ORIGINAL RESEARCH—WOMEN'S SEXUAL HEALTH: Ultrasonographic and Doppler Findings of Subclinical Clitoral Microtraumatisms in Mountain Bikers and Horseback Riders


Cesare Battaglia, MD, PhD, Department of Obstetrics and Gynaecology, University of Bologna, Via Massarenti, 13-40138 Bologna, Italy. Tel and Fax: +39-051-6364377; E-mail: cesare.battaglia@unibo.it


Introduction.  Repeated microtraumas in horseback riders and mountain bikers are, in males, associated with perineal and scrotal lesions. No data are reported in the females.

Aim.  To report five cases of clitoral microcalcifications, diagnosed by ultrasonography, in six healthy, eumenorrheic athletes, and to verify the clinical and sexual impact of the ultrasonographic findings.

Main Outcome Measures.  Translabial ultrasonographic evaluation of the clitoris, Doppler analysis of dorsal clitoral arteries, and the two-factor Italian McCoy Female Sexuality Questionnaire (MFSQ)

Methods.  The patients were assessed with a detailed history, and were submitted, in the periovulatory phase of the cycle (day 14), to clitoral ultrasonographic analysis and color Doppler evaluation of the dorsal clitoral arteries. The women were not sexually aroused. On the same day, in a separate room—and prior the ultrasound and Doppler examinations took place—the subjects completed the two-factor Italian MFSQ.

Results.  All the patients were completely asymptomatic but reported a past history of intermittent perineal tenderness or discomfort. In five out of the six subjects, the ultrasonographic assessment of the clitoris evidenced a disseminated clitoral microlithiasis. Only the youngest (18 years old) biker showed a normal pattern of the clitoral structures. A normal clitoral body volume (0.68 ± 0.21 mL) and a normal mean dorsal artery pulsatility index (PI) was found (PI = 1.75 ± 0.32) in all the patients. The two-factor Italian MFSQ showed a mean value of 42 ± 4 (range 37–45).

Conclusions.  The chronic traumatisms may be responsible, especially in well-trained riders, for microhematomas, inflammation, and/or degenerative processes at level of the clitoral structure. Further studies should be undertaken to determine the clinical significance of the described disseminated clitoral microlithiasis. Battaglia C, Nappi RE, Mancini F, Cianciosi A, Persico N, and Busacchi P. Ultrasonographic and Doppler findings of subclinical clitoral microtraumatisms in mountain bikers and horseback riders. J Sex Med 2009;6:464–468.