title: Are hormonal components of oral contraceptives associated with impaired female sexual function? A questionnaire-based online survey of medical students in Germany, Austria, and Switzerland.
abstract: OBJECTIVE
  To investigate in a large cohort of young university women whether different progestins and different ethinyl estradiol (EE) dosages in oral hormonal contraceptives (OHCs) adversely affect sexual function.
  
  
  METHODS
  Female medical students from German, Austrian, and Swiss universities (14/1/1) completed an anonymous online questionnaire comprising the 19 Female Sexual Function Index (FSFI) questions and 17 additional questions concerning demographics, lifestyle, sexual activity, and contraceptive use. OHCs were categorized by EE dose (≤20, <20 to ≤30, and >30 µg) and partially androgenic or antiandrogenic progestins. FSFI scores were analyzed by contraceptive method using descriptive statistics and standard nonparametric tests.
  
  
  RESULTS
  We analyzed 2612 questionnaires submitted by respondents aged ≤30 years [mean age (SD) 23.5 (2.5) years]. Of 2126 contraceptive users, 1535 (72.2 %) used OHCs. Median FSFI total scores (ranges) were 28.2 (2.0-36.0) for all respondents. Median FSFI was significantly lower in non-users (24.4) versus users (28.7) of contraception (p < 0.001). Stratified analysis showed that 279/486 (57.4 %) respondents using no contraceptives, 563/1535 (36.7 %) using OHCs, 71/227 (31.3 %) using non-oral hormonal contraceptives, and 96/351 (27.4 %) using non-hormonal contraceptives were at risk for female sexual dysfunction (FSFI total score <26.55). FSFI scores for the three EE dosage categories and progestin components did not differ significantly.
  
  
  CONCLUSIONS
  For OHCs, the FSFI score was lower than for other contraceptives but there was no significant association with EE dose or progestins, possibly due to small sample sizes. Further research needs to clarify the role of OHCs in female sexual function.
authors.affiliation: Department of Women's Health, Research Institute for Women's Health, University of Tübingen, Calwerstraße 7, 72076, Tübingen, Germany, cwallwiener@gmail.com.
authors.forename: Christian W
authors.initials: CW
authors.lastname: Wallwiener
authors.forename: Lisa-Maria
authors.initials: LM
authors.lastname: Wallwiener
authors.forename: Harald
authors.initials: H
authors.lastname: Seeger
authors.forename: Birgitt
authors.initials: B
authors.lastname: Schönfisch
authors.forename: Alfred O
authors.initials: AO
authors.lastname: Mueck
authors.forename: Johannes
authors.initials: J
authors.lastname: Bitzer
authors.forename: Stephan
authors.initials: S
authors.lastname: Zipfel
authors.forename: Sara Y
authors.initials: SY
authors.lastname: Brucker
authors.forename: Florin-Andrei
authors.initials: FA
authors.lastname: Taran
authors.forename: Markus
authors.initials: M
authors.lastname: Wallwiener
mesh_terms: D000293:Adolescent; D000328:Adult; D001317:Austria; D003267:Contraception / Q000379:methods; D003278:Contraceptives, Oral, Hormonal / Q000008:administration & dosage / Q000009:adverse effects*; D004997:Ethinyl Estradiol / Q000008:administration & dosage / Q000494:pharmacology*; D005260:Female; D005858:Germany; D006801:Humans; D020407:Internet; D007989:Libido / Q000187:drug effects / Q000502:physiology; D011372:Progestins / Q000008:administration & dosage / Q000494:pharmacology*; D012725:Sexual Behavior; D012735:Sexual Dysfunction, Physiological / Q000139:chemically induced*; D019529:Sexuality / Q000502:physiology*; D013337:Students, Medical / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013557:Switzerland; D055815:Young Adult
chemical_list: D003278:Contraceptives, Oral, Hormonal; D011372:Progestins; D004997:Ethinyl Estradiol