Dear Alice,

My girlfriend recently (one month ago) received her first depo-provera shot; she decided to move to depo because condoms were not effective. (She became pregnant and had an abortion several months ago.)

The thing is, since her shot, her sex drive has been nil. She says that she doesn't "remember" how to become aroused and that, even though she wants sex emotionally and intellectually, her body is completely unresponsive. Whenever we attempt any kind of physical intimacy of a sexual nature, she says she feels claustrophobic and that she can't breathe. However, other physical intimacy is not a problem; we sleep together often (sleepovers), hug, cuddle, kiss (but sweetly, not passionately), etc.

I think I saw symptoms of this before the shot, though, and I have begun to wonder if this is possibly a psychological reaction to her pregnancy/abortion and other changes and crisis over the past year or a general hormonal reaction to everything that's happened. Or both.

As frustrating as this is for me, I'm worried about her as she is demonstrating an increasing anger towards herself for being "dysfunctional" and "less than a whole woman," and has fears that I'm going to break up with her because of the lack of sex. (I won't.)

I guess, what I'm really asking is: What can I do? We're talking, but it doesn't seem to be enough. Should we just change contraceptives, or is there possibly something worse going on?

— What can I do?

Dear What can I do?,

Sometimes even the most supportive relationships hit roadblocks in the bedroom. Issues with sexual desire can be a difficult and frustrating experience for both partners. Although, it sounds like you’re already off to a great start by being a patient partner who listens and is respectful of your girlfriend’s needs. There are so many reasons why a person’s sex drive might change, and hormones or significant life events could definitely be potential culprits. You may encourage her to talk with a health care provider to figure out if the hormones from the shot are to blame or if there are other factors that may be impacting her libido. Either way, having your support through this process may help her get through this tough time.

It’s true that changes in hormone levels caused by medroxyprogesterone acetone injections (a.k.a. birth control shot, brand name: Depo-Provera) or other forms of hormonal birth control can sometimes diminish sexual interest and responsiveness. The birth control shot also contains higher levels of hormones than other contraceptive options. These increased hormone levels may be more likely to cause side effects like changes in menstrual patterns, bone density, as well as weight gain, depression, nervousness, and decreased libido. Many times, these side effects are temporary and improve with continued use, but if your girlfriend finds that they persist or are particularly worrisome or bothersome, she may want to talk with a health care provider about switching to another form of birth control. For example, if your girlfriend isn’t interested in barrier methods like condoms, she could consider other alternatives with lower levels of hormones, such as the oral contraceptive pill, or even a non-hormonal copper IUD. A health care provider can also help your girlfriend rule out other possible causes of her decreased sex drive, and they can even provide resources and support for her sexual and reproductive health in general. If your girlfriend does end up switching, she can also discuss with her provider which contraceptive options are best for her, and how to effectively transition from one method to another.

Changes in sexual interest and arousal fall under the complicated umbrella term sexual dysfunction. It’s a concept that characterizes if and to what extent a person experiences difficulty with any stage of normal sexual activity — whether it be sexual interest, arousal, orgasm, and even pain. A person’s sexual functioning depends on that person’s collective well-being. Everything from their social, financial, mental and physical health or other general life circumstances can impact sexual activity. For example, physical causes could include anything from pain during sex to fatigue; psychological causes could range from typical stress to a history of trauma, or even relationship issues like unresolved conflicts could inhibit a person’s sex drive. Because these factors can fluctuate over time, so too can sexual functioning, which means peaks and dips in libido are very normal — according to some studies, more than half of all women report feeling a decrease in sexual desire sometimes. So while hormones like estrogen, progesterone, and testosterone can definitely play a role in physiological sexual dysfunction, they may only be part of the reason. (For more on hormones and sex drive, check out Lowered testosterone levels reduce sexual desire in women? and Testosterone cream for low sex drive? in the Alice! archives). 

What can I do?, you also mentioned hints of diminishing sexual desire before your girlfriend started DMPA. Significant life changes and stress can certainly put a damper on a person's sex drive, and it wouldn't be unusual if your girlfriend still has some feelings attached to the pregnancy or abortion. For some people, these experiences can be very difficult and it could be possible that your girlfriend needs more time to process what has happened. Has she been able to talk about what the experience felt like for her? Is she interested in getting additional support? When she is ready, and if she's interested, you could suggest resources like Exhale (link is external), a free, national, multi-lingual, confidential talk line service for people who’ve had abortions. Exhale also offers their services to partners, friends, allies, and family members of people who’ve had abortions. Resources like these can help your girlfriend find a safe space to talk about the experience and find confidential support.

Additionally, talking with a mental health provider may help to address any other underlying issues causing her decreased interest in sex. If she’s okay with it, you can offer to go with her. Couples therapy could give you both an opportunity to talk about steps you can take together to rekindle your sex life. It could also give the two of you a chance to work through some of the frustrations or anxieties either of you may be feeling. In the meantime, continue supporting each other and find ways to connect and stay intimate that don’t involve sex — and it sounds like you’ve already figured out some types of physical contact and communication that do work. There is no blame to be assigned for your girlfriend’s current lack of sexual desire; hopefully time, compassion, and maintaining open communication will help you both feel better.

Alice!

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