Department of General Surgery and Medical Surgical Specialties, Gynecological Clinic, Research Group for Sexology, University of Catania, Catania, Italy.
Department of General Surgery and Medical Surgical Specialties, Gynecological Clinic, Research Group for Sexology, University of Catania, Catania, Italy.
J Sex Med. 2019 Mar;16(3):375-382. doi: 10.1016/j.jsxm.2019.01.003. Epub 2019 Feb 14.
The effects of phosphodiesterase-type 5 (PDE5) inhibitors on the in vivo clitoral structure of women with diabetes have never been investigated.
To study the in vivo structural and hemodynamic changes of the clitoris in premenopausal women with type 1 diabetes on PDE5 inhibitors.
38 premenopausal women with type 1 diabetes aged 36 -46 years. A randomized 1:1 study design was used: Study Group (group A) on Tadalafil 5 mg daily, and control group (group B). Blood samples were taken from each woman to measure HbA1c, testosterone, and Free Androgen Index. The women underwent microbiopsy of the clitoral body by means of semiautomatic gun during total anesthesia for surgery therapy of a benign gynecological pathology. The tissue removed was processed for electron microscopy. Translabial color Doppler ultrasound was used to measure the peak systolic velocity (PSV), the end diastolic velocity (EDV), and the pulsatility index (PI) of clitoral arteries.
Micro-ultrastructure observation of clitoral tissue and color Doppler sonography of clitoral blood flow.
Of the 38 women, 13 (68.4%) of group A and 15 (78.9%) of group B completed the study. Group A showed a mean PSV and EDV increase, and a mean PI decrease with respect to baseline (P < .001). Group B did not show any change in both the parameters (P = NS). By a quantitative study in both groups a variable degree of ultrastructural abnormalities of smooth muscle cells (SMCs) was observed, consisting in increased glycogen and lipoic deposits, cytoplasmic vacuoles, and focal increase of electron density of SMCs. Moreover, the mean SMC thickness of group A (1.83 ± 0.68 µm) was larger than that of group B (1.3 ± 0.41 µm) (P = .02).
PDE5 inhibitors could be used to treat diabetic women with genital arousal disorder.
STRENGTHS & LIMITATIONS: The study shows a clear effect of PDE5 inhibitors on clitoral SMCs. However, a limit was to not have investigated the sexual function/behavior of women of both groups, this was because of the short time of the study.
This study could help to understand in what way PDE5 inhibitors act on the ultrastructural pathophysiological clitoral cavernous tissue of women with diabetes. It could support PDE5 inhibitor usage in women with genital sexual arousal disorder due to metabolic diseases. Caruso S, Cianci A, Cianci S, et al. Ultrastructural Study of Clitoral Cavernous Tissue and Clitoral Blood Flow From Type 1 Diabetic Premenopausal Women on Phosphodiesterase-5 Inhibitor. J Sex Med 2019;16:375-382.
磷酸二酯酶 5（PDE5）抑制剂对糖尿病女性体内阴蒂结构的影响从未被研究过。
研究 1 型糖尿病绝经前女性服用 PDE5 抑制剂后阴蒂的结构和血流动力学变化。
38 名年龄在 36-46 岁的 1 型糖尿病绝经前妇女。采用随机 1:1 研究设计：研究组（A 组）每日服用他达拉非 5mg，对照组（B 组）。从每位女性采集血样，以测量 HbA1c、睾酮和游离雄激素指数。在进行良性妇科疾病手术治疗的全身麻醉期间，女性通过半自动枪对阴蒂体进行微生物活检。切除的组织进行电子显微镜处理。经阴道彩色多谱勒超声测量阴蒂动脉的收缩期峰值速度（PSV）、舒张末期速度（EDV）和搏动指数（PI）。
阴蒂组织的微观超结构观察和阴蒂血流的彩色多谱勒超声。
38 名女性中，A 组 13 名（68.4%）和 B 组 15 名（78.9%）完成了研究。A 组的 PSV 和 EDV 均值增加，PI 均值降低（P<0.001）。B 组两个参数均无变化（P=NS）。在两组的定量研究中，均观察到平滑肌细胞（SMCs）不同程度的超微结构异常，表现为糖原和硫辛酸沉积增加、细胞质空泡和 SMC 电子密度局灶性增加。此外，A 组的平均 SMC 厚度（1.83±0.68 µm）大于 B 组（1.3±0.41 µm）（P=0.02）。
PDE5 抑制剂可用于治疗患有生殖器唤醒障碍的糖尿病女性。
该研究清楚地显示了 PDE5 抑制剂对阴蒂 SMC 的作用。然而，一个局限性是没有研究两组女性的性功能/性行为，这是因为研究时间短。
本研究有助于了解 PDE5 抑制剂如何作用于糖尿病女性的超微结构病理阴蒂海绵体组织。它可以支持 PDE5 抑制剂在代谢性疾病导致女性生殖器性唤醒障碍中的应用。
