Hormonal contraception and female sexual desire:

Transcription

1 Hormonal contraception and female sexual desire: A randomized within-subject crossover study with the vaginal ring, a low-dose combination pill and a progestinonly pill. Els Elaut 1, Griet De Cuypere 1, Petra De Sutter 2, Ann Buysse 3, Jan Gerris 2, Ellen Deschepper 4, Guy T Sjoen 1 1 Department of Sexology and Gender Problems, Ghent University Hospital, Belgium 2 Department of Reproductive Medicine, Ghent University Hospital, Belgium 3 Department of Clinical-Experimental and Health Psychology, Ghent University, Belgium 4 Department of Medical Statistics, Ghent University Hospital, Belgium ESC 2010, The Hague

2 Overview Design of the present study Results: baseline characteristics Points of discussion regarding study design Results: effects on sexual desire Conclusions

3 Design study 55 heterosexual couples female partners consecutively used three products: vaginal ring (VR) : 15 µg EE µg etonogestrel progestin-only pill (POP): 75 µg desogestrel combined oral contraceptive (COC): 20 µg EE µg desogestrel at random assignment to three conditions: POP - VR COC POP COC VR COC POP - VR

4 Design study baseline assessment (both partners) monthly re-assessment of psychosexual variables (both partners) e.g. Sexual Desire Inventory, Female Sexual Functioning Inventory, Rosenberg self-esteem, Maudsley Marital Questionnaire, SCL-90 assessment of hormonal changes (female partner) DHEA-S, SHBG, total/free testosterone, androstenedione assessment of genetic marker for androgen sensitivity (female partner) CAG repeat lengths

5 Design Study 1: study heterosexual couples inclusion of N=55 heterosexual couples N=5 side effects N=9 break-up N=2 pregnancy N=39 (117) completed study

6 Results: Study 1: baseline heterosexual characteristics couples by condition POP - VR - COC POP - COC - VR COC - POP - VR p N=20 N=16 N=19 age female partner (years) ± ± ± age male partner (years) ± ± ± relationship duration (years) 2.73 ± ± ± BMI female partner ± ± ± CAG repeat length (median) Sexual Desire Inventory (SDI) solitary sexual desire 9.50 ± ± ± dyadic sexual desire ± ± ±

7 Results: Study 1: baseline heterosexual characteristics couples by condition

8 Results: baseline characteristics by condition POP - VR - COC POP - COC - VR COC - POP - VR p total testosterone (ng/dl) ± ± ± free testosterone (ng/dl) 0.19 ± ± ± SHBG (nmol/l) ± ± ± DHEA-S (μg/dl) ± ± ± androstenedione (ng/dl) ± ± ± baseline contraception COC 16 (80%) 12 (75%) 12 (63.1%) VR 0 2 (12.5%) 4 (21.1%) POP (5.3%) condoms 4 (20%) 2 (12.5%) 2 (10.5%).454

9 Results: Study 1: baseline heterosexual characteristics couples by condition

10 Points Study of 1: discussion heterosexual on couples study design 1. test-retest effect SDI due to repeated measures: -correction for the lowering of SDI during study in all models by the variable assessment time 2. difficulties due to the design: -not all products held all positions (e.g. POP never last product) -correction for absence of a wash out period

11 Study Mixed 1: heterosexual model (SAS 9.2) couples 1 : dyadic sexual desire Type 3 Tests of Fixed Effects Effect Num Den DF DF F Value Pr > F SDI_DYAD_BASELINE <.0001 PRODUCT ASSESSMENT_TIME AGE_AT_START CONDITION FREETESTO_BASE CAG_REPEAT_LENGTH FSFI_BASELINE SCL_DEP_BASELINE MMQ_RELATION_BASELINE MMQ_SEXUAL_BASELINE SELFESTEEM_BASELINE

12 Is Study the female 1: heterosexual desire couples predicted by? mixed model 1 (SAS 9.2): dyadic sexual desire - throughout study is predicted by - baseline dyadic sexual desire (p<.0001) - product (p=.009) - assessment time (p=.007) - baseline relationship satisfaction (MMQ) (p=.025) - throughout study is NOT predicted by - condition (p=.667) - free testosterone at baseline (p=.768) - androgen sensitivity (CAG Repeat Length) (p=.760) - sexual satisfaction (MMQ) at baseline (p=.933) - sexual functioning (FSFI) at baseline (p=.797) - self-esteem at baseline (p=.139)

13 Is Study the female 1: heterosexual desire couples predicted by? mixed model 1 : dyadic sexual desire - predicted by product : women showed - stronger sexual desire with COC-use than POP-use (p=.028) - stronger sexual desire with VR-use than POP-use (p=.003) - similar sexual desire with COC-use and VR-use (p=.094) - predicted by 'relationship satisfaction': women showed - a stronger sexual desire with better relationship satisfaction (p=.025)

14 Study Mixed 1: heterosexual model 2 (SAS 9.2): couples solitary sexual desire Type 3 Tests of Fixed Effects Num Den Effect DF DF F Value Pr > F SDI_SOL_BASELINE <.0001 PRODUCT ASSESSMENT_TIME AGE_AT_START CONDITION FREETESTO_BASE CAG_REPEAT_LENGTH FSFI_BASELINE SCL_DEP_BASELINE MMQ_RELATION_BASELINE MMQ_SEXUAL_BASELINE SELFESTEEM_BASELINE

15 Is Study the female 1: heterosexual desire couples predicted by? mixed model 2 (SAS 9.2): solitary sexual desire - throughout study is predicted by - baseline solitary sexual desire (p<.0001) - assessment time (p=.003) - throughout study is NOT predicted by - product (p=.076) - free testosterone at baseline (p=.211) - androgen sensitivity (CAG Repeat Length) (p=.784) - sexual functioning at baseline (FSFI) (p=.258) - relationship satisfaction at baseline (MMQ) (p=.975) - sexual satisfaction at baseline (MMQ) (p=.097) - self-esteem at baseline (p=.847)

16 Conclusions Study 1: heterosexual (1) couples - The best predictor for sexual desire in users of hormonal contraception is their baseline sexual desire! - There seems to be an indication for a lower sexual desire to behave sexually with a partner with POP-use (in comparison to COC- and VR-use). - The fact this result was NOT confirmed for sexual desire to behave sexually by oneself warrants great caution in the interpretation of these results.

17 Conclusions Study 1: heterosexual (2) couples - Differing effects on dyadic and solitary sexual desire: -different effects of non-estrogenic contraception use on male partners? -different pathway for dyadic sexual desire?

18 Thank you!