Cardiometabolic risk and female sexual health: the Princeton III summary

Female sexual function is dependent, in part, upon normal endothelial function within the genital arterial (hypogastric-cavernosal) vascular bed. The first two Princeton Consensus Conferences were focused on relationships between male sexual function and cardiovascular health, and development of contemporary clinical guidelines for dysfunction management.

The third Princeton Consensus Conference updated recommendations and assessed, for the first time, the association between female sexual dysfunction (FSD) and presence of systemic vascular endothelial dysfunction and its consequences in women. This report focuses on the association between cardiometabolic risk factors and female sexual health.

A panel of experts reviewed multinational data concerning associations between several cardiometabolic risks in women (hypertension, dyslipidemia and/or hyperlipemia, cigarette smoking, diabetes mellitus, and metabolic syndrome/obesity) and sexual health. Literature was reviewed concerning associations between FSD and presence or absence of cardiovascular disease, predictive association of FSD with cardiovascular events, and the possibility of vascular risk factor treatment modifying FSD.

Main outcome measures used were cardiometabolic risk factors and female sexual health, specifically genital arousal.

Women treated for hypertension have more FSD than normotensives. Women with hyperlipidemia but without cardiovascular disease have more FSD than women without hyperlipidemia. Women with metabolic syndrome/obesity have more FSD than those without. Cardiometabolic risk factors, diabetes, and coronary heart disease are associated with more FSD. Data support that treatment of metabolic syndrome/obesity is associated with less FSD. Currently, there are no data to support that FSD is a predictor of future cardiovascular events.

Female sexual health is complex: there is relative independence between subjective and objective aspects of arousal and desire, with numerous contributing factors (hormonal, psychological, interpersonal, and social). Based on limited current data, there appears to be an association between female sexual health and vascular risk factors (hypertension, hyperlipidemia, metabolic syndrome/obesity, diabetes, and coronary heart disease). More research is needed.