Alternatives to oral contraceptives/ ways to increase sex drive?

[melancholyhills]

I've been using birth control to help treat my hormonal imbalance (excess testosterone) for a good few years now. I'm considering starting a serious sexual relationship with my partner, but I've found that my sexual desires have decreased to the point that I'm rarely in the mood when he wants get things going. I never used to be like this prior to taking birth control, so I'm wondering if there's something I could do to increase my drive without interfering with my pills. Alternatively, I've considered quitting my pills in favor of a getting a copper IUD, but I would really miss all the benefits (lighter periods, no acne, etc). Is there anything else I could take aside from oral contraception that would balance my hormones?

[Heather]

Really, this is a question for the endocrinologist who has prescribed you the pill for your hormone issues. Since they're the only person who has diagnosed you and knows what exactly they are looking to treat, and all of your treatment options, they're the right person to ask. That's the kind of thing an online service like ours just can't stand in for.

Mind, a lack of sexual interest may or may not have anything to do with the oral contraceptives, and that's something people will often struggle with at least once (and often more than once) in a lifetime, many of whom aren't using oral contraceptives. Figuring out if this is or isn't about the OCs -- or at least getting a better sense of if it might be or not -- is, however, something we can likely help you with if you'd like. And since it sounds like you otherwise like the OCs, you probably want to be pretty sure it's not about something else before you ditch something that's working for you in so many ways.

If you're up for that, you cool with me tossing a bunch of questions at you to try and help you figure out what might be the culprit here (including if there even is one, as changes in sexual desire in life are also just a thing that tends to happen sometimes)?

[melancholyhills]

Oh wow! I didn't expect to get such a quick reply!

I'm perfectly fine with answering any questions, I just want to see if there is a way I can solve this problem. I think within the first year or so of using my OCs, my sex drive was fine enough- I was still with my current partner, and while we weren't having penetrative or oral sex, we were pretty playful (sexting and online stuff, but nothing physical. We were both warming up to it, I guess.)

And I suppose it would be better for me to consult my doctor, but that's a little awkward for me since I still depend on my mother to take me to appointments. Even then, I feel awkward about asking questions because it still feels inappropriate of me to have a sex life when I'm so much younger than my doctors.

[Heather]

We try and be quick around here.

Is your mother going into the exam room with you? If so, can you ask her for some privacy? Given your age, I'd say that if she isn't giving you that already, developmentally, it's time regardless, unless you WANT her in there. But even if you do, if her being in there with you is keeping you from being able to voice concerns about possible medication side effects, then that's obviously a problem, you know?

It's not inappropriate for you to have a sex life or a sexuality just because you're younger than your doctors. People of all ages have sexualities, and 18-year-old people will more often than not have sexual lives of some kind when they have the opportunity to have them. It might feel awkward to ask about concerns like this at first with healthcare providers, but with practice, it'll usually get less so. And it's not like any of us won't live through feeling a bit awkward.

I need to gather some extra brain cells (read: have a cup of tea), but then I'll post a bunch of questions here for you to consider and answer so we can see if we can't help you better sort out what might be up here and if this is or isn't likely to be about the OCs. I'll be heading off for the day after that, but will be around in the morning to pick this up.

[melancholyhills]

Thank you so much! I've been increasingly worried about this, and the kindness and speed of replies is really helping me out.

[Heather]

My pleasure.

Really, any added stress is only going to always make matters worse: stress is often enemy number one when it comes to any part of sexual response, including desire. So, before anything else, I'd suggest you do what you can to try and at least chill out about it some. Like I said, in a lifetime, sexual desire will wax and wane no matter what, and sometimes will even go into outright hibernation for a while. Often, nothing is wrong at all, and there isn't anything TO worry about or anything a person can just fix, besides just waiting it out and accepting it as a thing. So long as the way we construct our sexual lives always leaves room for that -- and it always needs to, because again, this is just going to happen sometimes, to pretty much everyone -- while I get it's a bummer, it shouldn't be anything to feel very afraid about.

But for sure, sometimes something is amiss, and can at least be fine-tuned if not "fixed," so let's see if we can't get a sense of the bigger picture here to try and suss out what's up.

Here we go!

• Previous to this, would you say that you DID feel strong desires to be sexual with this person in ways you're saying you no longer feel now? I hear you saying you previously felt desires to engage in things like sexting, but I am not sure if you're saying you previously felt the desire to engage in things like intercourse or oral sex, which is sounds like are kinds of sex you seem to be saying you want to pursue now, but aren't feeling desire for.

• Is being together in person something new for you? In other words, was sticking to things like sexting in the past because this started as an online relationship you've now moved to one that's in-person?

• Assuming you DID previously feel desires to be sexual with this person in the ways you're saying you don't or rarely do now, can you think of anything else that has changed in the interim for you: in your life as a whole, in this relationship, with your physical or mental health, etc?

• Have you also been experiencing changes with sexual desire or arousal with masturbation or sexual fantasy, or just when it comes to sexual desire for/with this partner?

• Have you had sexual relationships with others in the past where you experienced sexual desire at a level, for lack of a better word, that you're not now?

• You say you are rarely in the mood: what about when you are? When ARE you feeling a desire to be sexual with them that feels like what you want and what works for you? Can you think about anything about those times that's different than the times you aren't? For example, when you are in the mood vs. when you aren't, is there anything different in the sexual or interpersonal dynamics between you, or the environment you're in? Are you more often in the mood on days or at times in your week/month/whatever when you are better rested or under less stress? When there's more time or lead-up, or when you have done things that have turned you on in the past, like say, by creating anticipation by sexting first?

• Would you say that on the whole, just for yourself and by yourself, you're feeling pretty good and comfortable with your sexuality and with sexual activity, like masturbation or the mere idea of being sexual with a partner? For instance, you seem to be saying it feels inappropriate for you to even have a sex life at your age: is that a way you feel just when discussing it with a healthcare provider, or is that a more general feeling for you?

(Think that's enough to get me started! I know that's a lot, so feel free to take your time, whether that's a few hours or a few days. I'll check back in again soon.)

[melancholyhills]

Our relationship started off online, yes. I've always wanted to be physical with him, but at the time when we first started dating, I think it was for the best that we had the distance between us. I was way too nervous about sex and I didn't want to disappoint him. We've planned visits before, and now that I'm going to college I'll have the opportunity to visit him more often because 1) I won't have to worry about my parents, and 2) I'll be closer in proximity.

As far as changes in my mental health go, I was pretty unstable when we first started dating. I was very depressed and anxiety-prone, whereas now I have a better outlook on life and a (marginally) better control over my anxieties. Physically I've gained a little weight, but I don't feel like either of these aspects of my life have been influencing my drive/ our relationship.

When it comes to sexual desires, I try to be as open as possible since we're both into some strange things. I tell him about things I want and vice versa. My decreased drive is more of an overall thing, I'm just as crazy about my partner as ever.

I've never had a sexual relationship with anyone else before- or at least, I've done sexting and non-physical stuff with other people, and a little beyond that, but never intercourse. I've never felt sexual attraction for a man before, and my current partner is the first male I've ever been with.

I'm naturally more inclined to be in the mood when me work load has lessened- so I'm usually up for things on weekends or breaks. What bothers me is that I used to be up for anything regardless of stress levels, and I could actually retreat to sexual things to help me de-stress and unwind. Now it feels so much more circumstantial. I notice I only ever masturbate now after the four days of my placebo pills in my pack, when the actual pills haven't had a chance to kick in yet- which is what's making me think that the OCs are the issue.

However, we have been pretty inactive lately. We don't really engage in anything online anymore. He is still open to it, but for a time he felt online-only things were stale so we held it off for a while. Sometimes he starts initiating things, and it really turns me on, but it's been so long now that I'm too nervous to reciprocate. I'm sticking to the attitude that things will be better when we can meet again, I just don't want things to get stale again and then not have him want to try anything at all. But there's also the fact that, prior to my being with him, my needing someone else to interact with and stimulate me was never something I needed. Maybe it's just a matter of having a different threshold now that I'm in an intimate relationship?

I think I'm comfortable enough with my identity and activity. I'm just not used to being able to be open about it. I only turned 18 a few months back, and I guess the stigma of it being inappropriate/ not something I should be public about is something that's still sticking with me. I think it's perfectly normal for people my age to be active, but I guess I still hold myself as the exception. I'm still sorting things out with my sexuality, but I'm comfortable with it for whenever I figure out what I identify as. I'm not too concerned with labeling myself.

[Heather]

Heading out for the day, but letting you know I saw this, it was very helpful and I have thoughts! Will share in the morning, first thing.

(Oh, one quick extra question: presuming your endocrinologist had other treatment options for you, would you WANT to go off the pill? In other words, do you want a different BC method anyway, or are you only considering others because of the concern it may be dampening your sexual desire?)

[melancholyhills]

If my endo had another treatment I'd like to try it. As it is, I'm not confident enough in my current method to be super effective- or at least, I've looked into IUDs and think it's much safer, and I know my partner wants to try vaginal sex without having to use a condom all the time.

One thing I didn't mention in my prior post is that I had a very stressful/negative first sexual experience a few years ago that stigmatized me from a lot of my kinks. This happened when I was first dating my current partner (shortly after we started having a sexual relationship, and when I was at my ideal drive). With a lot of time and effort I managed to get past it and have a fulfilling relationship, but it's harder for me to get excited by those kinks now. Back then I used to have full-on panic attacks whenever I encountered things of that nature or even thought of it- and thankfully now that's not the case, but sometimes I catch myself getting upset by things- like a video, or any other content that have it, and I can't help but feel disappointed in myself because I can't make myself feel good indulging in that kind of content anymore.

I suppose that last bit was pretty crucial, but I never considered this could still be an issue with me now.

[Heather]

Also all very helpful, thanks. Will report back!

[Heather]

This was later than I intended, my apologies. I'm a sexual assault survivor, and one who is particularly triggered by justice system disbelief of survivors, especially based on their post-traumatic responses, so the Ghomeshi verdict made a mess of my head and heart when I woke up today. I appreciate your patience.

So, here are my thoughts and ideas based on what you've posted:
• As a sexual health advocate, I'm always going to strongly lobby for condom use, especially in the first six months of a sexual relationship and before testing at the end of that time, assuming the relationship is sexually exclusive. So, I'd encourage you, personally, to choose partners who don't come in from the front wanting to talk about not using condoms. That's your choice to make, by all means, but just my two cents. That said, if you would feel better about a different method of BC than the pill, and given it sounds like the healthcare providers you're seeing aren't yet providers you feel confident talking to about possible sexual side effects of your pill as one reason, I'd suggest just telling your current endo you want to go off the pill because you would prefer using a long-acting method of BC. If they're someone you can talk with about your options there (for instance, it may be an implant is a good choice for you for whatever your endocrine issue is and the side benefits of a method you also want, so you might want to consider that instead of just considering an IUD), then what you can do is do this this way, while also talking about your treatment options besides the pill for your endocrine issue. It may be there's a long-acting method that dovetails there, or it may be that you get your IUD and try a different treatment for the hormonal stuff. Alternately, if you think you'd feel more comfortable talking to a sexual healthcare provider about all of this, you could pick one -- you'll need one anyway -- and have them work in concert with your endo. That way, you might have someone you DID feel more comfortable talking about possible impacts on desire from the pill with.

• Looking at all you have posted here, and knowing that it actually isn't that common for the pill to just axe desire in big ways, I'd gather that if the pill is playing a part here, it's only that, a part. And it may not actually be playing a part at all, as I'm seeing some things that seem pretty likely to be part of this picture. Like:

1) That as you are edging closer to engaging in activity that is triggering for you, that's shutting some desire down.

2) That you and your partner haven't been doing much of the things that you HAVE found create feelings of desire for them with you: you know from the past that things like sexting have turned you on and been the way you have been sexual together so far, so that being something that's gone mostly poofie seems likely to be playing a part here. I see that kind of major sea change as akin to a magician pulling the tablecloth out from under the dishes, and the dishes flying everywhere because they blew that trick, if you follow me. Often, the things that have played the biggest part in what we most strongly associate with desire and arousal -- and sexual connection, period -- with a partner will always remain important, even as our relationship grows and changes and evolves.

3) It's pretty typical, as people move into adulthood to find that while when younger, desire and arousal were often frequent, and seemingly not impacted by things like stress, that changes. In fact, I'd say that the older we get, the more and more impactful our stresses tend to become on our sexualities and sexual responses, both from a neurological frame, but also just because they will tend to increase as we grow up and have more and more stress to carry from things like increasing responsibility and autonomy. So, I get being growly about that (I'm middle-aged, so boy, do I), but I'd also say it's a for-real thing that's manageable, but fairly unavoidable. And it's probably playing a part here for you like it does for so many of us.

4) It's also often stressful, and anxiety-ful (that so isn't a word, but I'm sticking with it), to enter into something that's sexually brand new for us. And stress and anxiety tend to shut down desire.

5) And it does sound like you do have *some* conflicted feelings about sex being appropriate for you based on your age, even if intellectually, you know better.

So, beyond the suggestions about BC and treatment options and healthcare, I would also suggest you think about/try some of the following:

1) If you haven't been talking to your partner or other people you trust and get support from about some of the things above, I'd start doing that. Often, just giving real voice to our fears and worries can help dial them down considerably.

2) I'd talk with your partner about the loss of your previous sexual activity (the text and online stuff that's been core for the two of you), and see if you can't find some middle ground so that that doesn't have to just be gone, and you don't have to basically be trying -- intentionally or not -- to create a whole new basis for sexual desire and getting aroused than you've had from scratch, effectively. For instance, perhaps you two can start testing a few hours before you see each other to drum up feelings of desire and anticipation for you: as foreplay to being sexual with your bodies, basically.

3) With whatever you're talking about in terms of kinks that feel core to your sexuality, but which got demonized for you, and now feel out of reach in a way you don't like, that's another area where thinking and brainstorming about some half-steps may be helpful. In what ways can you bring some of that in that make you happy, and make you excited, not panicked?

4) Think about what you might need not to feel excited, but to feel comfortable emotionally. A lot of what I'm hearing as a thread in a lot of your answers here sounds like discomfort to me, and certainly, not feeling comfortable -- including comfortable voicing or expressing our desires, asking partners for what we like and need, being comfortable with simply being a sexual being, period, and being whatever kind of sexual being we are -- can be a serious desire buzzkill. It sounds to me like in some of your responses, thinking about some of this isn't something you have been doing, and you're pretty quickly finding some things you hadn't considered that might be players here. If that's the case, then you probably haven't been talking about them with your partner, either, and really trying to work out for yourself and together what you need when it comes to just feeling safe and comfortable.

5) Lastly, sometimes LDRs with limited visits can put a LOT of pressure on us: the pressure to make the most of our limited time sexually, to be ready to go, as it were, from minute one of seeing someone again, and of even feeling like it's not totally okay NOT to be sexual with a visit -- or to talk about all of this kind of stuff instead so we can eventually get there. I'd just think about that, and if you come to the conclusion that the way you're thinking about or doing visits puts any pressure on you, you see what you can do to at least take some of it off. (I'm not sure it's realistic to say all of it, since in a for-real way, when our time is very limited, we're just going to want to make the most of it, and when that relationship is one we want to be sexual, wanting to BE sexual is going to be part of that.)

I hope at least some of this feels helpful and like a place to start. I need to make the rest of my workday about things that just involve paperwork so I can deal with my own feelings, but I'll be checking in briefly again tomorrow, and then back around for my workweek starting on Sunday (as it's my Monday). I'm also certainly not the only person you can talk to about any of this here.

3)

[melancholyhills]

Alright- first off, I'm sorry that my response is so late. I'm so thankful for how thought-out your responses have been, and I didn't want to send another message without following through with anything first.

So, I talked to my partner.

Let me just say first that, WOW, I had no idea how helpful that was going to be towards solving my dilemma. In hindsight that seems to be the most painfully obvious course of action, but I guess I just needed to get out of my own head to see that. Again, I have to thank you for the advice- you managed to type things out that I wasn't able to pinpoint or articulate quite so accurately. I suppose that part of me being so ready to jump to my OCs as the root of the issue is that I didn't want to make my partner feel like this is his fault. Working towards the whole digital-to-physical transition will be pretty difficult (in addition to all the other things)- and I won't pretend that the conversation I just had with him is the cure-all to my problem- but knowing that he recognizes it as an issue and that it's not all staying in my head makes me feel better.

Now, as far as my birth control issue goes, part of me does still feel like something other than my OCs would be better- both in the sexual and hormonal parts of my issues. This will just have to be something I look into more. I'll definitely talk it over with my endo- I've scheduled an appointment with her and should be seeing her in about a week and a half from now.

Again, thank you so much!

(Oh, and just to clarify- NOT using condoms was never something I would consider! I'm far too scared by the financial prospects a pregnancy would entail, and as much as I want to make my partner happy, he knows better than to expect me to be okay with us having sex without any protection.)

[Heather]

No need to be sorry, this is all for you, not me!

So, so glad my responses were helpful.

When you talk to your endo, I'd suggest asking them what they think about a hormonal IUD for you. They don't use estrogen, the hormone in OCs that tends to be attributed to sexual side effects when people are having them from that method, so it may be a hormonal IUD is the best of both worlds for you, giving you some of the benefits you have liked from the OCs and being a method it sounds like you want to try anyway.

[melancholyhills]

Thanks for the suggestion! I've only ever been familiar with the standard copper IUDs (Paragard) since I've only ever seen them used as an alternative to hormonal birth control (and since it seems to be the one with the most reviews). I'll be sure to ask!

[Heather]

The hormone in hormonal IUDs is localized, and at a much smaller amount than hormonal methods like OCs, and it is also progestin-only. So, often people don't experience the same kinds of negative side effects they do with the pill, patch or ring.