Pelvic Atherosclerosis in Women: A Case Report of the Alleviation of Dyspareunia and Vaginal Dryness after Pelvic Artery Revascularisation

Abstract

Misdiagnosed and inadequately treated vasculogenic sexual dysfunction affects millions of females worldwide, highlighting the importance of a mostly overlooked pathology. Organic female sexual dysfunction, such as vaginal engorgement and clitoral erectile insufficiency, may be associated with hypogastric atherosclerosis. In the author’s vascular medicine setting, they encountered a case of a post-menopausal female patient with symptomatic common iliac and hypogastric artery occlusion. This case highlights the diagnostic management of atherosclerosis and its secondary clinical manifestations, the differentiation between physiological post-menopausal hormonal changes and pathological vasculogenic dysfunction, as well as currently available endovascular treatment options. The 57-year-old patient presented with symptoms indicative of bilateral peripheral artery disease, Fontaine Stage IIb, along with vaginal dryness and dyspareunia. Upon finding occlusions of the common iliac and hypogastric artery, bare metal stenting of the left distal common iliac artery and percutaneous transluminal angioplasty of the internal iliac artery was performed. At 6-week follow-up, an unlimited pain-free walking distance as well as greatly improved vaginal and clitoral erectile function was reported. Local oestrogen application for a year showed no clinical improvement, whereas a significant difference in vaginal and clitoral erectile function was reported shortly after endovascular revascularisation. Vaginal engorgement and clitoral erection depend on increased blood inflow and pulsatile, non-calcified arterial walls. In females with cardiovascular risk factors, arterial insufficiency of the hypogastric-cavernous bed is an underestimated atherosclerotic manifestation for sexual impairment. In these patients with arteriogenic sexual dysfunction, endovascular therapy using drug-eluting stents may be considered as an effective treatment option.