Clitoral circulation in postmenopausal women with sexual dysfunction: A pilot randomized study with hormone therapy

The aim of the present pilot, randomized, study was to assess hemodynamic status of clitoral erectile tissues in postmenopausal women reporting female sexual dysfunction (FSD), namely libido and arousal disorders, under hormone therapy (HT). Vaginal health and sexual function were also investigated. Fifty patients presenting for clinical evaluation of menopausal status and suffering from FSD were randomly assigned to receive tibolone (2.5 mg) or 1 mg 17β-estradiol .5 mg NETA (EPT) for 6 months. The observational period lasted 7 months during which women underwent to duplex Doppler ultrasonography to obtain clitoral hemodynamic data, were evaluated by using the vaginal health score index (VHIS) and filled in the two-factor Italian McCoy female sexuality questionnaire (MFSQ). Tibolone significantly increased clitoral peak systolic and end diastolic velocity ( p < .001 for both), while no significant difference was evident in clitoral circulation of women under EPT at the end of the study. Both tibolone and EPT significantly increased VHIS ( p < .001), an effect already evident following 3 months of HT. The atrophic state was significantly improved at 6 months ( p < .001) with no significant differences between the two HT regimens. After 3 months, both tibolone and EPT significantly increased the sexuality score ( p < .001, for both), but such an effect was significantly more pronounced in FSD women treated with tibolone in comparison with those assuming EPT ( p < .002). Between the 3rd and the 6th month, tibolone caused a further significant improvement of sexuality score ( p < .001), while women under EPT did not show any significant further change displaying a lower score ( p < .001) at the end of the study in comparison with women assuming tibolone. Clitoral circulation in postmenopausal women reporting FSD is significantly increased under tibolone in comparison with EPT with a better improvement of sexual function, as measured by MFSQ, following 6 months of treatment.