Vascular Modifications of the Clitoris Induced by Topic Nitric Oxide Donor Gel—Preliminary Study

Abstract

Introduction The clitoral blood flow increase is dependent of nitric oxide (NO) and it occurs due to sexual arousal. Female sexual disorder mechanisms are poorly understood and NO therapeutic role in this scenario is to be determined. Aim To assess topic NO donor S-nitrosoglutationa (GSNO) gel—100 µM effect on clitoral blood flow in healthy women. Methods Forty healthy women were double-blinded randomized for Group 1, GSNO gel, n = 20 and Group 2, placebo gel, n = 20. All patients underwent Doppler ultrasound test in the clitoral artery. Hemodynamic analysis consisted of: systolic peak speed, diastolic speed, and vase resistance rate. Ten random patients were analyzed regarding sexual function after two double-blinded placebo and NO donor gel periods of 30 days. Main Outcome Measures To consider female sexual dysfunction treatment through local NO-dependent pathway. Results Mean age was 31 years (20–39) and mean female sexual function index score 31.5 (26–34). Group 1: The mean and standard deviation baseline and 15 minutes after the application of the GSNO gel systolic (11.7 ± 2.1 cm/second to 15.9 ± 2.4 cm/second) and diastolic speeds (2.7 ± 0.3 cm/second to 4.2 ± 0.4 cm/second) and resistance (0.71 ± 0.04 to 1.38 ± 0.06) were significantly increased (P = 0.002) (P = 0.043), and (P = 0.005), respectively. No local or systemic adverse effect was observed in women or in their sexual partners and the sexual function presented a slightly insignificant improvement (P = 0.065), although eight of 10 women could subjectively identify the GSNO gel as the preferred and most pleasant between both tried. Group 2 presented no significant differences at baseline and 15 minutes after the application of the placebo gel, P > 0.05. Conclusion The topic GSNO gel increased significantly the clitoral blood flow and could be considered therapeutically in selected cases of female sexual dysfunction warranting further investigation.

S-Nitrosoglutathione

“…GSNO has been administered through intravenous infusion [127], as an aerosolized inhalant [128], and more recently, as a topical gel [129] and poly vinyl alcohol film [130]. The best-characterized effects of GSNO in humans are on its direct and selective action in platelets.…”

“…Its beneficial effects in the vasculature extend to cardiac left ventricular function [127], systemic vasodilation [137], and preeclampsia [138]. Topical administration of a GSNO gel has also been shown to increase clitoral blood flow and has been suggested as a treatment for female sexual dysfunction [129]. …”

Cigarette Smoking Decreases the Genital Vascularization in Young Healthy, Eumenorrheic Women

“…Furthermore, the frequency of orgasms during intercourse was inversely correlated with dorsal clitoral artery PIs. We think that cigarettes may decrease the clitoral vascularization and engorgement by: inducing a moderate decrease of NO 2‐ /NO 3‐ [39] circulating levels, increasing the β‐adrenergic receptor formation, enhancing the anticholinergic effect at clitoris level. This may be associated with a fall of the clitoral vascularization, with the reduction of vaginal lubrication, and with a decreased frequency of sexual intercourse.…”

Polymer‐Based Nitric Oxide Therapies: Recent Insights for Biomedical Applications

“…[149] Forty subjects were randomly assigned to receive Pluronic F-127 gel (1 mL) with or without GSNO (100 μ m ). Using Doppler ultrasound, the systolic peak speed, diastolic speed, and resistance rate were measured in the clitoral artery.…”