Endothelial Function Testing

Content Written By: Irwin Goldstein, MD

Cardiovascular disease in women and sexual arousal disorders in women may be linked to endothelial dysfunction, as they have been well-documented in men. As with small vessels of the limb, increased ?ow and resultant increased shear stress-induced vasodilatation in the clitoral cavernosal and vaginal arteries appear to be mediated via nitric oxide.

Menopausal women with vascular risk history or women with metabolic syndrome (increased waist circumference, diabetes, high blood pressure, hypercholesterolemia, etc) with sexual arousal disorders may have endothelial dysfunction in other vascular beds as well in the clitoral cavernosal or vaginal arteries. However, endothelial damage may occur differentially in various vascular beds and in a time-dependent manner such that dysfunction within the clitoral artery or vaginal artery endothelium could theoretically occur prior to its occurrence in other parts of the circulation. More research is needed.

Chronic low-grade in?ammation contributes to all stages of the arterial disease called atherosclerosis. Chronic low-grade in?ammation is noted from the initial phase of increased permeability of the arterial lining cells, the endothelium. Chronic low-grade in?ammation is noted during formation of the mature atherosclerotic plaque that blocks and reduces arterial inflow.

Increased blood levels of in?ammatory markers have been documented in coronary artery disease. Endothelial cell function and in?ammation are highly associated. Normal arterial vascular endothelium has anti-in?ammatory properties. On the other hand, endothelial function is impaired in the presence of in?ammatory conditions.

It is not yet well known, as it is in men, that sexual arousal disorder in menopausal women with vascular risk factor exposure or with metabolic syndrome, are associated with markers and mediators of subclinical in?ammation and endothelial activation.

If however a pre- or post menopausal woman has sexual arousal disorder, has a family history of vascular disease, has metabolic syndrome or has exposure to vascular risk factors, a logical work up would include some inflammatory biomarkers such as: hs C-reactive protein, ?brinogen, von Willebrand factor, interleukins (IL)-1b and 6 and adhesions molecules (intracellular adhesion molecule-1 [ICAM] and vascular cell adhesion molecule-1 [VCAM]).

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