The sexuological impact of hormonal contraceptives based on their route of administration

Abstract

Evidence on the effects of hormonal contraceptives on female sexuality is conflicting. We enrolled 556 women, divided into six groups: two composed of subjects using a combined hormonal contraceptive (COC) containing 0.020 (“COC20”) and 0.030 (“COC30”) mg of ethynyl estradiol (EE), “natural”, using COC containing 1.5 mg of estradiol (E₂), “ring”, using a vaginal ring releasing each day 0.015 mg of EE + 0.120 of etonogestrel, “subcutaneous”, using a progestin only subcutaneous contraceptive implant releasing etonogestrel and “controls”, using no hormonal contraceptive methods. The subjects were required to answer to the McCoy female sexuality questionnaire and were subjected to a blood test for hormonal evaluation. An ultrasound evaluation of the dorsal clitoral artery was also performed. The higher McCoy sexological value were recorded in the subdermal group; significant differences were recorded among the groups in terms of hormone distribution, with the higher levels of androstenedione in subdermal and control groups. The ultrasound evaluation of dorsal clitoral artery shows a significative correlation between pulsatility and resistance indices and orgasm parameters of McCoy questionnaire. The recorded difference in the sexual and hormonal parameters among the studied hormonal contraceptives may guide toward the personalization of contraceptive choice.

Chinese abstract

关于激素类避孕方式对女性性欲的影响一直都存在争议。本研究将556名受试女性分成6组, 两组分别服用含0.020mg (”COC20组”) 和0.030mg (”COC30组”) 炔雌醇的复方避孕药；一组服用含1.5mg雌二醇复方避孕药 (natural组) ；一组应用可每日释放0.015mg炔雌醇和0.120mg依托孕烯的阴道环 (ring组) ；一组应用释放依托孕烯的皮下埋植法 (subcutaneous组) 及一组不采用激素类避孕方式的对照组。要求受试者回答McCoy女性性欲问卷并检测血清激素水平。同时需超声检测阴蒂背动脉。皮下组具有较高的McCoy性欲评分。各组间的激素水平具有显著差异, 且皮下组和对照均有较高水平的雄烯二酮。阴蒂背动脉超声所测动脉搏动指数和阻力指数与McCoy问卷中的高潮参数存在明显相关性。性欲参数和激素水平在不同激素类避孕方式间的差异, 对个体化避孕方法的选择起到一定指导作用。

Keywords:

• Combined hormonal contraceptive
• dorsal clitoral artery ultrasound
• hormonal profile
• McCoy female sexuality questionnaire
• personalized contraception

Declaration of interest

Prof. M. Guida has got financial relationships (lecturer, member of advisory boards, and/or consultant) with Bayer Pharma, IDI, Gedeon Ricther, MSD, Teva/Theramex.

During the past two years, Prof. C. Di Carlo had financial relationship (lecturer, member of advisory boards and/or consultant) with Bayer Pharma, Gedeon-Richter, HRA Pharma, Merck Sharpe & Dohme, Shionogi Limited, TEVA, Zambon.

During the past two years, Prof. R.E. Nappi had financial relationship (lecturer, member of advisory boards and/or consultant) with Bayer-Schering Pharma, Endoceutics, Gedeon-Richter, HRA Pharma, Merck Sharpe & Dohme, Novo Nordisk, Pfizer Inc, Shionogi Limited, TEVA/Theramex, Zambon SpA.

Other authors declare no conflict of interest. This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.