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At least 325 records · Page 18Linked to original sources
PubMed2005

Genital duplex Doppler ultrasonography before and after sexual stimulation in women with sexual dysfunction: gray scale, volumetric, and hemodynamic findings.

OBJECTIVE: To report gray scale, volumetric, and duplex ultrasound data before and after sexual stimulation in a large population of women with sexual dysfunction. DESIGN: Retrospective review of women with sexual dysfunction. SETTING: An academic center. PATIENT(S): Pre- and postmenopausal women with sexual dysfunction. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): This is an Institutional Review Board-approved retrospective study of 142 women who underwent duplex Doppler ultrasound (DDU) arousal testing for sexual dysfunction. RESULT(S): This study revealed that DDU was able to record morphologic, volumetric (clitoral and corpora spongiosa diameters), and hemodynamic (peak systolic and end-diastolic) changes in women with sexual dysfunction before and after sexual stimulation. Resistive index measurements, which are indicative of veno-occlusive function, did not significantly change before and after arousal in both the clitoris and corpora spongiosa. We also found a correlation between genital diameter and genital end-diastolic velocity value. Gray scale scanning revealed tunical thickening or plaque in several patients who sustained blunt perineal trauma. CONCLUSION(S): The role of DDU in the management of women with sexual dysfunction remains to be determined; however, end-diastolic velocity values suggest that this parameter has an important physiologic implication as a direct determinant of genital engorgement.

Adult↗
PubMed2006

[Results of surgical clitoral repair after ritual excision: 453 cases].

OBJECTIVE: Ritual excision is responsible for urologic, gynaecologic and obstetrical complications, whose surgical treatment has been fully described. Sexual sequelae deserve the same attention. We describe and analyze the results of a surgical procedure for clitoral rehabilitation. PATIENTS AND METHODS: Women requesting this surgery between 1992 and 2005 have been prospectively included in this study. The skin covering the stump was resected and the clitoris identified. The suspensor ligament was sectioned in order to mobilize the stump, the sclerous tissues were removed from the extremity and the neo glans brought to a normal situation. Pre operative pain and clitoral impairment were assessed within five categories. The same was done with anatomical and functional postoperative results at six months. RESULTS: Four hundred and fifty-three patients have been completely evaluated. Hospitalisation stay was 24 hours and the procedure never lasted more than 30 minutes. Minor early complications were recorded in 58 patients (hematoma, disrupture of the suture, pain). Four patients reported persisting pain at four months. A visible clitoral massif could be restored in 87% of the cases and a real improvement in clitoral function was obtained in 75% of the patients. DISCUSSION AND CONCLUSION: This surgical procedure is easy and reliable. It provides promising cosmetic and functional results with minor complications.

Adolescent↗
PubMed2004

Conservative clitoral preservation surgery in the treatment of vulvar squamous cell carcinoma.

OBJECTIVE: To determine the safety and efficacy of clitoral-sparing surgery in women with squamous cell carcinoma (SCCA) of the anterior vulva not involving the clitoris. METHODS: Patients with vulvar SCCA diagnosed between 1984 and 2000 were identified and data collected. In this descriptive analysis, women treated with complete radical vulvectomy were compared to those treated with clitoral-sparing modified radical vulvectomy. All slides were re-reviewed. RESULTS: Of the 41 women with vulvar carcinoma, 13 had clitoral-sparing modified vulvectomies (group A) while the remaining 28 underwent complete radical vulvectomies (group B). The 13 patients in group A included, 8 with stage I, 2 stage II, 2 stage III, and 1 with stage IV disease. The two groups had similar demographic and pathologic prognostic factors. After a median follow-up of 59 months, no patients in group A had loco-regional failure. CONCLUSION: Clitoral-sparing vulvar cancer surgery does not compromise the rate of loco-regional control in patients and may be offered to selected women.

Adult↗
PubMed2006

[Contribution of ultrasonography to the diagnosis of non-hormonal acquired clitoromegalia: a case report].

We report the case of a 30-year-old woman, consulting for a painful clitoromegaly which developed progressively and rapidly. The gyneco-endocrinological assessment ruled out hyperandrogenism. Ultrasound examination of the clitoris revealed the presence of a clitoral cyst. Acquired clitoromegaly is a symptom which occurs in severe hyperandrogenism. Other organic etiologies include clitoral cysts of various nature and solid tumors. An ultrasonographic examination should be included in the diagnostic work-up for acquired clitoromegaly.

Adult↗
PubMed1986

Bladder duplication with one exstrophy and one cloaca.

Bladder duplication is a rare anomaly. Less than 100 cases of all types have been described in the literature. When duplication of the bladder occurs, it has previously been described as a mirror image or as a septate bladder. A newborn female presented with what appeared to be a complete bladder exstrophy, a large ruptured omphalocele with perforated large bowel, an imperforate anus, and a bifid clitoris. Urine was seen emanating from various sites: the bladder mucosa, the mucous fistula constructed at the time of the colostomy, and the left hemiclitoris. The anatomic puzzle was resolved when multiple studies disclosed the problem to be a bladder duplication. The bladder on the anterior abdominal wall was exstrophied, the intraabdominal bladder was a cloaca, and the left hemiclitoris contained a phallic urethra, which drained the intraabdominal bladder. Total correction with normal function was obtained. This patient demonstrates that bladder duplication may present in various ways.

Abnormalities, Multiple↗
PubMed1975

Fetal phallic growth and penile standards for newborn male infants.

No appreciable difference in size of the fetal clitoris versus the fetal penis was noted until 14 weeks' gestation, which is after the period of masculine differentiation of the external genitals. However, significant differences in the rate of penile and clitoral growth were evident in second trimester fetuses. The majority of the prenatal growth of the penis occurs after 14 weeks gestation at an almost linear rate. The penile stretched length of the full-term infant was 3.5 cm plus or minus 0.7 cm and the diameter was 1.1 cm plus or minus 0.2 cm.

Clitoris↗
PubMed1990

Single-stage feminization genitoplasty.

We present a modified technique for feminization genitoplasty, which combines the main features of the Hendren and Crawford pull-through operation and the Kogan reduction clitoroplasty. The unique features of the operation are the use of a flap of preputial skin to construct the vestibule and the anterior vaginal wall, and the universal use of the urogenital sinus to form the distal urethra, which avoids creation of female hypospadias. The new introitus is ample and, because there is no cut-back of the urogenital sinus, we avoid accidental incision of the urethral sphincter and the potential for urinary incontinence. There is no pull-through of the vagina because the introitus is created by mobilization of anterior and posterior skin flaps. The clitoris and the neourethra are exteriorized through the folded preputial skin, which simulates the normal female anatomy. The cosmetic and functional results in 9 children who have undergone this procedure have been excellent.

Adrenal Hyperplasia, Congenital↗
PubMed1987

The use of mechanical stimulation to obtain the sacral reflex latency: a new technique.

We determined sacral reflex latencies and morphologies in 18 neurologically normal patients and 83 with neurological disease by stimulating the glans penis or clitoris using electrical and a new technique of mechanical stimulation, and recording from the external urethral sphincter. The results with both stimulation techniques were compared among various diagnostic groups. In normal patients the mean sacral reflex latencies were 35.3 +/- 2.5 (standard deviation) msec. with electrical stimulation, and 39.1 +/- 4.0 msec. with mechanical stimulation. The mean reflex latencies in patients with lower motor neuron lesions studied by both methods were statistically longer than in normal subjects, and the mean reflex latencies in patients with upper motor neuron impairment studied by both methods were not statistically different from those in normal subjects. The morphological findings of the reflex tracings suggest that both types of evoked responses follow the same general anatomical pathway and both resemble a special human flexor reflex. The mechanical technique has advantages over the electrical technique because it is less painful and in certain instances it is easier to obtain.

Adult↗
PubMed1986

Pudendal cortical somatosensory evoked potentials.

To determine normal reference latencies pudendal cortical somatosensory evoked potentials were evaluated in 20 healthy volunteers. The dorsal nerve of the penis or clitoris was stimulated electrically and the cortical response was recorded from the CZ-2 point (2 cm. behind the central vertex). Reproducible responses were obtained and reference values were established.

Adult↗
PubMed1983

Clinical application of sacral reflex latency.

We determined the sacral reflex latency in 108 neurologically normal subjects and 110 patients with neurological lesions by applying stimulating current to the glans penis or clitoris and measuring the response with electrodes inserted in the external urethral and anal sphincters. In normal men the mean latencies were 34.6 plus or minus 5.1 (standard deviation) msec. at the external urethral sphincter and 36.0 plus or minus 5.2 msec. at the external anal sphincter. In normal women the mean latencies were 37.4 plus or minus 5.5 msec. at the external urethral sphincter and 38.6 plus or minus 4.0 msec. at the external anal sphincter. The mean reflex latency in patients with upper motor neuron lesions was significantly shorter. To our knowledge this is the first single electrophysiological test to show a difference between such patients and normal subjects. An increased mean latency was found in patients with lower motor neuron impairment. We conclude that measurement of sacral reflex latency can add to the diagnostic information obtained from conventional electromyography and cystometry.

Adolescent↗
PubMed2000

Sildenafil relaxes rabbit clitoral corpus cavernosum.

The role of phosphodiesterase type 5 inhibition in the modulation of female sexual dysfunction was investigated by assessing its effects on in vitro relaxation of rabbit clitoris. Stimulation of the non-adrenergic, non-cholinergic neurons of the clitorus elicited a frequency-dependent relaxation response. Inhibition of NO synthase with L-NAME (100 microM) or inhibition of soluble guanylate cyclase with ODQ (1.0 microM) almost completely abolished the electrical field stimulation-induced relaxation of clitorus suggesting that NO-cGMP pathway mediates the relaxation response to electrical field stimulation. Similarly, tetrodotoxin, a neuronal sodium channel blocker abolished the electrical field stimulation-induced clitoral relaxation implying a neuronal release of NO contributes to the electrical field stimulation elicited relaxation. Pretreatment of the clitoral corpus cavernosum strips with sildenafil (100 nM) enhanced the electrical field stimulation-induced relaxations both in magnitude and duration. The results suggest that sildenafil enhances electrical field stimulation elicited clitoral relaxation by a NO-cGMP dependent pathway. These data also imply that sildenafil may be useful to treat female sexual dysfunction.

3',5'-Cyclic-GMP Phosphodiesterases↗
PubMed2000

Clitoroplasty with preservation of neurovascular pedicles.

BACKGROUND: Optimal sexual function after surgical correction of clitoral hypertrophy requires an adequate postoperative innervation and vascular supply to the glans clitoris. Several clitoroplasty methods have been reported, but few describe preservation of dorsal and ventral neurovascular bundles in sexually mature women. CASE: A 22-year-old woman with clitoromegaly caused by non-salt-wasting classic 21-hydroxylase deficiency presented for a second surgical procedure after an operation in her infancy. The erect clitoral length exceeded 7.5 cm. Clitoral reduction was done through a semicircular incision in the phallus, with preservation of dorsal and ventral neurovascular pedicles. CONCLUSION: Preservation of ventral and dorsal vascular pedicles at clitoroplasty had a satisfactory result in sexually mature women.

Adult↗
PubMed2000

Normative values for female genital sensation.

OBJECTIVES: Neurologic disorders might be responsible for many cases of female sexual dysfunction. Yet, they are currently undiagnosed because of the lack of measurement tools to assess genital neural function. Therefore, our objective is to provide norms for sensory thresholds in the vagina and clitoris, for a wide range of patient ages. METHODS: Vaginal and clitoral warm, cold, and vibratory sensory thresholds were measured in 89 healthy paid volunteers by the method of limits. Normograms were derived from this group of healthy volunteers. An additional 61 patients were also tested, for a total of 150 individuals. Sixty-two individuals (42 healthy volunteers and 20 patients) from the total group were tested twice to provide test-to-test repeatability data across the range of clinical (normal and abnormal) responses. RESULTS: Normograms are presented, providing age-corrected upper and lower normal values, expressed as 95% confidence limits for warm, cold, and vibratory thresholds. Intertest repeatability is also reported. CONCLUSIONS: Thermal and vibratory thresholds of both the vaginal and clitoral region are clinically feasible, valid, and repeatable. These can be applied as a valuable diagnostic tool to assess neural dysfunction through sensory assessment of the female genitalia.

Adolescent↗
PubMed2002

Type 5 phosphodiesterase expression in the human vagina.

OBJECTIVES: It has been demonstrated that clitoral and vaginal tissues express nitric oxide synthase isoforms in a way that parallels that of the penile corpus cavernosum. Considering the role of the vagina in the female sexual response and the anatomic connection between the clitoris and the anterosuperior vaginal wall, our aim was to study the distribution of type 5 phosphodiesterase (PDE5) in the anterosuperior wall of the human vagina. METHODS: Immunohistochemistry was performed on the vaginal tissue of 14 women obtained at autopsy and on exfoliated cells of the vaginal epithelium obtained from 5 healthy female donors. Specific antibodies against PDE5 were tested on both paraffin sections and cytologic smears. Immunoblotting experiments were performed in parallel with the same antibodies. RESULTS: The histologic analysis of human cadaveric vaginal tissue revealed that PDE5 immunoreactivity was mostly localized in the smooth muscle of vessels, forming a pseudocavernous tissue in the vaginal wall and endothelium. The Skene periurethral glands and vaginal epithelium were also positive for the antibody. The latter finding was confirmed using exfoliated cells of the vaginal epithelium harvested in vivo. CONCLUSIONS: The presence and tissue distribution of PDE5 in the human vagina suggest that the integrated system of nitric oxide synthase-PDE5 may play a physiologic role not only in the male sexual response but also in female sexual arousal.

3',5'-Cyclic-GMP Phosphodiesterases↗
PubMed2003

The effect of clitoral surgery on sexual outcome in individuals who have intersex conditions with ambiguous genitalia: a cross-sectional study.

BACKGROUND: The effects on sexual function of surgical removal of parts of the clitoris are unknown. For infants with intersex conditions and ambiguous genitalia being raised female, this surgery is often undertaken in early childhood. Our aim was to assess the effects of surgery on sexual outcome in this population. METHOD: We did a cross-sectional study to which we recruited 39 adults who had intersex conditions with ambiguous genitalia who were living as female from clinical (n=15) and peer-support (n=24) settings. We obtained data by use of a postal questionnaire, incorporating a validated sexual function assessment inventory. We also obtained hospital notes of 36 respondents who did not want to remain anonymous, and did genital examinations of 19 women. We assessed sexual problems in relation to surgical history and compared the results for our population to those of a healthy control group. FINDINGS: Of the 39 individuals enrolled, 28 had been sexually active and all had sexual difficulties. The 18 women who had undergone clitoral surgery had higher rates of non-sensuality (78%) and of inability to achieve orgasm (39%) than did the ten who had not had surgery (20% [p=0.002] and 0% [p=0.03], respectively). INTERPRETATION: Sexual function could be compromised by clitoral surgery. Debate on the ethics of the use of this surgery in children should be promoted and further multicentre research is needed to ensure representative samples and comprehensive outcome assessment. Meanwhile, parents and patients who consent to clitoral surgery should be fully informed of the potential risks to sexual function.

Adolescent↗