Vaginal dryness or decreased lubrication during sexual activities is an uncommon but not rare side effect.

It is usually caused by some combination of two hormonal factors, decreased estrogen and decreased testosterone.

Birth control pills usually suppress ovarian function (because of the progestin half of the pill). This suppression causes a big drop in a woman’s female hormone, estrogen, which is produced primarily in the ovary. But most women don’t notice the drop, because of the other half of the pill, estrogen, which builds their hormone levels back up. The net effect of these two influences (among those using low dose, combination BCPs) is circulating blood estrogen levels that are typically a little lower than before the woman started the BCPs.

Benefits of this lower estrogen level include lighter, shorter menstrual cycles. One drawback to the lowere estrogen level is the potential for a decrease in vaginal lubrication.

Ovarian suppression also results in a drop in circulating testosterone. About 1/3 of a woman’s male hormone production comes from her ovaries and if these are suppressed, her male hormone levels will fall by about one-third. This drop can be beneficial to women seeking an improvement in their acne (largely driven by testosterone plus genetic factors), but for those very sensitive to these levels, it can adversely affect their libido. With decreased sex drive, the internal mechanisms for vaginal lubrication, blood flow to the genitals, and sexual arousal are diminished.

There are several approaches to this clinical problem that may be effective in resolving it.

• “Personal Lubricants” can be used to overcome the problem, such as AstroGlide, Lubrin, Replense, or KY Jelly.
• Stopping the BCP altogether will usually solve the lubrication problem, but may leave the woman vulnerable to pregnancy, so other contraception options can be explored.
• Changing the BCP to less strong progestin pill, with a shorter half life can be tried. These less strong pills still provide contraception, but are less consistent in their suppresion of ovarian function.
• In the context of other evidence of low estrogen levels (very light, scant periods), additional estrogen can be given, in the general dosage range of post menopausal HRT (such as Premarin 0.625 or 0.3 mg daily, or topical vaginal estrogen). While adding additional estrogen can be effective, long-term use may pose added cardiovascular risks such as is seen in the medium-dose or high-dose BCPs.