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 Contraception
and Sexual Function
 Most
family planning training and services fail to include discussions of how
various methods of contraception may affect sexuality and sexual function.
However, these considerations are an important part of contraceptive counseling,
since they significantly affect clients’ satisfaction and continuation
of a contraceptive method.
A person’s attitude toward
sexuality and sexual relationships can affect her or his choice of contraceptive
methods. In addition, one’s perception as to whether a contraceptive
method enhances or diminishes sexual pleasure influences use of a method.
For example, studies have shown that women are less likely to be satisfied
with their contraceptive method if they believe that the method will make
sex less pleasurable.
This list highlights considerations
to include in discussions with clients to further support informed decision
making and successful contraception:
- Abstinence (refraining
from sexual activities; nonpenetrative sexual behavior) reduces the
risk of STIs; enhances alternative expressions of sexuality.
- Coitus interruptus
(withdrawal). Learning this technique may increase men’s sensitivity
to the erotic sensations leading to orgasm, thereby helping them manage
premature ejaculation; may reduce pleasure by interrupting the plateau-to-orgasm
transition.
- Fertility awareness
(abstinence from intercourse during fertile periods) may increase
sexual pleasure with the removal of the fear of pregnancy; enhances
creativity in sexual expression during fertile times when avoidance
of penile-vaginal contact is required.
- Lactational amenorrhea
(breastfeeding) may increase sexual pleasure with the removal of the
fear of pregnancy. Increased breast size may be arousing; breast sensations
during breastfeeding may be erotic. Low estrogen can result in diminished
vaginal lubrication; the woman may experience reduced desire or loss
of desire. Sexual activity with a breastfeeding woman may be taboo in
some cultures.
- Condoms (male) may
increase sexual pleasure with the removal of the fear of pregnancy or
STI transmission (including HIV); can reduce penile sensation; may prevent/minimize
premature ejaculation; may cause latex allergy; use may interrupt intercourse.
Some men may not be able to maintain an erection with condom use.
- Condoms (female)
may increase sexual pleasure with the removal of the fear of pregnancy
or transmission of HIV and other STIs; do not significantly reduce penile sensation;
may be noisy; may be considered unattractive; insertion may interrupt
intercourse.
- Spermicides may
increase sexual pleasure with the removal of the fear of pregnancy;
increase vaginal lubrication; reduce the occurrence of certain infections
(e.g., gonorrhea, trichomonas); may have an unpleasant taste (during
oral-genital sex); may irritate genitalia of woman or man; may increase
occurrence of urinary tract infections; insertion may interrupt intercourse.
- Diaphragm/cervical cap
may increase sexual pleasure with the removal of the fear of pregnancy;
may protect cervix from cancer; may cause pelvic discomfort if too large;
insertion may interrupt intercourse.
- IUD may increase
sexual pleasure with removal of the fear of pregnancy.
- Combined orals/injectables
may increase sexual pleasure with the removal of the fear of pregnancy;
improve perimenopausal symptoms; decrease vaginal lubrication; reduce
free testosterone, resulting in diminished libido or loss of desire.
- Progestin-only orals/injectables/implants
may increase sexual pleasure with the removal of the fear of pregnancy;
may reduce sexual activity in settings where sex with bleeding (spotting)
in women is taboo or if sex in the presence of vaginal bleeding is not
appealing.
- Tubal occlusion/vasectomy
may increase sexual pleasure with the removal of the fear of pregnancy.
© 2007 EngenderHealth
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