A Bitter Pill to Swallow?

There’s been research on the link between the birth control Pill or Oral Contraceptive Pill (OCP) and vulvodynia going on for a little while. So what’s the story? Let me take you through a brief history.

A study in 2008 found a 30% risk of vulvodynia in OCP-takers (a risk that was highest among those that started the Pill before age 18. However, this was not statistically significant, which means, in essence, there’s a strong chance it could have been caused by chance!

In 2010, a case study was presented of a woman who developed vestibulodynia once on the OCP, and whose symptoms resolved completely once she stopped the OCP. While this is interesting – and provided ground for further research – a study of a single person is not very convincing of what happens ”en masse”.

Then, in 2012, a review found that the OCP can have negative effects on various aspects of a woman’s sexuality. Some of the things they looked at included libido and painful sex.

In summary, the research hasn’t been very conclusive – while those of us in clinical practice working with vulvodynia became more convinced there could be a link.

Hot off the press is a study presented at the American Urological Association conference in 2013. It has found that the low-dose contraceptive Pill (i.e. the type commonly taken) can increase the risk of pelvic pain, including pain with sex.

The hypothesis of the researchers was that the OCP could possibly lead to vulvodynia via its effects on serum estradiol (estrogen), free testosterone levels, hormonal receptors, and vulvar mucosa. There were 957 women in the study (a lot more than the 177 women in the 2008 study cited above). They put these women into three groups:

-did not use the OCP (“nonusers”)

-used the “low-dose” OCP, 20ug ethinyl estradiol or less

-used the “normal-dose” OCP, more than 20ug ethinyl estradiol

Low-dose users were significantly more likely to meet the criteria for a diagnosis of chronic pelvic pain than nonusers. Twice as many low-dose users than nonusers reported pain during orgasm (25% vs 12%).

Because the high-dose users were not more likely than nonusers to have chronic pelvic pain or pain during orgasm, the investigators suggested that women with pain could be put on a higher-dose Pill. That certainly warrants consideration. So does reconsidering whether the Pill is the right contraception for you if you have problems with pelvic pain or vulvodynia. One study in 2012 found an increased pain sensitivity in women on the Pill who had a certain genetic make-up. This possibility is also currently being explored by Dr Andrew Goldstein, one of the world’s foremost clinicians dealing with vulvodynia.

For now, it seems that taking the OCP for contraception should not be treated as a decision to be taken lightly, especially if you have persistent pelvic pain – and especially if it came on after you started the Pill.

If you would like help getting off the Pill, read my blog post series here.

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