Cardiometabolic Risk and Female Sexuality: Focus on Clitoral Vascular Resistance

Abstract

Introduction The relation between sexual and cardiovascular health in women is not well defined. Clitoral color Doppler ultrasound (CDU) with assessment of the pulsatility index (PI), reflecting resistance to blood flow, has been proposed as an objective measurement of sexual functioning. Aim To investigate associations between clitoral PI and cardiometabolic risk factors, sexual and intrapsychic parameters, and self-perception of body image. Methods Seventy-one adult heterosexual women in a stable relationship attending our clinic for sexual dysfunction were consecutively recruited. Main Outcome Measures Patients underwent physical, laboratory, and clitoral color Doppler ultrasound examinations and completed the Female Sexual Function Index, the Middlesex Hospital Questionnaire, and the Body Uneasiness Test (BUT). Results Clitoral PI was positively correlated with body mass index (r = 0.441, P < .0001), waist circumference (r = 0.474, P < .0001), glycemia (r = 0.300, P = .029), insulin (r = 0.628, P = .002), homeostatic model assessment index (r = 0.605, P = .005), triglycerides (r = 0.340, P = .011), total cholesterol (r = 0.346, P = .010), and low-density lipoprotein cholesterol (r = 0.334, P = .016). All relations, with the exception of glycemia, retained statistical significance after adjusting for age, smoking habit, and years since menopause (P < .0001 for body mass index, waist circumference, and triglycerides; P < .05 for all other associations). Analysis of covariance, after adjusting for confounders, showed that women with obesity or metabolic syndrome (MetS) showed significantly higher PI values (obesity: F = 17.79, P = .001; MetS: F = 7.37, P = .019). In particular, a stepwise increase of PI was found as a function of increasing MetS components (β = 0.434, P = .007). Clitoral PI was negatively associated with Female Sexual Function Index arousal (β = −0.321, P = .014) and satisfaction (β = −0.289, P = .026) scores and positively associated with Middlesex Hospital Questionnaire somatized anxiety symptoms, even after adjusting for age, smoking habit, years since menopause, and current use of psychiatric medication (β = 0.354, P = .011). A positive association also was observed between PI and the BUT positive symptom distress index (β = 0.322, P = .039) and BUT for dislike of the womb, genitals, and breast (β = 0.538, P < .0001; β = 0.642, P < .0001; β = 0.549, P < .0001, respectively). After introducing waist circumference as another covariate, the associations between clitoral PI and the BUT positive symptom distress index and BUT dislike of the womb, genitals, and breast retained statistical significance (P = .038 for positive symptom distress index; P < .0001 for dislike of womb, genitals, and breast). Conclusion Clitoral vascular resistance is positively associated with MetS (in particular insulin resistance), decreased sexual arousal, body image concerns, and increased somatized anxiety symptoms. Further studies are needed to establish whether treatment of metabolic abnormalities might improve clitoral color Doppler ultrasound indices and sexual outcomes.

Cycling and Female Sexual and Urinary Function: Results From a Large, Multinational, Cross-Sectional Study

“…These null findings may potentially be explained by the cardiovascular benefits of cycling, which may promote sexual health by improving blood flow. 21 Cyclists were more sexually active than non-cyclists, and thus, the protective effect was attenuated in the adjusted analysis. The prevalence of sexual dysfunction in our study was high among all athletic groups (FSFI score average among sexually active women was 26.5), yet these averages mirror those findings in a nationally representative sample of women in the United States (FSFI score average 27.3e28.5).…”

Association between type 1 diabetes and female sexual dysfunction

“…Diabetes is associated with tissue hypotrophy and sensitivity impairment, as a consequence of the synergetic effects of vasculopathy and neuropathy [7,8]. Interestingly, a positive association between clitoral vascular resistance (assessed by clitoral ecocolorDoppler ultrasound) and metabolic syndrome (mainly insulin resistance) with decreased sexual arousal, body image concerns, and increased somatised anxiety symptoms was also reported [9].…”

Addressing Female Genital Mutilation/Cutting (FGM/C) in the Era of Clitoral Reconstruction: Plastic Surgery

“…Engorgement of the clitoral tissue is seen as a prerequisite for orgasm due to the stimuli of the clitoris [ 12 ] and, when impaired, can have a significant impact on sexual function. This has been shown in women with atherosclerosis and metabolic syndrome with color Doppler ultrasound [ 12 , 48 , 49 ]. The remaining clitoral tissue of women subjected to FGM/C is often embedded in scar tissue, retracted to the pubic bone [ 3 ].…”