Some pills may be better than others. Very-low-estrogen pills that contain drospirenone, desogestrol or norgestimate seem to have the greatest negative impact on libido and vaginal dryness, so if you’re taking one of these, talk to your doctor about whether it’s contributing to any symptoms you might have. Use a silicone lubricant, and ask your doctor for a prescription for hormonal creams to apply to the opening of the vagina. And know that you are not crazy.
Dr. Goldstein discovered that about 5% of women have a genetic variant that results in a defective or inefficient testosterone receptor. These women require much more testosterone to keep the vulvar and vaginal tissue healthy and for their glands to function normally. The effects are not obvious until testosterone levels become lower than normal, but that happens to every woman who takes the pill.
So, in women with this genetic variant, the problem is threefold:
- The pill causes the ovaries to produce less total testosterone and less is in a usable form.
- The synthetic progesterone found in newer birth control pills poisons the testosterone receptor at high doses.
- The testosterone receptor doesn’t work well, making it extra dependent on high amounts of testosterone being present.