ESSM Newsletter # 40

13 ESSM Today Cardiomatebolic risk and female sexual dysfunction: A gender issue sexual response and cardiometabolic risk profile. Considered the reduced incidence of CV events in women compared to men up to the age of menopause, it has long been considered that endogenous estrogens exert a protective effect on the CV apparatus in contrast to androgens. However, the influence of these hormones is more complex and involves a multitude of bio- logical processes. The milder association between FSD and CV determinants in women compared with men might be related also to sex differences in the CV system and/or in the pathogenic mechanisms leading to CVD. Although women and men share most of the classic risk factors, the relative weighting of these in the pathogenesis of CVD can differ. Many risk factors (like smoking habit, DM and MetS) seems to take a greater CVD risk in women than in men but CVD in women is often under-recognized, leading to less aggressive treatment strategies and lower representation of women in clinical trials. Methods to investigate peripheral vascular changes The physiologic component of the female sexual response is typically quantified by measuring blood flow change within the genital and pel- vic regions. Validated assessment techniques of vascular changes in female genitalia include indirect measures of heat dissipation, vaginal photoplethysmography and CDU. Specifically, CDU is the most recently introduced validated technique in the field and represents a quick and non-invasive tool that allows for continuous real-time assessment of anatomic and vaso- congestive components of the female genitalia. Recently, clitoral PI has been further investigated in a study enrolling 71 women with FSD, which aimed to analyze the associations between ba- sal clitoral vascularization and cardiometabolic risk factors. Notably, clitoral PI was significantly correlated with MetS (in particular Insulin Resist- ance), number of MetS components and obesity, independently of age, smoking habit and years of menopause; women with a higher PI, and, hence, with greater clitoral vascular resistance, reported a decreased subjective sexual arousal. According to these findings, CDU might be pro- posed as a reliable method of inquiry into the cardiometabolic correlates of FSD. Conclusions In women, cardiometabolic risk factor show a milder association with sexual dysfunction and FSD is far from being fully recognized as an independent marker of increased CV risk. To overcome gender-differences on this issue, the female genital vascular district should be ex- tensively assessed with objective, standardized and validated methods. CDU appears a promis- ing technique but further study are necessary to establish normative values. Longitudinal in- tervention trials on the effect of the treatment of CV risk factors on FSD also are urgently needed. References Elraiyah T, Sonbol MB, Wang Z et al. Clini- cal review: The benefits and harms of systemic testosterone therapy in post- menopausalwomen with normal adrenal function: A systematic review and meta- analysis. J Clin Endocrinol Metab. 2014 Oct;99(10):3543-50. Maseroli E, Fanni E, Cipriani S et al. Cardio- metabolic risk and female sexuality: Focus on clitoral vascular resistance. J Sex Med. 2016 Nov;13(11):1651-1661. Maseroli E, Scavello I, Vignozzi L. Cardiometa- bolic risk and female sexuality-part I. Risk factors and potential pathophysiological un- derpinnings for female vasculogenic sexual dysfunction syndromes. Sex Med Rev. 2018 May 2. pii: S2050-0521(18)30045-3. Maseroli E, Scavello I, Vignozzi L. Cardiometa- bolic risk and female sexuality-part II. Understanding (and overcoming) gender differences: The key role of an adequate methodological approach. Sex Med Rev. 2018 Apr 13. pii: S2050-0521(18)30044-1. Park K, Goldstein I, Andry C et al. Vascu- logenic female sexual dysfunction: The hemodynamic basis for vaginal engorge- ment insufficiency and clitoral erec- tile insufficiency. Int J Impot Res. 1997 Mar;9(1):27-37. Take your Chance – Become a Member of ESSM, now ! See application form on page 27.