The effect of topical synthetic prostaglandin E1 (misoprostol) on clitoral hemodynamics.

Introduction: Genital blood flow plays an important role on female sexual function. Measures that increase genital blood flow may be a therapeutic approach for female sexual dysfunction.

Aim: This study aims to show the effect of topical misoprostol, a synthetic prostaglandin, on clitoral blood flow.

Methods: Seventeen volunteers with female sexual dysfunction on the basis of female sexual function index scores were included in the study. All women were premenopausal and within their sexually active ages. Hormonal profiles were also normal. Those with suspected pregnancy, history of pelvic or vaginal surgery or radiotherapy, and diabetes or hypertension were excluded. Female sexual function index scores were determined. Clitoral peak systolic velocity (PSV) and clitoral artery diameter of all women were measured by using Doppler ultrasound. The measurements were done on two occasions as before and after placebo in one session and before and after 100 µg of misoprostol in another. This is a double-blind study where the patient and the ultrasonographist were unaware of either placebo or active drug has been applied before measurements.

Main Outcome Measures: Clitoral artery diameter and peak systolic velocity.

Results: Misoprostol caused a significant increase in clitoral artery PSV compared to basal level (P = 0.0001), while changes in clitoral artery PSV with placebo remained insignificant. Remarkably, misoprostol caused 118.3% increase in clitoral artery PSV and 47.5% increase in clitoral artery diameter when compared to basal levels. No side effects were observed.

Conclusion: Topical misoprostol can significantly increase clitoral blood flow without any unwanted effects and this finding may be promising for future investigations with relevance to female sexual dysfunction.