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Low sex drive, the birth control pill, and why the diaphragm may make a revival.

I spend my days talking to women about low libido. Low sex drive is the number one women’s sex issue for therapists and doctors. Without exception all of the women have been on the birth control pill for a number of years and find their sexual desire disappearing. It isn’t a coincidence. Just like on the front of the cigarette packages that warn about lung cancer, I believe that a big red sign should be across the oral contraceptive pill that says LOWERS YOUR SEX DRIVE. The pill causes many women to lose their interest in sex.

The pill should be contraindicated for women who struggle with sexual desire issues. Couple the birth control pill with anti-depressants (and especially SSRI’s), a low BMI (think of those petite yoga/spinning girls, size 8 or smaller), and low iron/B complex and you get a perfect storm of missing sex drive. But there are some things you can do to get it back. I have a whole kit that I call “the start me up kit” to bring back that loving feeling. But it begins with getting off the birth control pill.

According to Ms. Magazine “last year’s combined sales of Yaz and Yasmin, the most popular oral contraceptives in the U.S., totaled $1.64 billion. Did you know the drugs are also the target of 1,100 lawsuits for potentially fatal blood clots? Did you know that an estimated 50 women have died from taking those contraceptives?
Despite such health risks, however, oral contraceptives remain an extremely popular method of birth control in the U.S., second only to sterilization. The Guttmacher Institute reports that whether a woman prefers the Pill or sterilization is largely a function of age, with women under 30 choosing the Pill and women over 30 choosing permanent methods. These trends have been fairly stable since 1982.”

So what’s a girl to do if she gets off the pill to keep from getting pregnant? The IUDs are a better choice than the pill for impact but most still have the hormones estrogen and progesterone in them. The hormones tend to be localized (beside the ovaries) and are less likely to kill your libido. But IUDs aren’t perfect. You have to get them inserted for up to five years, they can lead to a perforated uterus and can often increase bleeding. And they still have hormones that can impact libido.
Condoms are possible as a method for birth control. But condoms are greatly disliked by both partners as a long term play for preventing pregnancy. And then there is the high failure rate. 11 out of 100 women using condoms alone for a year will get pregnant.

diaphragmI am talking about the diaphragm to my patients as a viable solution to the pill or IUD. If the patient is a woman under 30, she generally has no idea what I am talking about. I think diaphragms are great. My diaphragm got me through high school, the university years and all through my 20’s without a mishap. Now that I have a tubal, I use my 25 year old diaphragm as a way to block my menstrual flow when I want to have sex during my period. The nice thing internal barrier methods offer (the sponge and cervical cap along with the diaphragm are all internal barriers) is that women control it. And the type of barrier can change depending on the kind of sex (one off, or weekend marathon) that you have.
It turns out my old tried and true Ortho diaphragm from the 1980’s has been discontinued. I feel old. However there is a new diaphragm called the Caya diaphragm out of Europe that you can now get without a prescription in Canada. The sizing is general for everyone and fairly forgiving if you change sizes (based on weight) unlike the previous diaphragms. It’s great that the new Caya diaphragms are kind of a one-size-fits-all. I don’t know if there are any doctors out there who would know how to size them if they weren’t. Head and Hands in Montreal’s west end (where I got my cervical cap in 1986!) are carrying the Caya diaphragms at cost! $60 Yay! I’ve seen them for $80 online otherwise.

Diaphragms are back, and better than ever!


The also sell the FemCap which is a modern, better fitting cervical cap (then the old rubber tire ones) and they have a 98% efficacy rate. Meaning if you use it correctly you won’t get pregnant on it, and those rates rival the pill. Here are the details:
“The FemCap is a reusable anatomically designed silicone cap you place over your cervix before you have sex.
The FemCap is *Non Hormonal *Latex free *Completely Natural *Reusable

The FemCap’s design simply prevents sperm from entering the cervix and womb. The FemCap was designed to conform to the anatomy of the cervix and the vagina to ensure maximum fit and comfort. The underside of the dome forms a bowl which covers the cervix completely.
The brim serves to form a seal against the vaginal wall and acts as a funnel to direct the ejaculate fluid into the groove. The FemCap is designed with a unique groove facing the vaginal opening. This groove stores the spermicide and traps the sperm.”

So don’t feel like you are out of options and only have to go on some kind of hormonal birth control method or condoms that are a real killer to sensuality to keep from getting pregnant. The only downside for some women was that they feared that the diaphragm and cap would be messy. Messy? Great sex is messy. In fact all sex is messy. With or without any kind of diaphragm or Femcap. That’s why I recommend disposable puppy pads for having sex. The mess gets on the pad and you throw them out. Given that both of these methods also let you have blood-free sex during your periods I think they should be in every modern women’s medicine cabinet.

Finally, I should give a shout out for the Cyclotest electronic fertility tester. The caution zone for getting pregnant is about 6 days a month. Those six days are roughly the day you ovulate and the five or so days before that. Sperm have been proven to live up to 5 days in the fallopian tubes. The challenge has been to figure out exactly when you ovulate. Over the last decade the ovulation predictors you can buy it the drug store (pee on a stick) have gotten better. But now we have an electronic predictor that keeps data month after month so you are far more likely to understand EXACTLY when that egg pops out. The Cyclotest tells you when you ovulate, you can plan your sex life around your fertile periods. Use a backup those days or skip the intercourse.

diaphragm1 You can always do things with other parts of your body besides your vagina. There is no reason for taking the pill if you are experiencing any side effects. Especially a decreased libido. It doesn’t magically get better. So take some steps to reclaim your lost sexual desire. You can find that bounce in your step again.