[Psychosomatic aspects of oral contraception]

Abstract

Oral contraceptive use is influenced by multiple emotional factors. Physiological and psychological effects are closely correlated. Contraception may assist women in pursuing important psychosocial goals, on the other hand, it may cause a number of problems. Many unconscious wishes or fears may interfere with the clear separation of sexuality from fertility. Ambivalence about pregnancy, neurotic personalities and problems in partner relationship may cause psychic conflicts with regard to contraception. Anxiety, side effects, misuse of contraceptives or problems in the relationship between doctor and patient may result. As a further development psychosomatic symptoms such as discomfort, nervousness, sleep disturbance, fatigue, nausea and sexual disorders may appear. The physician must take contradictory feelings of the patient into consideration, including her anxiety and her possible ambivalence with respect to pregnancy.

PIP: Oral contraceptive (OCs) which are highly effective, simple to use, and reversible, are used by 50 million women globally. In Germany 37.1% of women used them in 1985. Recently their acceptance has declined because of the fear of side effects such as cancer, thrombophlebitis, and frigidity. Other negative factors are opposition of partner, religious views, inconvenience of daily intake, negative reports from the press, discussion by family physician, and anxiety about complications in the offspring. Psychological and psychosomatic side effects very from 1% to 56%. Most are psychovegetative symptoms: headache, sweating, heart disorders, gastrointestinal tract (GI) disorders, nausea, and sleep disturbance. Psychological symptoms include increased irritability, impulsiveness, affective lability, anxiety, depressive feelings, reduced libido, and sexual disorders. Unconscious and ambivalent feelings about wanting a child and problems with the partner can result in forgetting to take the pill. Inhibitions, shame, guilt, and repressed feelings about sexuality lead to a sense of victimization in the form of pregnancy. The Catholic Church holds the view that contraception and abortion are unnatural as enunciated in a 1968 encyclical on human life. Conflicts with the partner can be resolved by compromise and by medical counseling of both parties. True psychopathological disorders have to be distinguished from the psychological problems of healthy people. The soundness of the physician-patient relationship is essential for contraceptive counseling and for resolving such conflicts.