Research Article| Volume 55, ISSUE 3, P288-295, October 20, 2006

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.

      Study design

      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.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Maturitas
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Dennerstein L.
        • Dudley E.C.
        • Hopper J.L.
        • Guthrie J.R.
        • Burger H.G.
        A prospective population-based study of menopausal symptoms.
        Obstet Gynecol. 2000; 96: 351-358
        • Dennerstein L.
        • Randolph J.
        • Taffe J.
        • Dudley E.
        • Burger H.
        Hormones, mood, sexuality, and the menopausal transition.
        Fertil Steril. 2002; 77: S42-S48
        • Laumann E.O.
        • Paik A.
        • Rosen R.C.
        Sexual dysfunction in the United States: prevalence and predictors.
        JAMA. 1999; 281: 537-544
        • Castelo-Branco C.
        • Blumel J.E.
        • Araya H.
        • et al.
        Prevalence of sexual dysfunction in a cohort of middle-aged women: influences of menopause and hormone replacement therapy.
        J Obstet Gynaecol. 2003; 23: 426-430
        • Bachmann G.A.
        • Leiblum S.R.
        Sexuality in sexagenarian women.
        Maturitas. 1991; 13: 43-50
        • Meston C.M.
        Aging and sexuality.
        West J Med. 1997; 167: 285-290
        • Berman J.R.
        • Adhikari S.P.
        • Goldstein I.
        Anatomy and physiology of female sexual function and dysfunction: classification, evaluation and treatment options.
        Eur Urol. 2000; 38: 20-29
        • Dennerstein L.
        • Lehert P.
        • Burger H.
        The relative effects of hormones and relationship factors on sexual function of women through the natural menopausal transition.
        Fertil Steril. 2005; 84: 174-180
        • Park K.
        • Goldstein I.
        • Andry C.
        • Siroky M.
        • Krane R.J.
        • Azadzoi K.
        Vasculogenic female sexual dysfunction: the hemodynamic basis for vaginal engorgement insufficiency and clitoral erectile insufficiency.
        Int J Imp Res. 1997; 9: 27-37
        • Laan E.
        • Everaerd W.
        Physiologic measures of vaginal vasocongestion.
        Int J Imp Res. 1998; 10: S107-S110
        • Berman J.R.
        • Berman L.A.
        • Werbin T.J.
        • Flaherty E.E.
        • Leahy N.M.
        • Goldstein I.
        Clinical evaluation of female sexual function: effects of age and estrogen status on subjective and physiologic sexual responses.
        Int J Impot Res. 1999; 11: S31-S38
        • Garcia S.
        • Talakoub L.
        • Maitland S.
        • Tennis A.
        • Goldstein I.
        • Munarriz R.
        Genital duplex ultrasonography before and after sexual stimulation in women with sexual dysfunction: grey scale, volumetric and hemodynamic findings.
        Fertil Steril. 2005; 83: 995-999
        • Basson R.
        Introduction to special issue on women's sexuality and outline of assessment of sexual problems.
        Menopause. 2004; 11: 709-713
        • Meston C.M.
        • Frohlich P.F.
        The neurobiology of sexual function.
        Arch Gen Psychiatry. 2000; 57: 1012-1030
        • Munarriz R.
        • Kim N.N.
        • Goldstein I.
        • Traish A.M.
        Biology of female sexual function.
        Urol Clin North Am. 2002; 29: 685-693
        • Modelska K.
        • Cummings S.
        Female sexual dysfunction in postmenopausal women: systematic review of placebo-controlled trials.
        Am J Obstet Gynecol. 2003; 188: 286-293
        • Alexander J.L.
        • Kotz K.
        • Dennerstein L.
        • Kutner S.J.
        • Wallen K.
        • Notelovitz M.
        The effects of postmenopausal hormone therapies on female sexual functioning: a review of double-blind, randomized controlled trials.
        Menopause. 2004; 11: 749-765
        • Bachmann G.A.
        • Leiblum S.R.
        The impact of hormones on menopausal sexuality: a literature review.
        Menopause. 2004; 11: 120-130
        • Davis S.
        • Tran J.
        Testosterone influences libido and well-being in women.
        Trends Endocrinol Metab. 2001; 12: 33-37
      1. Rosen, R. et al., (Eds.). Androgen Insufficiency in women: the Princeton Conference. Fertil Steril 2002; 77,Suppl 4.

        • Davis S.R.
        The effects of tibolone on mood and libido.
        Menopause. 2002; 9: 162-170
        • Nappi R.E.
        • Mancini M.
        • Veneroni F.
        • Colpi G.M.
        • Ferdeghini F.
        • Polatti F.
        Clitoral artery blood flow in healthy young women: preliminary report on menstrual cycle and hormonal contraception.
        J Sex Marital Ther. 2002; 28: S187-S193
        • Bachmann G.A.
        • Notelovitz M.
        • Kelly S.J.
        • et al.
        Long-term non-hormonal treatment of vaginal dryness.
        Clin Pract Sexuality. 1992; 8: 3-8
        • Rellini A.H.
        • Nappi R.E.
        • Vaccaro P.
        • Ferdeghini F.
        • Abbiati I.
        • Meston C.M.
        Validation of the McCoy female sexuality questionnaire in an Italian sample.
        Arch Sex Behav. 2005; 34: 641-647
        • Sarrel P.M.
        Sexuality and menopause.
        Obstet Gynecol. 1990; 75: S26-S35
        • Davis S.R.
        • Davison S.L.
        • Donath S.
        • Bell R.J.
        Circulating androgen levels and self-reported sexual function in women.
        JAMA. 2005; 294: 91-96
        • Santoro N.
        • Torrens J.
        • Crawford S.
        • et al.
        Correlates of circulating androgens in mid-life women: the study of women's health across the nation.
        J Clin Endocrinol Metab. 2005; 90: 4836-4845
        • Sarrel P.M.
        Effects of hormone replacement therapy on sexual psychophysiology and behaviour in postmenopause.
        J Womens Health Gend Based Med. 2000; 9: S25-S32
        • Nappi R.E.
        • Baldaro Verde J.
        • Polatti F.
        • Genazzani A.R.
        • Zara C.
        Self-reported sexual symptoms in women attending menopause clinics.
        J Obstet Gynecol Invest. 2002; 53: 181-187
        • Rymer J.
        • Chapman M.G.
        • Fogelman I.
        • Wilson P.O.
        A study of the effect of tibolone on the vagina in postmenopausal women.
        Maturitas. 1994; 18: 127-133
        • Genazzani A.R.
        • Petraglia F.
        • Facchinetti F.
        • et al.
        Effects of Org OD 14 on pituitary and peripheral beta-endorphin in castrated rats and post-menopausal women.
        Maturitas. 1987; 1: S35-S48
        • Doren M.
        • Rubig A.
        • Coelingh Bennink H.J.
        • Holzgreve W.
        Differential effects on the androgen status of postmenopausal women treated with tibolone and continuous combined estradiol and norethindrone acetate replacement therapy.
        Fertil Steril. 2001; 75: 554-559
        • Pluchino N.
        • Genazzani A.D.
        • Bernardi F.
        • et al.
        Tibolone, transdermal estradiol or oral estrogen-progestin therapies: effects on circulating allopregnanolone, cortisol and dehydroepiandrosterone levels.
        Gynecol Endocrinol. 2005; 20: 144-149
        • Castelo-Branco C.
        • Vicente J.J.
        • Figueras F.
        • et al.
        Comparative effects of estrogens plus androgens and tibolone on bone, lipid pattern and sexuality in postmenopausal women.
        Maturitas. 2000; 34: 161-168
        • Sarrel P.
        • Dobay B.
        • Wiita B.
        Estrogen and estrogen-androgen replacement in postmenopausal women dissatisfied with estrogen-only therapy. Sexual behavior and neuroendocrine responses.
        J Reprod Med. 1998; 43: 847-856
        • Laan E.
        • van Lunsen R.H.
        • Everaerd W.
        The effects of tibolone on vaginal blood flow, sexual desire and arousability in postmenopausal women.
        Climacteric. 2001; 4: 28-41
        • Braunstein G.D.
        • Sundwall D.A.
        • Katz M.
        • et al.
        Safety and efficacy of a testosterone patch for the treatment of hypoactive sexual desire disorder in surgically menopausal women: a randomized, placebo-controlled trial.
        Arch Intern Med. 2005; 165: 1582-1589
        • Simon J.
        • Braunstein G.
        • Nachtigall L.
        • et al.
        Testosterone patch increases sexual activity and desire in surgically menopausal women with hypoactive sexual desire disorder.
        J Clin Endocrinol Metab. 2005; 90: 5226-5233
        • Van Lunsen R.H.
        • Laan E.
        Genital vascular responsiveness and sexual feelings in midlife women: psychophysiologic, brain, and genital imaging studies.
        Menopause. 2004; 11: 741-748