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Why a biopsychosocial approach is needed when studying the sexual effects of hormonal contraception

Approval by the US Food and Drug Administration of the first oral contraceptive (OC) on 9 May 1960 stirred both public and scientific debate. Initially, concerns regarding the sexual effects on women were limited. Even today, despite decades of widespread use of OCs by over 100 million women worldwide, it is astonishing how little we know about the effects of hormonal contraception on women’s sexuality. In the late 1980s, the human reproduction programme of the World Health Organization (WHO) appointed John Bancroft to conduct a series of studies into OC use and sexual health [1–4]. This short paper discusses the three main conclusions of these studies, supplemented by recent additions to the field, to show why research in this area requires a biopsychosocial approach. To be able to put studies on OC use and female sexual desire (also termed sexual interest or sexual motivation) into perspective, we refer to a leading theoretical, biopsychosocial model called the incentive motivation model [5] (Figure 1), in which it is stated that sexual desire, or sexual motivation (in both women and men), is the result of a complex, layered process. According to the model, sexual desire typically emerges when a functional ‘sexual system’ (influenced by receptors, sex steroids, genetic sensitivity, etc.) is activated by an internal or external stimulus that is sexually meaningful to the individual concerned. This stimulus can be visual, olfactory or otherwise, and its valence depends on the sexual memory (attitudes, norms and previous sexual experiences) of the person (Figure 1). For example, some individuals will find a certain smell or sound sexually stimulating, since it reminds them of earlier positive experiences with that smell or sound, in their personal memory associated with a sexual reward. This same stimulus can be experienced as neutral or even negative by another person, depending on the specific associations in that person’s sexual memory [5].