The Female Sexual Functions With Progestogen-only Contraception
Condition: Female Sexual Function
Study type: Observational

Summary: 
      Female sexual dysfunction is age-related, progressive, and very common condition. The
      physiology of the female sexual function is a complex condition affected by emotional,
      medical and hormonal elements.

      Progestogen-only contraception relies on progestogens alone to achieve contraception. There
      are several progestogen only contraceptive methods include progestogen only pill (minipill),
      subdermal implants, Depo-Provera (DMPA) and levonorgestrel intrauterine system. Many studies
      in literature reported the negative effect of combined oral contraceptive pills (COCs) on
      female sexual function due to decrease in bioavailability of testosterone and increase level
      of sex hormone binding globulin (SHBG) which leads to decrease in free testosterone level
      contributes to dysfunction.

      However, the progesterone only methods contains no estrogen, so it has less effect on sex
      hormone binding globulin and therefore less effect on free testosterone. DMPA (injectable
      progestins) is an injectable progestin is a highly reliable form of contraception. Nelson in
      1996 found that about 6% of women using DMPA reported either lost or decreased libido. More
      recent study by Fortenberry in 2011 reported that DMPA had no effect on sexual interest
      compared with nonusers of any hormonal method of contraception in an adolescent population.
      The etonogestrel implant (Implanon) is a single rod that is inserted into the medial side of
      non dominant upper arm. Although in general, it is very effective and has relatively low side
      effect, a decreased libido has been noted.

      Cerazette is a progestogen-only contraceptive pill containing 75 micrograms of desogestrel.
      It acts mainly by inhibiting ovulation. Cerazette users also may complain of decreased
      libido.

      The estrogen is the main hormone which responsible for vitality of the pelvic organ
      especially the vagina. The main mechanism of action of the DMPA, Implanon and Cerazette is
      inhibition of ovulation, which leads to decrease in the estrogen level, which causes a drop
      in blood flow in uterine artery and accordingly the vagina artery. That can affect vaginal
      lubrication, causing the vagina to be too dry for comfortable sex.
    


Intervention name(s): Depot Medroxyprogesterone Acetate 150 mg; Implanon( 68 mg etonogestrel implant); Cerazette pills (75 micrograms desogestrel)
Intervention type(s): Drug; Drug; Drug
Intervention description(s): the DMPA user" where they are using Depot Medroxyprogesterone Acetate 150 mg (DMPA; Phrmcia) injection every 3 month; where they are using etonogestrel 68 mg implant (Implanon; Organon); where they are using desogestrel 75 micrograms (Cerazette; Organon), one pill every day for 28 days without pill-free interval.
Intervention MeSH terms: Medroxyprogesterone Acetate; Medroxyprogesterone; Desogestrel; Etonogestrel
Observational model: Other
Time perspective: Cross-Sectional
Sampling method: Probability Sample
Study population: 
        The participants will be recruited from the Outpatient Family planning Clinic of the
        Women's Health Hospital in the period between the first of November 2015 and the first of
        May 2016. All recruited women are using injectable progestin (DMPA), subdermal implant
        (Implanon) or progesterone only pills (Cerazette) for 6-12 months.