Department of Surgery, University of British Columbia, Vancouver, BC, Canada.
Department of Ophthalmology and Visual Sciences, Faculty of Medicine, Department of Anesthesia, Pharmacology and Therapeutics, The Eye Care Center, University of British Columbia, Room 323-2550 Willow Street, Vancouver, BC, V5Z 3N9, Canada.
Eur J Clin Pharmacol. 2021 Jan;77(1):133-140. doi: 10.1007/s00228-020-02983-0. Epub 2020 Aug 15.
To examine whether there is a positive association between sexual dysfunction (SD) and different types of progestin-based contraceptives.
Nested case-control study in women of child-bearing age (15-45 years) from the IQVIA® Ambulatory electronic medical record database from 2008 to 2018. Cases defined by diagnosis of sexual dysfunction identified by international classification for disease clinical modification code 9th and 10th. Each case was matched to four controls and rates of prescriptions of the following were compared: levonorgestrel intra-uterine device (IUD), progestin, and ethinyl estradiol (EE) combined oral contraceptive (COC) formulations including levonorgestrel, norgestimate, drospirenone, desogestrel, norethindrone, and norgestrel; etonogestrel vaginal ring; and medroxyprogesterone injection.
Overall, 6689 cases of patients with SD were matched to 26,756 matched controls. Compared with matched controls, more subjects with SD used levonorgestrel IUD (OR 1.24, 95% CI 1.08-1.44), EE-levonorgestrel COC (OR 1.18, 95% CI 1.00-1.41), EE-drospirenone (OR 1.28, 95% CI 1.00-1.67), and medroxyprogesterone (OR 1.38, 95% CI 1.12-1.70). The use of norgestrel exhibited a protective effect (OR 0.83, 95% CI 0.73-0.95). When using the EE-levonorgestrel COC as a comparator, norgestrel users exhibited a protective effect (OR 0.70, 95% CI 0.57-0.87) while no other contraceptives showed a statistically significant difference in association with SD.
Our study found an increase in the use of levonorgestrel (COC and IUD), drospirenone, and medroxyprogesterone in subjects with SD. The risk of contraceptives did not differ when compared with oral levonorgestrel. The small association size and lack of difference between drug formulations suggest a minimal impact of progestin-based contraceptives on sexual dysfunction.
研究不同类型孕激素避孕药与性功能障碍（SD）之间是否存在正相关关系。
本研究是一项嵌套病例对照研究，研究对象为年龄在 15-45 岁的育龄妇女（15-45 岁），数据来自 IQVIA®Ambulatory 电子病历数据库，研究时间为 2008 年至 2018 年。SD 的诊断依据为国际疾病分类临床修正第 9 版和第 10 版的性功能障碍诊断代码。每个病例都匹配了 4 个对照，并比较了以下药物的处方率：左炔诺孕酮宫内节育器（IUD）、孕激素和含炔雌醇（EE）的复方口服避孕药（COC）制剂，包括左炔诺孕酮、去氧孕烯、屈螺酮、地诺孕素、诺孕酯和炔诺孕酮；依托孕烯阴道环；以及醋酸甲羟孕酮注射液。
共有 6689 例 SD 患者病例与 26756 例匹配对照进行了匹配。与匹配对照相比，更多的 SD 患者使用了左炔诺孕酮 IUD（OR 1.24，95%CI 1.08-1.44）、EE-左炔诺孕酮 COC（OR 1.18，95%CI 1.00-1.41）、EE-屈螺酮（OR 1.28，95%CI 1.00-1.67）和醋酸甲羟孕酮（OR 1.38，95%CI 1.12-1.70）。去氧孕烯的使用则表现出保护作用（OR 0.83，95%CI 0.73-0.95）。当以 EE-左炔诺孕酮 COC 作为对照时，去氧孕烯使用者表现出保护作用（OR 0.70，95%CI 0.57-0.87），而其他避孕药与 SD 之间的关联没有统计学差异。
本研究发现 SD 患者中左炔诺孕酮（COC 和 IUD）、屈螺酮和醋酸甲羟孕酮的使用有所增加。与口服左炔诺孕酮相比，这些避孕药的风险没有差异。药物制剂之间的关联规模较小且无差异表明孕激素避孕药对性功能障碍的影响很小。
