Open Jo urnal of Obstetr ics and Gynecology, 2011, 1, 131-135 OJOG
doi:10.4236 /ojog.2011.13024 Published Online September 2011 (http://www.SciRP.org/journal/ojog/).
Published Online September 2011 in SciRes. http://www.scirp.org/journal/OJOG
A multivariate analysis of the factors that influence the
modification of sexual desire in or al hormonal contraceptive
(OC) users
Mariano Martin-Loeches1*, Yadira Pallas1, Pedro Lopez Sanchez2, Manuel Lloret1,
Jose Jesús Lopez-Galvez1
1Department of Human Reproduction, “San Carlos” General Ho s pital, Denia (Alicante), Sp ain;
2Department of Gynaecologia, “Marina Alta” University Hospital, Denia (Alicante), Spain.
E-mai l : *
Hmm-loeches@ coma.esH
Received 4 July 2011; revised 12 August 2011; accepted 19 August 2011.
ABSTRACT
Objectiv: This work studie d the inf luencing fact ors of
age, level of education, family planning awareness,
relationship with partner, the age at which sexual re-
lationships were initiated, parity, the method of con-
traceptive previously used, the type of contraceptive
pill used and the duration of oral hormonal contra-
ception (OC) use in relation to the modification of
sexual desire in OC users. Materials and Methods.
Prospective study of 760 OC users at the Family
Planning Center “Marina Alta” in Alicante (Spain).
A logistical regression analysis was carried out to
study the relative risk of reduction in libido, taking
other risk factors into account. Results: In the si mple
analysis, women who initiated sexual relationships
between 18 and 25 years of age had a lower sexual
desire in comparison with women who were sexually
active before the age of 18 (OR = 2.11; CI: 1.15 - 3.91).
Nulliparo us wo men had a re duced sexua l desire co m-
pared with those women that had given birth (OR =
2.32; CI: 1.41 - 3.82). An OC use of betw een 6 months
and 1 year reduced sexual desire in comparison with
a use of less than 6 months (OR = 0.24; CI: 0.09 -
0.64). In the multivariate analysis, age (OR = 1.12; CI:
1.01 - 1.21) and the use of OC within an initial 6
month to a year period (OR = 0.24; CI: 0.09 - 0.64)
presented a statistically significant relationship with
the modification of sexual desire. The level of educa-
tion, family planning awareness, relationship with
partner, the method of contraception previously used
and the type of contraceptive pill prescribed showed
no statistical significance with the modification of
sexual desire in O C users. Conclusion s: Sexual desire
in OC users decreases as a woman’s age increases and
in an early stage of use in the first six months after
beginning O C treatment.
Keywords: Oral Contraceptive; Sexual Desire; Sex
Hormo n e s
1. INTRODUCTIO N
The human sexual response or libido is a complex phe-
nomenon which combines biological factors, via hormo-
nal stimuli, and psychosocial factors in the form of in-
ternal and external stimuli regulated by the central ner-
vous system, resulting in a cascade of biochemical, hor-
monal and circulatory changes [1-4]. It is characterised
by a desire to maintain or initiate sexual relationships
and varies between human beings as it is subject to large
fluctuations [4]. Its neuroanatomical and neurophysiolo-
gical bases have yet to be accurately established [5,6]
and to date no substance has been isolated with which a
biologica l theory on the subject mi ght be developed [7].
Contraception should not only be directed at avoiding
unwanted pregnancy, yet al.so at favouring the develop-
ment of the sexual facet of the human being, in who m it
plays an integral and undeniably important role. The
above factors are, therefore, two activities which are in-
trinsically linked and which the prescribing doctor
should always take into account [7,8].
Studies of the evolution of sexual desire during the
physiological menstrual cycle demonstr ate an increase i n
this desire halfway through the cycle, coinciding with
ovulation, and a decrease in the early luteal phase and a
further increase in the late luteal phase [9]. The action
mechanism of hormones is not totally clear [9,10] and
although estroprogestatives are one of the influencing
factors in sexual behaviour (decrease in interest, desire,
etc), they are by no means the most important factor [10].
Likewise, some studies affirm the influence of age on
sexual activity, demonstrating that female adolescents

M. Martin-Loeches et al. / Open Journal of Obstetrics and Gynecology 1 (2011) 131-135
132
present an increase in coital r elationship s co mpared wit h
older women [11,12].
The aim of this work is to study the influencing facto rs
of age, level of education, family planning awareness,
relationship with partner, the age at which sexual rela-
tionships were initiated, parity, the method of contracep-
tive previously used, the type of contraceptive pill used
and the duration of OC use in relation to the modificatio n
of sexua l desire in OC users.
2. MA TERIAL AND METHODS
Prospective study of 760 OC users, with no signs or sus-
picion of organic or psychological illness was carried out
between January of 2000 to January of 2010 at the Fa-
mily Planning Center “Marina Alta” in Alicante (Spain).
The general characteristics of these women were stu-
died regar ding to the age, level of education, fa mily plan-
ning awareness, relationship with partner, age at which
the sexual rela tionship s were initiated , parit y, the method
of contraceptive previously used, the type of contracep-
tive pill prescrib ed, the duration of OC trea tment and the
modification of sexual desire. The established medical
controls were carried out at 3, 6 and 12 months after
commencing treatment.
The mean age of the women in this st udy was of 26.6
± 4.1 years o f a ge (with a range which oscillated between
15 and 34 years). 518 women (68.1%) had elementary
education (basic education) and 231 women (30.4%) had
an intermediate or higher level of university degrees. 87
women (11.4%) possessed no information on family
planning (they are aware of various methods but practise
coitus interruptus and use condoms with some reserva-
tion), 287 women (53%) had a basic awareness ( the y use
condoms and know of the contraceptive pill and IUD)
and 430 women (34.7%) were well informed (they know
of almost all existing methods and have read literature on
the subject). With regard to partner relationship, 644
women (84.8%) enjoyed a good relationship, 85 women
(11.21%) qualified their relationship as average, and 15
(1.9%) as poor. 250 women (32.9%) initiated sexual re-
lationships before 18 years of age, 85 women (62.2%)
did so between 18 and 25 years of age whilst 15 women
(2.4%) initiated sexual activity after the age of 25. 485
women (63.8%) were nulliparous whilst 274 (36.1%)
were multiparous. 158 women (26.6%) used a prepara-
tion containing 30 micrograms of ethinylestradiol and
150 micrograms of desogestrel (Microdiol®), 202 women
(20.8%) used 35 micrograms of ethinylestradiol and 2
milligrams cyproterone acetate (Diane®), 360 women
(47.3%) were prescribed ethinylestradiol and triphasic
levonorgestrel (Triagynon® and Triciclor®) and 40 wo-
men (5.3%) received 30 micrograms of ethinylestradiol
and 75 micrograms of gestodene (Gynovin® and Minu-
let®). 37 women (4.9%) used the product for less than 3
months, 287 women (37.8%) for less tha n a year and 430
women (56.5%) used the product for over a year.
With regard to a modification of sexual desire, the
Female Sexual Function Index (FSFI) was used [13,14],
which consisted of a q uestionnaire made available by the
sexologist, in which each woman rated six main charac-
teristics-sexual desire, subjective arousal, vaginal lubri-
cation, orgasm, satis factio n and disco mfort duri ng coit us.
A decrease in sexual desire was classified as slight, mo-
derate and significant
In order to analyse t he relative risk of the di fferent O C
on sexual desire independently of the presence of other
risk factors, a logistical regression analysis was carried
out, which ad justed the effec t of the variables, preventing
the presence of after effects and including the variables
which could act as potential c onfusers. The data base and
the computer processed analysis were carried out using
the data analysis program “SSPS” (Statistical Package
for Social Sciences) 6.1 version for Windo ws (licence Nº
707852).
3. RESULTS
The find i n gs o f t he s tudy reveale d t hat 42 wo me n (5 . 4 %)
experienced an increase in sexual desire, 182 women
(23.6%) experienced a decrease and 536 women (70.3%)
registered no modification of their sexual desire.
In the simple analysis, those women who initiated se-
xual relationships between 18 and 25 years of age regi-
stered a lesser sexual desire than those who became sex-
ually active before the age of 18 (OR = 2.11; CI: 1.15 -
3.91). Nulliparous women showed a decrease in sexual
desire in relation to women that had given birth (OR =
2.32; CI: 1.41 - 3.82). The use of OC within an initial 6
to 12 month period increased sexual desire compared to a
use of less than 6 months (OR = 0.21; CI: 0.08 - 0.60)
(Ta ble 1).
The multivariate anal ysi s reve aled a statistically signi-
ficant relationship between the modification of sexual
desire and age (OR = 1.12; CI: 1.03 - 1.21) and the use
of OC for 6 months to a year (OR = 0.24; CI: 0.09 - 0.64).
The level of education, level of family planning aware-
ness, partner relationship, the contraceptive method pre-
viously used and the t ype of contr aceptive pill prescribed
showed no statistical significance with the modification
of sexua l desire in OC users (Table 2 and Figure 1).
4. DISCUSIO N
Studies o f the evolutio n of sexual desire during the phy-
siological menstrual cycle demonstrate an increase in this
desire halfway through the cycle, coinciding with ovula-
tion, and a decrease in the early luteal phase and a further
increase in the late luteal phase [15], with a higher levels

M. Martin-Loeches et al. / Open Journal of Obstetrics and Gynecology 1 (2011) 131-135
Copyright © 2011 Sc iRes. OJOG
133
Table 1. Simpl e analysis of the modification of sexual des ire in female oral hormonal contraceptive (OC ) users.
p Odds Ratio CI 95% OR
Level of studies Elementary 1 1
Intermediate/high 0.92 0.98 (0.57 - 1.66)
Family planning information Nil 1 1
Basic 0.53 1.29 (0.56 - 3.1)
Goo d 0.98 1 (0.4 - 2.5)
Partner relationship Goo d 1 1
Average 0.36 1.37 (0.65 - 2.83)
Poor 0.2 2.3 (0.5 - 9.1)
Age SR initiated < 18 years 1 1
18 to 25 years 0.01 2.11 (1.15 - 3.91)
> 25 years 0.4 1.83 (0.27 - 9.47)
Parity Yes 1 1
No < 0.001 2.32 (1.41 - 3.82)
Type of OC 30 mcg EE + 150 mcg DG 1 1
35 mcg EE + 2 mg AC 0.93 1.03 (0.49 - 2.16)
EE + triphasic LN 0.67 1.14 (0.6 - 2.2)
30 mcg EE + 75 mcg G 0.12 0.23 (0.01 - 1.72)
Duration of use < 6 months 1 1
6 to 12 months < 0.001 0.21 (0.08 - 0.6)
> 12 mo nt hs 0.13 0.53 (0.22 - 1.34)
CI = Confidence interval; OR = Odds ratio; FP = Family planning; SR = Sexual relationships; EE = Ethinylestradiol; DG = Desogestrel; CA = Cyproterone
acetate; LN = Levonorgestrel; G = Ges todene.
Table 2. Logistical regression analysis of the modification of sexual desire in female oral hormonal contraceptive (OC) users.
p Odds Ratio CI 95% OR
Age (y ears) 0.005 1.12 (1.03 - 1.2)
Level of st udies Elementary 1 1
Intermediate/higher 0.35 1.32 (0.73 - 2.38)
PF information Nil 1 1
Basic 0.77 1.14 (0.48 - 2.7)
Goo d 0.78 0.88 (0.34 - 2.25)
Partn er relationship Goo d 1 1
Average 0.56 1.23 (0.6 - 2.51)
Poor 0.51 1.62 (0.38 - 6.86)
Age SR initiated < 1 8 years 1 1
18 to 25 years 0.29 1.42 (0.74 - 2.7)
> 25 years 0.83 1.2 (0.22 - 6.41)
Parity Yes 1 1
No 0.1 1.6 (0.92 - 2.79)
Type of OC 30 mcg EE + 150 mcg DG 1 1
35 mcg EE + 2 mg AC 0.78 0.9 (0.43 - 1.9)
EE + triphasic LN 0.76 1.1 (0.57 - 2.13)
30 mcg EE + 75 mcg G 0.2 0.24 (0.27 - 2.11 )
Dura t ion o f us e < 6 months 1 1
6 to 12 months 0.04 0.24 (0.09 - 0.64)
> 12 mo nt hs 0.11 0.48 (0.2 - 1.2)
CI = Confidence interval; OR = Odds ratio; FP = Family planning; SR = Sexual relationships; EE = Ethinylestradiol; DG = Desogestrel; CA = Cyproterone
acetate; LN = Levonorgestrel; G = Ges todene.

M. Martin-Loeches et al. / Open Journal of Obstetrics and Gynecology 1 (2011) 131-135
134
Fi gure 1 . Relati ve risk of the de crease in sexual desire in rela-
tion to the duration of oral hormonal contraceptive (OC) use.
of androgens obtained in t hes e phases accounting for the
increase in sexual desire [16]. However, a decrease in
sexual desire is produced in OC users during the men-
strual and postmenstrual phases [13,17], due to the de-
crease in the free testosterone plasma levels and other
androgens [3].
The action mec hanism o f hormone s with re gard to the
human sexual response is not totally clear [9,10]. Glad-
kova [18], Bancroft [3] and other authors [11,19] refer to
the relationship between sexual desire and androgens, in
that women with a higher level of free testosterone pla-
sma levels present an increased rate of coitus and an in-
crease in sexual arousal and the human sexual response
to stimuli [1,20]. Hutchison [20] and van Lunsen and
Laan [1] state that the increase in the binding globulin o f
sexual hormones produces si milar response s. Warnock et
al. [21] and other authors [9,22] refer to the fact that
changes in sexuality are due to gestagens and the anti-
androgenic effect of estroprogestatives, with estrogens
playing a lesser role in the modification of sexual desire
in women, although van Goozen et al. [15] do not agree
with this proposal.
Estroprogestatives are also an influencing factor in
sexual behaviour (decrease in interest, desire etc), but are
by no means the mos t important [10]. To this effect Ban-
croft affirms that psychosocial influences have a greater
influence than the reduction of androgens caused by OC
treatment with regard to the decrease in sexual desire [ 3]
and that users have a higher rate of sex ual activity, great-
er motivation with regard to sex and are far more posi-
tive i n eval uat ing t heir par tner rela tio nship [2 ]. S a- batini
and Cagiano [23] states that OC users that have mad e an
informed choice are aware of the benefits and risks and
understand the efficiency of the method, pre- sent a bet-
ter acceptance of this contraceptive method. However,
Bastianelli et al. [24], in accordance with this study, af-
firm finding a decrease in sexual desire within the first
semester of OC tre atment.
Literature on the subject matter calculates the d ecrease
in sexual desire to be at between 5% and 6% of women
in studies carried out by Renier [25] and up to 31% in
stu- dies by Gómez [26] and Graham et al. [22]. Findings
in this study calculate the reduction in sexual desire in
women to be at 2 4%, in agre eme nt with Bastianelli [24] .
Other authors, such as Caruso et al. [27], place this de-
crease at 10% of users, whilst authors such as Oddens
[28] calculate the decrease to be at 16%.
The use of OC is influenced by a great number of
emotional factors, such as the distinction between sexu-
ality and fertility [20,24], which consequently give rise
to psychological conflicts regarding pregnancy within a
relationship, although Spanish users give the contracep-
tive pill a positive valuation [23]. Byne et al. [29] state
that temperament and character within the social and
family environment of a person is more important than
hormonal influence in sexual desire. Lachowsky [30]
affirms that the use of OC methods has modified tradi-
tional behavioural models, personal relationships be-
twee n the sexes a nd has br ought lo ve and sex uality cl os-
er together, whilst Bancroft et al. [2] suggest that their
use has given rise to a diminishing of restrictive sexual
morality.
McCoy et al. [31] publish that monophasic prepara-
tions give rise to a reducti on in va ginal l ubricat ion whe n
compared with the results of triphasic treatments, thus
producing an increase in sexual desire in triphasic OC
users, our study, however, does not coincide with these
results.
Creatsas et al. [11], coinciding with the findings pre-
sented in this study, describe an increase in the rate of
coital activity in adolescents compared to this activity in
older women, thus demonstrating a statistically signifi-
cant relationship between sexual activity and age.
5. CONCLUSIO NS
Sexual desire in female OC users decreases as the age of
women increases and increases within the first semester
to 12 months of OC treatment.
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