping meticulous records of physical symptoms like cervical position, vaginal discharge, and cycle-related pain. The good news is, the total time spent on all of this is probably less than five minutes a day (maybe six if you wash your hands really well afterward). The other good news? “There’s an app for that.”  Gone are the days of graph paper notebooks in the nightstand drawer.  21st-century couples can track and chart their fertility using the same smartphone they’re probably already using as their alarm clock anyway. But if you work third shift, do a lot of time-zone hopping, or have an unpredictable schedule, this method isn’t for you – for the most accurate readings, your temperature should be taken at the same time each day, preferably in the very early morning.

2. Billings/Creighton.  Purists will probably get on me for conflating these two, but since Creighton bills itself as a “standardization of the Billings method” on its own website, I’m not sweating it. This method is not for the squeamish, as it requires users to examine their cervical mucus each time they use the restroom. But it’s much less restrictive than sympto-thermal, and totally portable, since all you really need is a bathroom and your eyes.

3. Marquette.  This is the 21st-century lazy girl’s high-tech method of NFP, with both the benefits and drawbacks of any tech-based solution. On the plus side, you don’t have to touch or analyze any bodily fluids yourself – for that, you use an electronic fertility monitor, normally the ClearBlue Easy. If you clicked that link, you already know the downside – at roughly $250, the monitor isn’t cheap, and it requires a constant resupply of test sticks that cost about $1 per use.

There are other tools and methods of NFP, as well, all well worth researching. (I used the LadyComp for years with 100 percent success, for example.)  But for those looking for a way out of the pill-induced rut of a lackluster married sex life, these are a few of the “top dogs” when it comes to regulating your fertility in a natural, sex-positive way.

The best thing about NFP is that it is totally natural.  There are literally no side effects from its use, aside from potentially better sex. Women who quit using hormonal contraceptives and switch to NFP may experience not only heightened sexual desire and enhanced sexual pleasure, but weight loss, a greater sense of well-being and a decreased risk of serious health problems. 

The drawback, of course, is that proper use of NFP requires an education and some self-control.  NFP practitioners must learn to read their body’s signs, and – here’s the tough part – actually abstain – during the fertile window (usually a period of 3-7 days in the middle of the cycle*). This can be hard, because a woman whose body hasn’t been reprogrammed by hormones to think it’s already pregnant will often be downright randy during the fertile period. 

Abstaining under those circumstances can be, not to put too fine a point on it, no fun at all.  But some successful NFP couples simply treat that week as a time of delicious mental foreplay – and reap the benefits when their time apart is over. 

In the end, it comes down to which problem would you rather have?  A sex life so good that it hurts to give it up for a week each month … or sex-on-demand when one spouse is perpetually moody, bloated, and ultimately just not that into it?

(*NOTE: In some cases, a woman’s cycle may indicate fertility outside of this 3-7 day window.  This is almost always a sign of an underlying medical problem, such as polycystic ovarian syndrome. A good NFP instructor – regardless of method – should be able to help you interpret your charts and discern whether medical intervention may be needed … which calls to mind another benefit of getting off the pill: it can no longer mask the symptoms of illness, allowing women to seek real treatment.)