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Alteration of the Sexual Response Cycle in Women Using Combined Oral Contraceptives

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Alteration of the Sexual Response Cycle in Women Using Combined Oral Contraceptives artículo original/original article http://dx.doi.org/10.14482/sun.34.2.613.94 Alteration of the sexual response cycle in women using combined oral contraceptives Alteración del ciclo de respuesta sexual en mujeres que utilizan anticonceptivos orales combinados Franklin José Espitia De La Hoz1, Hoover Orozco Gallego2 Abstract Objective: To estimate the effect of female sexuality due to the use of the contraceptive combi- nation estradiol valerate / Dienogest against Ethinylestradiol / Drospirenone. Material and methods: A controlled, randomized, unblinded clinical trial was carried out on 174 women, between 18 and 39 years of age, who underwent two hormonal contraceptive options with estradiol valerate / Dienogest and ethinylestradiol / Drospirenone; in a private clinic in Armenia, Quindío, between 2013 and 2017. The female sexual function index (IFSF) was used to analyze the sexual function of the participating women; at the beginning, at six, at eighteen and thirty-six months after the start of the contraceptive. Results: At the end of the study, the contraceptive combination estradiol valerate / Dienogest was a less aggressive therapy in the alteration of the sexual response cycle of the users, while the ethinylestradiol / drospirenone combination significantly affects the desire and excitement with lower scores in the IFSF. 12 de marzo 2018 Conclusions: The results indicate that the estradiol valerate / Dienogest combination affects 20 de julio 2017 the desire, arousal and IFSF score less than the ethinylestradiol / drospirenone combination. Key words: Androgens; Contraceptive Agents; Women; Sexuality; Testosterone. Fecha de recepción: Fecha de aceptación: 1 Gynecology and Obstetrics, Universidad Militar Nueva Granada. Uroginecology / FUCS - Hospital San José / Unicamp, Brazil. Clinical Sexology Master in sexology: education and sexual counseling. University de Alcalá de Henares. Gynecology Service and Maternal Fetal Medicine, Clinica La Sagrada Familia, Ar- menia, Quindío, Colombia 2 Licenciatura En Física y Matemáticas, Maestría/Magister En Física, Universidad Tecnológica de Pereira – UTP Correspondence: Franklin Espitia de la Hoz. Carrera 12 # 0-75 (508) Teléfono 7459490 - Móvil 3127436696 Vol. 34, N° 2, 2018 [email protected] ISSN 0120-5552 eISSN 2011-7531 430 Salud Uninorte. Barranquilla (Col.) 2018; 34 (2): 430-442 Alteration of the sexual response cycle in women using combined oral contraceptives Resumen Objectivo: Estimar la afectación de la sexualidad femenina por el uso de la combinación anticonceptiva Valerato de estradiol/Dienogest frente a Etinilestradiol/Drospirenona. Material y métodos: Se realizó un ensayo clínico controlado, aleatorizado, no cegado en 174 mujeres, entre 18 y 39 años, sometidas a dos opciones de anticoncepción hormonal con Valerato de estradiol/Dienogest y Etinilestradiol/Drospirenona; en una clínica privada de Armenia, Quindío, entre 2013 y 2017. Se utilizó el índice de función sexual femenina (IFSF) para analizar la función sexual de las mujeres participantes; al comienzo, a los seis, a los dieciocho y treinta y seis meses de iniciado el anticonceptivo. Resultados: Al finalizar el estudio resultó la combinación anticonceptiva Valerato de estra- diol/Dienogest una terapia menos agresiva en la alteración del ciclo de la respuesta sexual de las usuarias, mientras que la combinación Etinilestradiol/Drospirenona afecta de forma significativa el deseo y la excitación con menores puntajes en el IFSF. Conclusiones: Los resultados indican que la combinación Valerato de estradiol/Dienogest afecta menos el deseo, la excitación y la puntuación del IFSF que la combinación Etiniles- tradiol/Drospirenona. Palabras clave: Andrógenos; Anticonceptivos; Mujeres; Sexualidad; Testosterona. INTRODUCTION includes 19 questions that evaluate the sexual activity of women in the Last four Sexual health is of fundamental importance to weeks The questions are gathered in six do- maintain the stability of affective relationships; mains: desire (items 1-2), excitement (items it is considered as one of the factors that help 3-6), lubrication (items 7-10), orgasm (items the appearance, recovery and maintenance 11-13), satisfaction (items 14-16) ) and pain of well-being and general good health of the (items 17-19) The score of each domain is individual (1). multiplied by a factor, and at the end of the arithmetic sum of the domains, the final The human sexual response cycle is a four- average is obtained; the higher the score, phase physiological model in response to sexual the better the sexuality. A score below 26.55 stimulation. In order of occurrence they are: means risk of impaired sexual function (5-8). arousal phase, plateau phase, orgasm phase and resolution phase (2,3) The sexual response and, in particular, desi- re, is influenced both by external factors and The female sexual disorders involve a wide by internal interactions (memories, percep- multifactorial relationship, and they include tions and internal concepts combined with four main disorders: orgasmic, sexual arousal, the emotional processing of sensory inputs) sexual desire and pain (vaginismus and dys- (9,10). The use of oral contraceptives has been pareunia) (4). associated with adverse effects on sexual function, particularly in relation to a possible The most commonly used questionnaire to negative impact on sexual desire (11). evaluate female sexual difficulties is the “Fe- male Sexual Function Index” (IFSF), which Salud Uninorte. Barranquilla (Col.) 2018; 34 (2): 430-442 431 Franklin José Espitia De La Hoz, Hoover Orozco Gallego Hormonal contraceptives contain estrogens frequency (20,21), perhaps due to the ability and progestins or only progestins. They are to reduce the activity of 5-alpha reductase. currently used by more than 100 million In turn, dienogest (a progestogen derived women worldwide, with more than 44,000 from 19-nortestosterone) has been shown to published scientific studies (12); being the lack estrogenic, mineral and glucocorticoid most effective method in terms of planned effects (22), which increases the likelihood pregnancy rates. Most commercial prepara- of acceptance among users. tions contain 20 to 35 μg of ethinylestradiol together with levonorgestrel, norethindrone In the case of oral contraceptives, reducing or a new generation progestin (13). the estrogen dose has, in addition to re- ducing the risk of thromboembolic disease, In combined oral hormonal contracep- reduced side effects such as headache, mas- tives, estrogen decreases the production of talgia, nausea and vomiting (23), favoring dehydroepiandosterone, testosterone and its tolerability and decreasing the negative androstenedione through the inhibition of impact on female sexual function. 5-alpha reductase and favors the production of sex hormone-binding globulin (SHBG, in In light of all these data of the questionable English: [sex hormone-binding globulin]), involvement of combined oral contracep- reducing levels of circulating free testosterone tives in the sexual response cycle of women, (14,15); Progestogens, on the other hand, have we decided to set ourselves the objective of a variable androgenic effect. The result of these evaluating and estimating the involvement mechanisms of action generates a iatrogenic of female sexuality by the use of the con- deficit of testosterone, which alters female traceptive combination estradiol valerate sexual function (14). / Dienogest (E2V / DNG) against Ethinyl- estradiol / Drospirenone (EE / DRSP). The gestagenic component of combined oral contraceptives is responsible for the inhibition METHODOLOGY of ovulation, by blocking the preovulatory discharge of LH, while Ethinyl Estradiol (EE) A controlled, randomized, unblinded clin- potentiates the antigonadotropic effect of ical trial was carried out on 174 women, be- gestagen (16). However, the main novelties in tween 18 and 39 years of age, who underwent hormonal contraception are the introduction two hormonal contraceptive options with of estradiol valerate (estrogenic component) E2V / DNG and EE / DRSP, attended at a and drospirenone (progestogen) (17). private clinic in Armenia, Quindío, between March 2013 and March 2017. The use of modern progestins, and even in low doses, has generated deleterious effects Sample size and type of sampling on the sexual health of women, by showing decreased vaginal lubrication (18) and in- The sample size was calculated in a popula- creased vestibular pain (19). In recent inves- tion of 36,000 women, based on a sampling tigations, drospirenone and dienogest have error of 10% and a confidence level of 99%, reported a positive effect on sexual response obtaining a minimum sample size of 165 as attraction, desire, satisfaction and coital women. 432 Salud Uninorte. Barranquilla (Col.) 2018; 34 (2): 430-442 Alteration of the sexual response cycle in women using combined oral contraceptives The randomization method was done in a the differences of the adverse effects between simple way, the women were divided into the two groups with the socio-demographic two groups, pairs (A) and odd (B), with group characteristics and other associated factors, as A being treated with E2V / DNG, and group well as to verify the existence of an association B treated with EE / DRSP. After informed between the categorical variables through the consent of the patients, the sexual function χ² tests and the exact test. of Fisher, according was evaluated through the IFSF (5-7), initially, to the distribution of the variables, with a then at
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