PS-02-001 Cardiometabolic risk and female sexuality: Focus on clitoral vascular resistance

Abstract

... The relationship between sexual and cardiovascular health in women is not well defined. Clitoral colour Doppler ultrasound (CDU) with assessment of pulsatility index (PI), reflecting resistance to blood flow, has been proposed as an objective measurement of sexual functioning. The aim of the present study was to investigate the associations between clitoral PI and cardiometabolic risk factors, sexual and intrapsychic parameters and self-perception of body image. Seventy-one adult heterosexual women in a stable relationship attending our clinic for sexual dysfunction were consecutively recruited. Patients underwent a physical, laboratory and clitoral CDU examination, and completed the Female Sexual Function Index (FSFI), the Middlesex Hospital Questionnaire (MHQ) and the Body Uneasiness Test (BUT). Clitoral PI was positively correlated with body mass index (BMI) (r=0.441, p<0.0001), waist circumference (r=0.474, p<0.0001), glycaemia (r=0.300, p=0.029), insulin (r=0.628, p=0.002), HOMA index (r=0.605, p=0.005), triglycerides (r=0.340, p=0.011), total cholesterol (r=0.346, p=0.010) and LDL cholesterol (r=0.334, p=0.016). All the relationships, with the exception of glycaemia, retained statistical significance after adjusting for age, smoking habit and years of menopause (p<0.0001 for BMI, waist circumference and triglycerides; p<0.05 for all the other associations). At ANCOVA, after adjusting for confounders, women with obesity or metabolic syndrome (MetS) showed significantly higher PI values (F=17.79, p=0.001; F=7.37, p=0.019, for obesity and MetS, respectively). In particular, a stepwise increase of PI was found as a function of increasing MetS components (β=0.434; p=0.007). Clitoral PI was negatively associated with FSFI arousal (β=-0.321, p=0.014) and satisfaction scores (β=-0.289, p=0.026) and positively associated with somatized anxiety symptoms (MHQ-S), even after adjusting for age, smoking habit, years of menopause and current use of psychiatric medication (β=0.354, p=0.011). A positive association was also observed between PI and BUT Positive symptom distress index (PSDI) (β=0.322, p=0.039) and BUT-B dislike of womb, genitals and breast (β=0.538, p<0.0001; β=0.642, p<0.0001; β=0.549, p<0.0001, respectively). After introducing waist circumference as a further covariate, the associations between clitoral PI and BUT-PSDI, dislike of womb, genitals and breast retained statistical significance (p=0.038 for PSDI and p<0.0001 for the dislike of womb, genital and breast, respectively).