Elsevier

Sexual Medicine Reviews

Volume 6, Issue 4, October 2018, Pages 508-524
Sexual Medicine Reviews

Review
Cardiometabolic Risk and Female Sexuality—Part I. Risk Factors and Potential Pathophysiological Underpinnings for Female Vasculogenic Sexual Dysfunction Syndromes

https://doi.org/10.1016/j.sxmr.2018.02.009Get rights and content

Abstract

Introduction

Erectile dysfunction is recognized as an opportunity for preventing cardiovascular (CV) events, and assessing the impairment of penile vascular flow by Doppler ultrasound is an important tool to ascertain CV risk. Conversely, the role of genital vascular impairment in the pathophysiology of female sexual dysfunction (FSD) remains contentious.

Aim

To focus on the current scientific support for an association between CV risk factors and female sexual health in the 1st part of a 2-part review.

Methods

A thorough literature search of peer-reviewed publications on the associations between CV risk factors and FSD and their underlying mechanisms was performed using the PubMed database.

Main Outcome Measures

We present a summary of the evidence from clinical studies and discuss the possible mechanisms providing the pathophysiologic bases of vasculogenic FSD syndromes.

Results

The peripheral sexual response in women is a vascular-dependent event, and evidence suggests that cardiometabolic-related perturbations in endothelial function can determine vascular insufficiency in female genital tissues. Although epidemiologic and observational studies demonstrate that the prevalence of FSD is higher in women with diabetes mellitus, a cause-effect relation between these clinical conditions cannot be assumed. Evidence on the effect of obesity, metabolic syndrome, and polycystic ovary syndrome on sexual function in women is controversial. Data on the associations of dyslipidemia and hypertension with FSD are limited.

Conclusion

Common cardiometabolic alterations could affect vascular function in the female genital tract. Based on limited data, there is an association between CV risk factors and female sexual health in women; however, this association appears milder than in men.

Maseroli E, Scavello I, Vignozzi L. Cardiometabolic Risk and Female Sexuality—Part I. Risk Factors and Potential Pathophysiological Underpinnings for Female Vasculogenic Sexual Dysfunction Syndromes. Sex Med Rev 2018;6:508–524.

Introduction

Despite increasing attention to the topic, female sexual dysfunction (FSD) remains a poorly studied and underdiagnosed condition. The multidimensionality of the disorder, the lack of universally accepted diagnostic procedures, the ever-changing definitions, and the different populations from which samples for epidemiologic studies are drawn result in a poor number of data establishing worldwide prevalence and risk factors for FSD. According to the Fourth International Consultation on Sexual Medicine 2015, there appears to be reasonable consensus that the prevalence of women who report at least 1 manifest FSD is approximately 40% to 50%, irrespective of age.1

For risk factors, the debate on the relative influences of sociocultural, psychological, relational, and biologic parameters on female sexuality continues. Compared with male sexuality, biologic determinants of female sexual response, in particular cardiovascular (CV) risk factors, have received scant attention. Erectile dysfunction (ED) is considered a harbinger for CV disease (CVD) and has been claimed as providing a “window of curability” in men to perform the requisite CV risk assessment. This stems from clinical and preclinical evidence that ED is predominantly a disease of vascular origin, with endothelial dysfunction as the unifying link. In contrast, although preclinical data and many sexual similarities suggest a close link between sexuality and CVD in women, definitive clinical evidence of this association is lacking. More importantly, the role of CVD-related genital vascular impairment in the pathophysiology of FSD remains contentious. A still unanswered question is whether sexual health can be a proxy for CV health in women.

This is the 1st part of a state-of-the-art review that focuses on the current scientific support for an association between CV risk factors and female sexual health. In the 2nd part, the potential reasons for the apparent sexual dimorphism in vasculogenic sexual dysfunction are reviewed, with a focus on available assessment techniques and suggested areas and methods for future investigation.

Section snippets

Diabetes Mellitus

Diabetes mellitus (DM) is the most-studied metabolic risk factor for FSD in women. Its prevalence has reached epidemic proportions: in 2013, the number of patients with DM was estimated to be roughly 382 million worldwide, with numbers predicted to reach approximately 600 million by 2035.2 In men, DM has long been recognized as a major risk factor not only for ED but also for ejaculatory, orgasmic, and desire problems.3, 4, 5 Interestingly, DM affects more women than men, and they share similar

Proposed Mechanisms Providing the Pathophysiologic Bases of Vasculogenic FSD Syndromes

As stated earlier, all these CV risk factors could affect vascular function in the genital tract in women, as observed in men. Vascular insufficiency states are universally associated with countless organ and system disorders and with arousal disorders in men. It is only in the past 2 decades that organic FSD has been speculated to be related in part to vasculogenic impairment of the hypogastric vaginal and clitoral arterial bed.114 The peripheral sexual response in women is manifested by

Additional Biologic Modulators of the Relation Between Cardiometabolic Risk and the Female Sexual Response

Adding another layer to the complexity of this issue, it should be recognized that factors other than metabolic factors might play a role in the link between FSD and CVD: sex steroid alterations and/or aging.

Conclusions

The peripheral sexual response in women is a vascular-dependent event, and evidence suggests that cardiometabolic-related perturbations in endothelial function can determine vascular insufficiency in female genital tissues. Moreover, based on limited clinical data, there appears to be an association between common cardiometabolic risk factors (DM, dyslipidemia, hypertension, obesity, and MetS) and sexual health in women; however, this association appears milder than in men.

In the 2nd part of

Statement of authorship

Category 1

  1. (a)

    Conception and Design

    • Elisa Maseroli; Irene Scavello; Linda Vignozzi

  2. (b)

    Acquisition of Data

    • Not applicable

  3. (c)

    Analysis and Interpretation of Data

    • Elisa Maseroli; Linda Vignozzi

Category 2
  1. (a)

    Drafting the Article

    • Elisa Maseroli; Irene Scavello; Linda Vignozzi

  2. (b)

    Revising It for Intellectual Content

    • Elisa Maseroli; Linda Vignozzi

Category 3
  1. (a)

    Final Approval of the Completed Article

    • Elisa Maseroli; Irene Scavello; Linda Vignozzi

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    Conflicts of Interest: None.

    Funding: None.

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