The role of 3-D ultrasonography in the evaluation of menstrual cycle-related vascular modifications of the clitoris. A prospective pilot study

SHBG as a Marker of NAFLD and Metabolic Impairments in Women Referred for Oligomenorrhea and/or Hirsutism and in Women With Sexual Dysfunction

PCOS is one of the most common endocrine disorders and NAFLD is one of its most dangerous metabolic consequences. The diagnosis of NAFLD is not a practical task and the condition is at risk of being overlooked. The use of simpler but still reliable surrogate markers is necessary to identify women with a high likelihood of NAFLD. The aim of this study was to evaluate the clinical correlates of NAFLD Liver Fat Score (NAFLD-LFS) in women with oligomenorrhea and/or hirsutism. Furthermore, the study aimed to evaluate whether, among the hormonal parameters evaluated in such women, possible hallmarks of NAFLD may be identified. To this purpose, 66 women who attended our Outpatient Clinic for oligomenorrhea and/or hyperandrogenism were included in the study. In order to validate the results obtained in the first cohort, a second independent sample of 233 women evaluated for female sexual dysfunction (FSD) was analyzed. In cohort 1, NAFLD-LFS positively correlated with metabolic and inflammatory parameters. Among the hormone parameters, NAFLD-LFS showed no significant relationships with androgens but a significant negative correlation with SHBG (p<0.0001) that therefore appeared as a candidate hallmark for pathologic NAFLD-LFS. The ROC analysis showed a significant accuracy (81.1%, C.I.69.1-93.0, p <0.0001) for SHBG in identifying women with a pathological NAFLD-LFS. In particular, a SHBG 33.4 nmol/l was recognized as the best threshold, with a sensitivity of 73.3% and a specificity of 70.7%. In order to validate this SHBG as a marker of metabolic impairment possible related with the presence of NAFLD, we tested this threshold in cohort 2. FSD women with SHBG <33.4 nmol/l had worse metabolic parameters than women with SHBG ≥33.4 nmol/l and a significantly higher NAFLD-LFS even after adjusting for confounders (B=4.18 [2.05; 6.31], p=0.001). In conclusion, this study provides a new evidence in the diagnostic process of NAFLD, showing that the measurement of SHBG, which is routinely assessed in the workup of women referred for possible PCOS, could identify women at higher metabolic risk, thus detecting those who may deserve further targeted diagnostic assessment.

Three-dimensional imaging of living transplanted kidney vasculature by 3D color Doppler ultrasonography

Background: It is of clinical importance to display the vasculature of transplanted kidney in three-dimensional (3D) and in non-invasive way. 3D color Doppler ultrasonographic imaging (3D-CDUI) is a non-invasive technique to display the 3D vasculature of living organs. Objective: Probe into characteristics of 3D vasculature of living transplanted kidney by 3D-CDUI, and evaluate the clinical value of 3D-CDUI on monitoring complications after operation of renal transplant. Methods: Nine patients who received allogeneic transplantation of kidney were monitored with 3D-CDUI. The instruments used included ACUSON Sequoia 512 and TomTec computer station of 3D-CDUI. Using magnetic positioning free-hand scanning, the 3D reconstruction and display of renal tissue structure and blood flow were performed off-line. Results: All patients underwent 3D-CDUI examinations without any side effect or complication. When acute rejection occurred, the 3D distribution change of renal blood flow signal could be observed clearly. During treatment of acute necrosis of renal tubules, changes of renal blood flow signal in 3D color Doppler images could be detected earlier compared with 2D color Doppler images. The position of embolized vassels could be diagnosed accurately by 3D-CDUI. Conclusion: The 3D-CDUI was helpful to improve diagnosis level of ultrasonography by monitoring complications after renal transplantation.

Weight gain, body image and sexual function in young patients treated with contraceptive vaginal ring. A prospective pilot study

INTRODUCTION

Oral contraceptives could induce mood changes. As far as our knowledge, there are no studies in literature that have examined the role of vaginal contraception in self-perceived body image.

AIM

To evaluate the effects of intravaginal contraception on weight gain and perceived body image in relation with the Beck's Depression Inventory questionnaire (BDI) and the McCoy Female Sexuality Questionnaire (MFSQ).

METHODS

Twenty-one adult (18-35 years old) eumenorrheic (menstrual cycle of 25-35 days), lean (body mass index - BMI - of 19-25 kg/m²) women who were referred for hormonal contraception were administered the Stunkard Figure Rating Scale (FRS), BDI and MFSQ. Subjects were studied in basal condition and after 6 months of therapy with vaginal contraception (NuvaRing®; Organon-Schering-Plough Italia, Milan, Italy).

MAIN OUTCOME MEASURES

BMI, FRS, MFSQ and BDI.

RESULTS

After 6 months of therapy with NuvaRing®, both body weight (60.0 ± 8.3; p = 0.050) and BMI (22.1 ± 3.1; p = 0.028) slightly, but statistically, increased. FRS and BDI showed no differences after the vaginal contraception. Hormonal contraception was associated with a significant decrease in the two-factor Italian MFSQ score.

CONCLUSIONS

Vaginal ring seems a good alternative to other hormonal contraceptive not significantly altering the female sexuality and not influencing the FRS and BDI.

Clitoral vascularization and sexual behavior in young patients treated with drospirenone-ethinyl estradiol or contraceptive vaginal ring: a prospective, randomized, pilot study

INTRODUCTION

Oral contraceptives (OC) are effective for birth control and have good cycle control and tolerability. However, the hormonal components could modify mood and libido.

AIM

The aim of this study is to evaluate the genital vascular effects and sexual behavior of an OC containing 30 μg ethinyl estradiol and 3 mg drospirenone in comparison with a flexible combined contraceptive vaginal ring.

METHODS

Forty women underwent a sonographic assessment of the clitoral anatomy and vascularization and were administered the McCoy Female Sexuality Questionnaire (MFSQ) and the Beck's Depression Inventory questionnaire (BDI). Estradiol, androstenedione, testosterone, and SHBG were assayed. Free Androgen Index (FAI) and Free Estrogen Index (FEI) were calculated. The patients were randomly submitted to OC (group I; n = 21) or vaginal ring (group II; n = 19).

MAIN OUTCOME MEASURES

Ultrasonographic clitoral volume, pulsatility index (PI) of dorsal clitoral arteries, MFSQ, BDI, and hormonal and biochemical assays were analyzed.

RESULTS

After therapy, the testosterone levels were reduced in both groups, whereas estradiol decreased only in group I women. The SHBG increased in all the subjects, and both FAI and FEI decreased. The clitoral volume decreased in all the women. The PI of the dorsal clitoral artery increased only in patients on OC. The hormonal contraception was associated, in both studied groups, with a significant decrease of the two-factor Italian MFSQ score, which was more marked in OC users. In group I subjects, there was a reduction of the number of intercourse/week and a reduction of orgasm frequency during intercourse. The pain during intercourse worsened after OC use. The vaginal ring users reported a vaginal wetness.

CONCLUSIONS

Six-month treatment with hormonal contraception is associated with a diminished MFSQ score. However, the frequency of sexual intercourse and orgasm was reduced only by the use of OC. The OC use was associated with increased pain during intercourse.

2D and 3D Ultrasound Examination of Labia Minora

The aim of the study was to prospectively evaluate, by using 2D/3D ultrasonography and 3D color Doppler analysis, the morphological and vascular changes in the labia minora during the menstrual cycle of women not sexually aroused. A total of 81 young, healthy eumenorrheic women, in a stable heterosexual relationship (>1 year) and without any sexual dysfunction, underwent 2D/3D ultrasound and color Doppler examination of the labia minora on Days 3-5 and 12-14 of the menstrual cycle. Estradiol serum levels were also evaluated. Estradiol plasma levels increased in the periovulatory phase. The labia minora thickness increased from the follicular (3.8 ± 0.3 mm) to the periovulatory phase (4.6 ± 0.4 mm; p = .005). Furthermore, in the periovulatory phase, the vaginal introitus area and the angles were wider than in the follicular phase. The Pulsatility Index of the posterior labial artery significantly decreased in the periovulatory period. Three-dimensional power Doppler indices of vascularization and blood flow in the labia minora significantly increased in the periovulatory period. The relationship between the different parameters showed that estradiol was positively correlated with labia minora thickness and vaginal introitus area and angles. Furthermore, the circulating levels of estradiol were negatively correlated with posterior labial artery PI and positively correlated with other indices of labia minora vascularization. In conclusion, it seems that estrogen production may influence the anatomic and vascular changes of the labia minora during the menstrual cycle and these changes can be easily identified by ultrasound.

Moderate alcohol intake, genital vascularization, and sexuality in young, healthy, eumenorrheic women. A pilot study

INTRODUCTION

The relationship between alcohol and sexual function is complex and not completely understood.

AIM

To evaluate (in the early follicular phase and independently from sexual stimulation) in young, eumenorrheic, healthy, lean women the genital vascular effects of the light and moderate use of alcohol.

METHODS

Eighty-four women undertook, in the early follicular phase of the menstrual cycle (days 3-5), the administration of the two-factor Italian McCoy Female Sexuality (MFSQ) and the Beck Depression Inventory (BDI) questionnaires; ultrasonographic measurement of the carotid intima-media thickness (IMT); and color Doppler evaluation of the carotid, clitoral, and labia minora arteries. Hormonal (estradiol, androstenedione, and testosterone) and biochemical (lipids, glucose, and insulin) parameters were tested.

MAIN OUTCOME MEASURES

The MFSQ and BDI questionnaires; the carotid IMT; the Pulsatility Index of internal carotid, clitoral, and labia minora arteries; blood pressure measurement; and hormonal and biochemical assays.

RESULTS

The subjects were divided in: nondrinkers (group I); current (>1 year) light drinkers--1-10 drinks/month (group II); and current moderate drinkers--11-20 drinks/month (group III). The majority of the studied parameters did not vary among the different groups. The mean BDI was normal in the studied women. However, the lowest values were observed in the moderate drinkers group. The MFSQ did not show any difference among all the studied women. However, the number of intercourses/week and the incidence of vaginal orgasm were significantly higher in group III (moderate drinkers). The relationship between the drinking habits and different parameters showed an inverse relationship with the BDI. Furthermore, the BDI inversely correlated with orgasm frequency and with orgasm intensity.

CONCLUSIONS

Chronic slight/moderate alcohol consumption has no effects on genital vessels and vaginal lubrication. However, a moderate consumption of alcohol, through psychological and social disinhibiting effects, may favor sexual activities.

Recurrent postcoital hematuria. A case of fibroepithelial urethral polyp in an adult female

INTRODUCTION

In males, an isolated gross postcoital hematuria is a very rare clinical phenomenon. No cases of postcoital macroscopic hematuria have been previously reported in females.

AIM

To report a case of female urethral fibroepithelial polyp (FEP) associated with recurrent postcoital hematuria.

METHODS

A young (31 years old), eumenorrheic woman complained of three episodes of postcoital macrohematuria. The patient was assessed with a detailed history, with a bimanual pelvic examination and with bidimensional and tridimensional ultrasonographic and color Doppler analyses of the internal genitalia and of the urethrovaginal space.

MAIN OUTCOMES MEASURES

Transvaginal two-dimensional (2-D) ultrasonographic evaluation of internal genitalia, bladder and urethra and three-dimensional (3-D) analysis of the urethra and paraurethral structures.

RESULTS

The 2-D transvaginal evaluation and the 3-D reconstruction showed a polypoid hypervascularized structure arising from the anterior urethral wall. A cystourethroscopy confirmed the presence of a FEP arising from the anterior wall of the urethra and allowed its removal.

CONCLUSIONS

A gross postcoital hematuria may be associated with a urethral polyp. The ultrasonographic evaluation of the urethrovaginal space can facilitate the diagnosis.