Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Association between clitoral tissue perfusion and female sexual dysfunction in healthy women of reproductive age: a pilot study

Abstract

The impact of abnormalities in the vascular bed of the external genitalia and vagina on female sexuality is not well defined because of some methodological difficulties in correctly assessing vascular changes of genitalia in women. Transmucosal oxygen tension (TmPO2) represents a precise measure of oxygen partial pressure at the clitoris surface and is expression of clitoral tissue perfusion. Aim of the study was to correlate TmPO2 with female sexual dysfunction (FSD) in healthy women in order to evaluate the impact of clitoral vascularization on female sexual health. Twenty-seven healthy, heterosexual, and sexually active women of reproductive age (mean age: 31.18 ± 4.71) were enrolled in the study. TmPO2 was assessed in every woman. In addition, all the women filled out the Female sexual function index (FSFI). After adjustment for some covariates (age, BMI, and smoking), TmPO2 significantly correlated with FSFI total score (r = 0.4261; p = 0.0379) and with arousal (r = 0.3239; p = 0.0390), lubrication (r = 0.4345; p = 0.0339), orgasm (r = 0.4092; p = 0.0471), and satisfaction (r = 0.4456; p = 0.0291) scores. In addition, TmPO2 was significantly lower in the FSD than in the NO FSD group (28.4 ± 14.5 versus 48.1 ± 25.1 mmHg; p = 0.0416). This study first shows that in healthy women of reproductive age clitoral tissue perfusion, as assessed by TmPO2, correlates very well with FSD and in particular with arousal, lubrication, orgasm, and satisfaction. Further studies should confirm our data and test TmPO2 as potential predictor for cardiovascular disease and metabolic conditions in women.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

References

  1. 1.

    Maseroli E, Scavello I, Vignozzi L. Cardiometabolic risk and female sexuality–Part I. Factors and potential pathophysiological underpinnings for female vasculogenic sexual dysfunction syndromes. Sex Med Rev. 2018;6:508–24.

    Article  Google Scholar 

  2. 2.

    Maiorino MI, Bellastella G, Esposito K. Diabetes and sexual dysfunction: current perspectives. Diabetes Metab Syndr Obes. 2014;7:95–105.

    PubMed  PubMed Central  Google Scholar 

  3. 3.

    Goldstein I, Berman JR. Vasculogenic female sexual dysfunction: vaginal engorgement and clitoral erectile insufficiency syndromes. Int J Impot Res. 1998;10:S84–9.

    PubMed  Google Scholar 

  4. 4.

    Maiorino MI, Bellastella G, Giugliano D, Esposito K. From inflammation to sexual dysfunctions: a journey through diabetes, obesity, and metabolic syndrome. J Endocrinol Investig. 2018;41:1249–58.

    CAS  Article  Google Scholar 

  5. 5.

    Gazzaruso C, Coppola A, Giustina A. Erectile dysfunction and coronary artery disease in patients with diabetes. Curr Diabetes Rev. 2011;7:143–7.

    Article  Google Scholar 

  6. 6.

    Maseroli E, Scavello I, Vignozzi L. Cardiometabolic risk and female sexuality–Part II- Understanding (and overcoming) gender differences: the key role of an adequate methodological approach. Sex Med Rev. 2018;6:525–34.

    Article  Google Scholar 

  7. 7.

    Rother U, Lang W. Noninvasive measurements of tissue perfusion in critical limb ischemia. Gefasschirurgie. 2018;23(Suppl 1):8–12.

    CAS  Article  Google Scholar 

  8. 8.

    Coppola A, Montalcini T, Gallotti P, Luzi L, Pujia A, Giustina A, et al. Transmucosal oxygen tension of the clitoris: a new parameter for future investigations of the sexual, metabolic, and cardiovascular health of women. Endocrine. 2019;63:177–81.

    CAS  Article  Google Scholar 

  9. 9.

    Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsign R, et al. The female sexual function index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marit Ther. 2000;26:191–208.

    CAS  Article  Google Scholar 

  10. 10.

    Wiegel M, Meston C, Rosen R. The female sexual function index (FSFI): cross-validation and development of clinical cutoff scores. J Sex Marital Ther. 2005;31:1–20.

    Article  Google Scholar 

  11. 11.

    Caruso S, Rugolo S, Mirabella D, Intelisano G, Di Mari L, Cianci A. Changes in clitoral blood flow in premenopausal women affected by type 1 diabetes after single 100-mg administration of sildenafil. Urology. 2006;68:161–5.

    Article  Google Scholar 

  12. 12.

    Battaglia C, Morotti E, Persico N, Battaglia B, Busacchi P, Casadio P, et al. Clitoral vascularization and sexual behavior in young patients treated with drospirenone-ethinyl estradiol or contraceptive vaginal ring: a prospective, randomized, pilot study. J Sex Med. 2014;11:471–80.

    CAS  Article  Google Scholar 

  13. 13.

    Gazzaruso C, Coppola A, Falcone C, Luppi C, Montalcini T, Baffero E, et al. Transcutaneous oxygen tension as a potential predictor of cardiovascular events in type 2 diabetes: comparison with ankle-brachial index. Diabetes Care. 2013;36:1720–5.

    CAS  Article  Google Scholar 

  14. 14.

    Gazzaruso C, Coppola A, Montalcini T, Baffero E, Garzaniti A, Pelissero G, et al. Lipoprotein(a) and homocysteine as genetic risk factors for vascular and neuropathic diabetic foot in type 2 diabetes mellitus. Endocrine . 2012;41:89–95.

    CAS  Article  Google Scholar 

  15. 15.

    Gandaglia G, Briganti A, Jackson G, Kloner RA, Montorsi F, Montorsi P, et al. A systematic review of the association between erectile dysfunction and cardiovascular disease. Eur Urol. 2014;65:968–78.

    Article  Google Scholar 

  16. 16.

    Gazzaruso C, Pujia A, Solerte SB, Amici ED, Emanuele E, Falcone C, et al. Erectile dysfunction and angiographic extent of coronary artery disease in type II diabetic patients. Int J Impot Res. 2006;18:311–5.

    CAS  Article  Google Scholar 

  17. 17.

    Gazzaruso C, Solerte SB, Pujia A, Coppola A, Vezzoli M, Salvucci F, et al. Erectile dysfunction as a predictor of cardiovascular events and death in diabetic patients with angiographically proven asymptomatic coronary artery disease: a potential protective role for statins and 5-phosphodiesterase inhibitors. J Am Coll Cardiol. 2008;51:2040–4.

    Article  Google Scholar 

  18. 18.

    Gazzaruso C, Coppola A, Pujia A, Falcone C, Collaviti S, Fodaro M, et al. Erectile dysfunction as a predictor of asymptomatic coronary artery disease in elderly men with type 2 diabetes. J Geriatr Cardiol. 2016;13:552–6.

    PubMed  PubMed Central  Google Scholar 

  19. 19.

    Gazzaruso C, Coppola A, Montalcini T, Valenti C, Garzaniti A, Pelissero G, et al. Erectile dysfunction can improve the effectiveness of the current guidelines for the screening for asymptomatic coronary artery disease in diabetes. Endocrine. 2011;40:273–9.

    CAS  Article  Google Scholar 

  20. 20.

    Coppola A, Sasso L, Bagnasco A, Giustina A, Gazzaruso C. The role of patient education in the prevention and management of type 2 diabetes: an overview. Endocrine. 2016;53:18–27.

    CAS  Article  Google Scholar 

  21. 21.

    Gazzaruso C, Coppola A, Montalcini T, Valenti C, Pelissero G, Solerte SB, et al. Screening for asymptomatic coronary artery disease can reduce cardiovascular mortality and morbidity in type 2 diabetic patients. Intern Emerg Med. 2012;7:257–66.

    Article  Google Scholar 

  22. 22.

    Owiredu WKBA, Alidu H, Amidu N, Obirikorang C, Gyasi-Sarpong CK, Bawah AT, et al. Sexual dysfunction among diabetics and its impact on the SQoL of their partners. Int J Impot Res. 2017;29:250–7.

    CAS  Article  Google Scholar 

  23. 23.

    Rabiepoor S, Khalkhali HR, Sadeghi E. What kind of sexual dysfunction is most common among overweight and obese women in reproductive age? Int J Impot Res. 2017;29:61–4.

    CAS  Article  Google Scholar 

  24. 24.

    Alidu H, Owiredu WKBA, Amidu N, Gyasi-Sarpong CK, Dapare PPM, Bawah AT, et al. Hypertension and obesity comorbidities increases coronary risk, affects domains of sexual function and sexual quality of life. Int J Impot Res. 2018;30:8–13.

    CAS  Article  Google Scholar 

  25. 25.

    Gazzaruso C, Coppola A, Montalcini T, Falcone C. Anti-diabetic agents and heart health: how to use new diabetes medications in a global strategy for the prevention of cardiovascular complications in type 2 diabetes. Ann Transl Med. 2018;6:195. 2018

    Article  Google Scholar 

  26. 26.

    Gazzaruso C, Solerte SB, De Amici E, Mancini M, Pujia A, Fratino P, et al. Association of the metabolic syndrome and insulin resistance with silent myocardial ischemia in patients with type 2 diabetes mellitus. Am J Cardiol. 2006;97:236–9.

    CAS  Article  Google Scholar 

  27. 27.

    Esposito K, Giugliano F, Martedì E, Feola G, Marfella R, D’Armiento M, et al. High proportions of erectile dysfunction in men with the metabolic syndrome. Diabetes Care. 2005;28:1201–3.

    Article  Google Scholar 

  28. 28.

    Battaglia C, Battaglia B, Mancini F, Persico N, Nappi RE, Paradisi R, et al. Cigarette smoking decreases the genital vascularization in young healthy, eumenorrheic women. J Sex Med. 2011;8:1717–25.

    Article  Google Scholar 

  29. 29.

    Battaglia C, Battaglia B, Mancini F, Nappi RE, Paradisi R, Venturoli S. Moderate alcohol intake, genital vascularization, and sexuality in young, healthy, eumenorrheic women. A pilot study. J Sex Med. 2011;8:2334–43.

    Article  Google Scholar 

  30. 30.

    Maseroli E, Fanni E, Cipriani S, Scavello I, Pampaloni F, Battaglia C, et al. Cardiometabolic risk and female sexuality: focus on clitoral vascular resistance. J Sex Med. 2016;13:1651–61.

    Article  Google Scholar 

  31. 31.

    Caruso S, Cicero C, Romano M, Lo Presti L, Ventura B, Malandrino C. Tadalafil 5 mg daily treatment for type 1 diabetic premenopausal women affected by sexual genital arousal disorder. J Sex Med. 2012;9:2057–65.

    CAS  Article  Google Scholar 

  32. 32.

    Goldstein SW, Gonzalez JR, Gagnon C, Goldstein I. Peripheral female genital arousal as assessed by thermography following topical genital application of alprostadil vs placebo arousal gel: a proof-of-principle study without visual sexual stimulation. Sex Med. 2016;4:e166–75.

    Article  Google Scholar 

Download references

Funding

This study was funded by the Istituto Clinico Beato Matteo, Vigevano (current research).

Author information

Affiliations

Authors

Corresponding author

Correspondence to Carmine Gazzaruso.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Coppola, A., Gallotti, P., Choussos, D. et al. Association between clitoral tissue perfusion and female sexual dysfunction in healthy women of reproductive age: a pilot study. Int J Impot Res 32, 221–225 (2020). https://doi.org/10.1038/s41443-019-0155-6

Download citation

Search

Quick links