Skip to main content

Advertisement

SpringerLink
Log in

Morphometric and Vascular Modifications of the Clitoris During Pregnancy: A Longitudinal, Pilot Study

  • Original Paper
  • Published:
Archives of Sexual Behavior Aims and scope Submit manuscript

Abstract

During pregnancy, women go through a series of physical and emotional changes that may have an impact on their sexuality. The aim of the study was to examine modifications in sexual function during pregnancy by means of translabial ultrasonography and administration of questionnaires on sexual activity. Eighteen healthy and adult (25–35 years) pregnant women without sexual dysfunction and with a stable heterosexual relationship were examined at 10–12, 18–20, and 30–32 weeks of gestation. Patients underwent ultrasonographic translabial clitoral volume and labia minora thickness measurements and color Doppler assessment of the dorsal clitoral and posterior labial arteries. On the same day, each patient completed the two-factor Italian McCoy Female Questionnaire (MFSQ) and the Female Sexual Function Index (FSFI). The mean clitoral body volume progressively increased during pregnancy, and color Doppler analysis of the dorsal clitoral artery showed a significant decrease in the pulsatility index from the first to the third trimester. Similarly, the labia minora thickness increased and the posterior labial artery pulsatility index progressively decreased throughout gestation. The MFSQ score for sexuality and partnership and the number of intercourses/week did not significantly change during the study period. However, the MFSQ score for partnership reached the lowest value in the third trimester of pregnancy. Analysis of the FSFI data showed no significant differences throughout pregnancy for the majority of the domains (sexual desire, arousal, orgasm, lubrication, and pain), with the exception of the satisfaction item, which decreased during the third trimester. A significant proportion of women are concerned that changes in their body during pregnancy may have a detrimental effect on sexuality. Despite significant changes in genital morphology and vascularity throughout gestation, these modifications do not seem to have an impact on sexual function in pregnancy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Aslan, G., Aslan, D., Kizilyar, A., Ispahi, C., & Esen, A. (2005). A prospective analysis of sexual function during pregnancy. International Journal of Impotence Research, 17, 154–157.

    Article  PubMed  Google Scholar 

  • Bartellas, E., Crane, J. M. G., Daley, M., Bennett, K. A., & Hutchens, D. (2000). Sexuality and sexual activity in pregnancy. British Journal of Obstetrics and Gynecology, 107, 964–968.

    Article  Google Scholar 

  • Basson, R. (2007). Hormones and sexuality: Current complexities and future directions. Maturitas, 57, 66–70.

    Article  PubMed  Google Scholar 

  • Battaglia, C., Artini, P. G., D’Ambrogio, G., Genazzani, A. D., & Genazzani, A. R. (1995). The role of color Doppler imaging in the diagnosis of polycystic ovary syndrome. American Journal of Obstetrics and Gynecology, 172, 108–113.

    Article  PubMed  Google Scholar 

  • Battaglia, C., Artini, P. G., Salvatori, M., Giulini, S., Petraglia, F., Maxia, N., & Volpe, A. (1998). Ultrasonographic patterns of polycystic ovaries: Color Doppler and hormonal correlations. Ultrasound in Obstetrics and Gynecology, 11, 332–336.

    Article  PubMed  Google Scholar 

  • Battaglia, C., Battaglia, B., Busacchi, P., Paradisi, R., Meriggiola, M. C., & Venturoli, S. (2013). 2D and 3D ultrasound examination of labia minora. Archives of Sexual Behavior, 42, 153–160.

    Article  PubMed  Google Scholar 

  • Battaglia, C., Battaglia, B., Mancini, F., Busacchi, P., Paganotto, M. C., Morotti, E., & Venturoli, S. (2012). Sexual behavior and oral contraception: A pilot study. Journal of Sexual Medicine, 9, 550–557.

    Article  PubMed  Google Scholar 

  • Battaglia, C., Nappi, R. E., Mancini, F., Cianciosi, A., Persico, N., Busacchi, P., … de Aloysio, D. (2008). Menstrual cycle related morphometric and vascular modifications of the clitoris. Journal of Sexual Medicine, 5, 2853–2861.

    Article  PubMed  Google Scholar 

  • Battaglia, C., Regnani, G., Marsella, T., Facchinetti, F., Volpe, A., Venturoli, S., & Flamigni, C. (2002). Adjuvant l-arginine treatment in controlled ovarian hyperstimulation: A double-blind, randomized study. Human Reproduction, 17, 659–665.

    Article  PubMed  Google Scholar 

  • Belsky, J., Rovine, M., & Fish, M. (1989). The developing family system. In M. R. Gunnar & E. Thelen (Eds.) System and development: The Minnesota symposia on child psychology (Vol. 22, pp. 135–158). Hillsdale, NJ: Erlbaum.

    Google Scholar 

  • Bennett, H. A., Einarson, A., Taddio, A., Koren, G., & Einarson, T. R. (2004). Prevalence of depression during pregnancy: Systematic review. Obstetrics and Gynecology, 103, 698–709.

    Article  PubMed  Google Scholar 

  • Bird, I. M., Zhang, L., & Magness, R. R. (2003). Possible mechanisms underlying pregnancy-induced changes in uterine artery endothelial function. American Journal of Physiology: Regulatory, Integrative and Comparative Physiology, 284, R245.

    PubMed  Google Scholar 

  • Boeldt, D. S., & Bird, I. M. (2017). Vascular adaptation in pregnancy and endothelial dysfunction in preeclampsia. Journal of Endocrinology, 232, R27–R44.

    Article  PubMed  Google Scholar 

  • Bogren, L. Y. (1991). Changes in sexuality in women and men during pregnancy. Archives of Sexual Behavior, 20, 35–45.

    Article  PubMed  Google Scholar 

  • Byrd, J. E., Hyde, J. S., DeLamater, J. D., & Plant, E. A. (1998). Sexuality during pregnancy and the year postpartum. Journal of Family Practice, 47, 305–308.

    PubMed  Google Scholar 

  • DeJudicibus, M. A., & McCabe, M. P. (2002). Psychological factors and the sexuality of pregnant and postpartum women. Journal of Sex Research, 39, 94–103.

    Article  PubMed  Google Scholar 

  • Dennerstein, L., Lehert, P., & Burger, H. (2005). The relative effects of hormones and relationship factors on sexual function of women through the natural menopause. Fertility and Sterility, 64, 174–180.

    Article  Google Scholar 

  • Erol, B., Sanli, O., Korkmaz, D., Seyhan, A., Akman, T., & Kadioglu, A. (2007). A cross-sectional study of female sexual function and dysfunction during pregnancy. Journal of Sexual Medicine, 4, 1381–1387.

    Article  PubMed  Google Scholar 

  • Facchinetti, F., De Martis, S., Neri, I., Caputo, A., & Volpe, A. (1997). Effects of transdermal glyceryltrinitrate on 24-h blood pressure changes in patients with gestational hypertension. Prenatal and Neonatal Medicine, 2, 22–28.

    Google Scholar 

  • Ficek, L., Miotła, P., & Rechberger, T. (2005). Women’s sexual life quality assessment with use of questionnaires in clinical trials-review of accessible tools, their characteristics and comparison of their properties. Ginekologia Polska, 76, 1000–1007.

    PubMed  Google Scholar 

  • Glazener, C. M. A. (1997). Sexual function after childbirth: Women’s experiences, persistent morbidity and lack of professional recognition. British Journal of Obstetrics and Gynaecology, 104, 330–335.

    Article  PubMed  Google Scholar 

  • Gokyldiz, S., & Beji, N. K. (2005). The effects of pregnancy on sexual life. Journal of Sex & Marital Theraphy, 31, 2010–2015.

    Google Scholar 

  • Gragasin, F. S., Michelakis, E. D., Hogan, A., Mougdil, R., Hashimoto, K., Wu, X., … Archer, S. L. (2004). The neurovascular mechanism of clitoral erection: Nitric oxide and cGMP-stimulated activation of BKCa channels. FASEB Journal, 18, 1382–1391.

    Article  PubMed  Google Scholar 

  • Hackel, L. S., & Ruble, D. N. (1992). Changes in the marital relationship after the first baby is born: Predicting the impact of expectancy disconfirmation. Journal of Personality and Social Psychology, 62, 944–957.

    Article  PubMed  Google Scholar 

  • Haugen, E. N., Schmutzer, P. A., & Wenzel, A. (2004). Sexuality and the partner relationship during pregnancy and the postpartum period. In J. H. Harwey, A. Wenzel, & S. Sprecher (Eds.), Handbook of sexuality in close relationship (pp. 411–435). Mahwah, NJ: Erlbaum.

    Google Scholar 

  • Isidori, A. M., Pozza, C., Esposito, K., Giugliano, D., Morano, S., Vignozzi, L., … Jannini, E. A. (2010). Development and validation of a 6-item version of the Female Sexual Function Index (FSFI) as a diagnostic tool for female sexual dysfunction. Journal of Sexual Medicine, 7, 1139–1146.

    Article  PubMed  Google Scholar 

  • Johnson, C. E. (2011). Sexual health during pregnancy and the postpartum. Journal of Sexual Medicine, 8, 1267–1284.

    Article  PubMed  Google Scholar 

  • Jones, L. R. (2002). The use of validated questionnaires to assess female sexual dysfunction. World Journal of Urology, 20, 89–92.

    Article  PubMed  Google Scholar 

  • King, M., Holt, V., & Nazareth, I. (2007). Women’s views of their sexual difficulties: Agreement and disagreement with clinical diagnoses. Archives of Sexual Behavior, 36, 281–288.

    Article  PubMed  Google Scholar 

  • Laumann, E. O., Gagnon, J. H., Michael, R. T., & Michaels, S. (1994). The social organization of sexuality: Sexual practices in the United States. Chicago: University of Chicago Press.

    Google Scholar 

  • Leite, A., Campos, A., Cardoso Diaz, A. R., Amed, A. M., & De Souza, E. (2009). Prevalence of sexual dysfunction during pregnancy. Revista Da Associacao Medica Brasileira, 55, 563–568.

    Article  PubMed  Google Scholar 

  • Levy-Shiff, R. (1994). Individual and contextual correlates of marital change across the transition to parenthood. Developmental Psychology, 30, 591–601.

    Article  Google Scholar 

  • Liu, H. L., Hsu, P., & Chen, K. O. (2013). Sexual activity during pregnancy in Taiwan: A qualitative study. Sexual Medicine, 1, 54–61.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lumley, J. (1978). Sexual feeling in pregnancy and after childbirth. Australian and New Zealand Journal of Obstetrics and Gynaecology, 18, 114–117.

    Article  Google Scholar 

  • Meston, C. M., & Derogatis, L. R. (2002). Validated instruments for assessing female sexual function. Journal of Sex and Marital Theraphy, 28(Suppl. 1), 155–164.

    Article  Google Scholar 

  • Nappi, R. E., Albani, F., Vaccaro, P., Gardella, B., Salonia, A., Chiovato, L., … Polatti, F. (2008). Use of the Italian translation of the Female Sexual Function Index (FSFI) in routine gynecological practice. Gynecological Endocrinology, 24, 214–219.

    Article  PubMed  Google Scholar 

  • Nappi, R. E., Federghini, F., Sampaolo, P., Vaccaro, P., De Leonardis, C., Albani, F., … Polatti, F. (2006). Clitoral circulation in postmenopausal women with sexual dysfunction: A pilot randomized study with hormone therapy. Maturitas, 55, 288–295.

    Article  PubMed  Google Scholar 

  • Nappi, R. E., Mancini, M., Veneroni, F., Colpi, G. M., Federghini, F., & Polatti, F. (2002). Clitoral artery blood flow in healthy young women: Preliminary report on menstrual cycle and hormonal contraception. Journal of Sexual & Marital Theraphy, 28(1 Suppl.), 187–193.

    Article  Google Scholar 

  • O’Connell, H. E., Sanjeevan, K., & Hutson, J. M. (2005). Anatomy of the clitoris. Journal of Urology, 174, 1189–1195.

    Article  PubMed  Google Scholar 

  • Palmer, S. K., Zamudio, S., Coffin, C., Parker, S., Stamm, E., & Moore, L. G. (1992). Quantitative estimation of human artery blood flow and pelvic blood flow redistribution in pregnancy. Obstetrics & Gynecology, 80, 1000–1006.

    Google Scholar 

  • Pauleta, J., Pereira, N. M., & Graca, L. M. (2010). Sexuality during pregnancy. Journal of Sexual Medicine, 7, 136–142.

    Article  PubMed  Google Scholar 

  • Pauls, R. N., Occhino, J. A., & Dryfthout, V. L. (2008). Effects of pregnancy on female sexual function and body image. A prospective study. Journal of Sexual Medicine, 5, 1015–1022.

    Article  Google Scholar 

  • Read, J. (2004). ABC of sexual health: Sexual problem associated with infertility, pregnancy, and ageing. British Medical Journal, 329, 559–561.

    Article  PubMed  PubMed Central  Google Scholar 

  • Regan, P. C., Lyle, J. L., Otto, A. L., & Joshi, A. (2003). Pregnancy and changes in female desire: A review. Social Behavior and Personality, 31, 603–612.

    Article  Google Scholar 

  • Rellini, A. H., Nappi, R. E., Vaccaro, P., Federghini, F., Abbiati, I., & Meston, C. M. (2005). Validation of the McCoy Female Sexuality Questionnaire in an Italian sample. Archives of Sexual Behavior, 34, 641–647.

    Article  PubMed  Google Scholar 

  • Rigano, S., Ferrazzi, E., Boito, S., Pennati, G., Padoan, A., & Galan, H. (2002). Blood flow of uterine arteries in human pregnancies determined using 3D and bi-dimensional imaging, angio-Doppler, and fluid dynamic modeling. Placenta, 31, 37–43.

    Article  Google Scholar 

  • Robertson, W. B., Brosens, I., & Dixon, G. (1975). Uteroplacental vascular pathology. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 5, 47–71.

    Article  PubMed  Google Scholar 

  • Sagiv-Reiss, D. M., Birnbaum, G. E., & Safir, M. P. (2012). Changes in sexual experiences and relationship quality during pregnancy. Archives of Sexual Behavior, 41, 1241–1251.

    Article  PubMed  Google Scholar 

  • Styles, S. J., MacLean, A. B., Reid, W. M. N., & Sultana, S. R. (2006). Laser Doppler perfusion imaging: A method for measuring female sexual response. British Journal of Obstetrics and Gynaecology, 113, 599–601.

    Article  PubMed  Google Scholar 

  • Tulcinsky, D., & Hobel, C. J. (1973). Plasma human chorionic gonadotropin, estrone, estradiol, estriol, progesterone and 17α-hydroxyprogesterone in human pregnancy: III. Early normal pregnancy. American Journal of Obstetrics and Gynecology, 117, 884–893.

    Article  Google Scholar 

  • Veille, J. C., Tatum, K., & Zaccaro, D. (1996). Maternal right hypogastric artery blood flow during normal pregnancy and 6 week postpartum. Journal of the Society for Gynecologic Investigation, 3, 191–198.

    Article  PubMed  Google Scholar 

  • von Sydow, K. (1999). Sexuality during pregnancy and after childbirth: A metacontent analysis of 59 studies. Journal of Psychosomatic Research, 47, 27–49.

    Article  Google Scholar 

  • Wiegel, M., Meston, C., & Rosen, R. (2005). The Female Sexual Function Index (FSFI): Cross-validation and development of clinical cutoff scores. Journal Sex Marital Therapy, 31, 1–20.

    Article  Google Scholar 

  • Wilkinson, R. B. (1995). Changes in psychological health and the marital relationship through childbearing. Transition or process as stressor. Australian Journal of Psychology, 47, 86–92.

    Article  Google Scholar 

  • World Health Organization. (2002). Sexual health: Working definitions. Available at: http://www.who.International/reproductive-health/gender/sexual_health.h.

Download references

Author information

Authors and Affiliations

  1. Department of Gynecology and Human Reproduction, Alma Mater Studiorum, University of Bologna, Via Massarenti, 13, 40138, Bologna, Italy

    Cesare Battaglia, Francesca Guasina, Mara Mattioli, Paolo Casadio & Elena Morotti

  2. Department of Obstetrics and Gynecology Mangiagalli, University of Milan, Milan, Italy

    Nicola Persico

  3. Department of Obstetrics Gynecology, University of Ferrara, Ferrara, Italy

    Isabella Zanetti

Authors
  1. Cesare Battaglia
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nicola Persico
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Isabella Zanetti
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Francesca Guasina
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mara Mattioli
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Paolo Casadio
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Elena Morotti
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Cesare Battaglia.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Battaglia, C., Persico, N., Zanetti, I. et al. Morphometric and Vascular Modifications of the Clitoris During Pregnancy: A Longitudinal, Pilot Study. Arch Sex Behav 47, 1497–1505 (2018). https://doi.org/10.1007/s10508-017-1046-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10508-017-1046-x

Keywords

Search

Navigation