ReviewCardiometabolic Risk and Female Sexuality—Part I. Risk Factors and Potential Pathophysiological Underpinnings for Female Vasculogenic Sexual Dysfunction Syndromes
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 Conception and Design Elisa Maseroli; Irene Scavello; Linda Vignozzi
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Analysis and Interpretation of Data
Elisa Maseroli; Linda Vignozzi
- (a)
Drafting the Article
Elisa Maseroli; Irene Scavello; Linda Vignozzi
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Revising It for Intellectual Content
Elisa Maseroli; Linda Vignozzi
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Final Approval of the Completed Article
Elisa Maseroli; Irene Scavello; Linda Vignozzi
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2022, Journal of Sexual MedicineCitation Excerpt :Indeed, more than half of diabetic women have reported orgasmic problems or decreased clitoral sensitivity.72 However, it has not been elucidated whether different types of diabetes have specific effects on female sexual function, since relative data are conflicting.2 What is currently ascertained, is that diabetic women show a higher risk for FSD, as supported by a recent meta-analysis on the topic,73 with arousal and lubrication being the most impaired sexual domains.2
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Conflicts of Interest: None.
Funding: None.