Dearest Alice,

I was wondering about the effects of the birth control pill on orgasms. Any connection? Some friends have told me it makes things easier while some say it makes getting orgasms more difficult. What's the real story?

— Curious

Dear Curious,

Hormonal birth control is not one size fits all and, in fact, there seems to be as many names for it ("the pill," oral contraceptive (OC), and the list goes on) as methods. Therefore, the mixed messages you are receiving about OC's effects on the "Big O" may be a result of your friends' different experiences with different pills. Since many women commonly find it difficult to reach orgasm, your question seems to be a concern over increased difficulty reaching orgasm. To address this, let's first discuss the two general categories of OC:

  • Minipills: These contain the hormone progestin and are taken daily. Hormone dosage ranges from brand to brand and dosages may vary within one pack (known as multiphasic birth control which mimics the natural hormone fluctuations in a woman's cycle). The number of pills per pack ranges from 28 to 84, including four to seven placebo sugar pills that are taken during the week a woman has her menstrual period.
  • Combination Pills: Like minipills, combination pills are taken daily and dosage depends on what a health care provider prescribes. These pills, however, contain estrogen as well as progestin.

In short, the hormones in both types of OCs trick the body into thinking it is pregnant so that it doesn't release an egg. When taken correctly, this leaves no egg to be fertilized, hence, no possibility for pregnancy. However, because sexual urges, responses, and emotions for both men and women are strongly correlated with the levels of hormones in our bodies, both minipills and combination pills have been associated with decreased libido in some women. In spite of this, research studies have not definitively shown a relationship between OC use and a woman's ability to orgasm.

That being said, orgasms result from a combination of physical and psychological triggers. If you have a safety lock on either one of those for any reason (such as decreased libido), they may not be as easy to achieve. Just as OC methods vary, so does individual experiences with them, as you have seen with your friends — but all is not lost! Some techniques that may increase the likelihood of experiencing orgasm include ample focus on foreplay and manual stimulation of the clitoris during sexual activity. See the Related Q&As for some additional ideas.

For many women, regardless of whether they are on the pill or not, achieving those sought after pelvic pyrotechnics is difficult. Learning what lights your fire through experimentation with masturbation may help address this but if climax remains elusive, a health care provider may be able to offer more guidance. Hopefully, with practice and experimentation, your friends on the pill (and all women for that matter) will master reaching the "Big O" instead of a "Big Uh-Oh." Good luck!


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