An assessment of vaginal lubrication and blood flow in women taking oral contraceptive pills

Genital sexual arousal, which consists of genital vasocongestion and lubrication, is critical to healthy sexual function in women and closely linked with hormone function. Oral hormonal contraceptive pills, which are used by over a quarter of reproductive-age women in the United States (Daniels, Daugherty, Jones, & Mosher, 2015; Jones, Mosher, & Daniels, 2013), contain either both ethinylestradiol and a synthetic progestin, or solely a synthetic progestin. Oral hormonal contraceptive pills (OCPs) tend to reduce the number of bioavailable androgens through upregulation of sex hormone binding globulin (SHBG; Zimmerman, Eijkemans, Coelingh Bennink, Blankenstein, & Fauser, 2014), and they have been associated with decrements in self-reported arousal and vaginal lubrication (Hassanin, El-Halwagy, Ismail, & Shehab, 2018; Smith, Jozkowski, & Sanders, 2014). The primary aim of this dissertation was to examine differences in physiological lubrication and vaginal blood flow among women using OCPs with varying androgenic properties, as well as the possible mediating role of SHBG in these relationships. Participants in this study were 130 women: 59 naturally-cycling control women, 50 women taking androgenic OCPs, and 21 women taking antiandrogenic OCPs. Participants watched sexual films while their sexual arousal responses were measured, completed questionnaires, and took part in a blood draw. Results indicated physiological deficits in women taking either form of OCP, with marked inhibitory effects found in women taking antiandrogenic OCPs. Whereas SHBG did not meaningfully mediate the relationships between study group and physiological sexual arousal response, paths within the models indicated significant relationships among these variables. Rates of sexual dysfunction were significantly greater in the antiandrogenic group compared to control. These results further elucidate the effect of sex steroid hormones on women’s sexual arousal response and suggest the presence of physiological sexual side effects of various OCPs. It is recommended that prescribing clinicians consult patients on such physiological effects, and future research should examine the maintenance of these effects after OCP discontinuation.