Effect of hormone replacement therapy on clitoral artery blood flow in healthy postmenopausal women

Introduction. Aging and the decline of ovarian hormonal secretion during menopause may alter libido, and sexual response and functioning. The effects of hormone replacement therapy (HRT) on the genital vascular hemodynamics have been widely studied. However, there is a lack of knowledge about the effect of HRT on basal clitorial blood flow. Aim. The aims of this study were to measure clitoral artery blood flow and to determine whether HRT has a significant effect in clitoral artery blood flow in postmenopausal women. Methods. Doppler sonography of clitoral arteries was performed in 25 postmenopausal women aged 51.3 +/- 4.5 years who had been using a continuous combined HRT (0.625 mg of conjugated equine estrogens plus 2.5 mg medroxyprogesterone acetate, in 1 tablet daily) for 2.0 +/- 1.1 years, and the clitoral artery peak systolic velocity, resistance index (RI) , and pulsatility index (PI) were measured. Thirty-five postmenopausal women aged 50.0 +/- 4.2 years who had not used HRT served as a control group. Main Outcome Measures. Assessment of clitoral blood flow with color Doppler ultrasonography by measuring the peak systolic velocity, RI, and PI. Results. Clitoral artery circulation was easily detectable by the color Doppler sonography. The clitoral artery peak systolic velocities were significantly higher in postmenopausal women taking HRT compared with the control group (11.8 +/- 5.2 cm/second vs. 15.0 +/- 5.4 cm/second, P = 0.025). Conclusion. HRT improves blood flow to the clitoris. A clitoris blood flow evaluation may be proposed as a potential tool to assess the impact of HRT on the genital tissues and to investigate female sexual response disorders in postmenopausal women.