title: Clitoral vascularization and sexual behavior in young patients treated with drospirenone-ethinyl estradiol or contraceptive vaginal ring: a prospective, randomized, pilot study.
abstract: BACKGROUND
  Oral contraceptives (OC) are effective for birth control and have good cycle control and tolerability. However, the hormonal components could modify mood and libido.
  
  
  OBJECTIVE
  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).
  
  
  METHODS
  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.
authors.affiliation: Department of Gynecology and Pathophysiology of Human Reproduction, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Battaglia
authors.forename: Elena
authors.initials: E
authors.lastname: Morotti
authors.forename: Nicola
authors.initials: N
authors.lastname: Persico
authors.forename: Bruno
authors.initials: B
authors.lastname: Battaglia
authors.forename: Paolo
authors.initials: P
authors.lastname: Busacchi
authors.forename: Paolo
authors.initials: P
authors.lastname: Casadio
authors.forename: Roberto
authors.initials: R
authors.lastname: Paradisi
authors.forename: Stefano
authors.initials: S
authors.lastname: Venturoli
mesh_terms: D000293:Adolescent; D000328:Adult; D000735:Androstenedione / Q000097:blood; D000736:Androstenes / Q000008:administration & dosage / Q000009:adverse effects*; D001158:Arteries / Q000000981:diagnostic imaging / Q000187:drug effects; D002987:Clitoris / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000187:drug effects*; D003274:Contraceptive Devices, Female / Q000009:adverse effects*; D003276:Contraceptives, Oral / Q000008:administration & dosage / Q000009:adverse effects*; D004997:Ethinyl Estradiol / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007989:Libido; D009948:Orgasm / Q000187:drug effects; D010865:Pilot Projects; D011446:Prospective Studies; D012725:Sexual Behavior / Q000187:drug effects; D019529:Sexuality / Q000187:drug effects; D011795:Surveys and Questionnaires; D013739:Testosterone / Q000097:blood; D018615:Ultrasonography, Doppler, Color; D014621:Vagina / Q000000981:diagnostic imaging / Q000187:drug effects; D055815:Young Adult
chemical_list: D000736:Androstenes; D003276:Contraceptives, Oral; C534342:drospirenone and ethinyl estradiol combination; D013739:Testosterone; D000735:Androstenedione; D004997:Ethinyl Estradiol
keywords: Clitoris; Contraception; Drospirenone; Effects of Contraceptives on Sexual Function; Sexuality; Vaginal Ring