Sexual MedicinePsychobiologic Correlates of the Metabolic Syndrome and Associated Sexual Dysfunction
Introduction
A worldwide epidemic increase in obesity has occurred in recent decades and will steadily increase in the near future, due to substantial lifestyle changes [1]. Increase in adiposity is strongly associated with severe health problems and with an overall decreased longevity [2]. In particular, an increase in visceral (android) adiposity is considered [3], [4], [5], [6] the key feature of a constellation of metabolic abnormalities, known as metabolic syndrome (MS), including also glucose intolerance and insulin resistance, dyslipidaemia, and hypertension, essentially characterized by an increased cardiovascular and diabetic risk [7], [8], [9].
Men with cardiovascular diseases or diabetes mellitus (DM) or both often have erectile dysfunction (ED), probably because of shared factors impairing hemodynamic mechanisms in both the penile and systemic vascular beds [10].
Interestingly, subjects with MS, according to National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP-III; three or more 3 MS components reported in Table 1) [11] have an increasing occurrence of ED [12], [13]. Recently, the concept that MS is also associated with male hypogonadism has emerged [3], [14], [15]. Because androgen deficiency can induce ED, or might modulate clinical response to therapy with phosphodiesterase-5 inhibitors [16], [17], [18], [19], we studied the prevalence and psychobiologic characteristics of MS and its possible correlation with hypogonadism, in a large series of patients (>800) consulting for sexual dysfunction.
Section snippets
Methods
A consecutive series of 803 patients, visiting our University Outpatient Clinic for the first time for sexual dysfunction, was studied. All patients were white. Two patients with mental retardation and seven patients unable to clearly understand the national version of Structured Interview on Erectile Dysfunction (SIEDY) [20] were excluded. The diagnosis of MS was made on the basis of NCEP-ATP-III criteria as previously described [11].
Patients were interviewed prior to the beginning of any
Results
Among the 803 patients studied (mean age, 53.6 ± 12.1 yr), 749 (93.3%) reported ED, 294 (36.6%) HSD, 206 (25.7%) PE, and 39 (4.8%) DE. The diagnosis of MS was made when three or more MS components (NCEP-ATP-III criteria) shown in Table 1 were present. In this population, 118 (14.7%) patients had no MS components, 244 (30.4%) had one MS component, 205 (25.5%) had two MS components, and 236 (29.4%) had MS (137 patients [17.0%] had three components and 99 [12.4%] had four or more MS components).
Discussion
MS (visceral obesity, high triglycerides/low HDL cholesterol, hyperglycaemia, and hypertension) has been proposed as identifying individuals with increased metabolic and cardiovascular risk. We now report its challenging association with male sexual health disorders and define its hormonal and psychobiologic correlates.
Although the relationship between cardiovascular risk factors and impaired sexual health has been known for at least two decades, in this study we report the specific association
Conclusion
Among patients with sexual dysfunction, those with MS are characterized by the worst erectile function. Recognising MSASD is not only important for improving their sexual life, but also for alerting patients and physicians on the potential cardiovascular and metabolic risks often associated with this condition. In addition, recognising MSAH is equally important for the treatment of hypogonadism, which, without the appropriate therapy, can further compromise both sexual and general health,
Acknowledgements
We would like to thank Csilla Krausz, Angela Magini, Alessandra D. Fisher, Andrology Unit of the University of Florence, and M. Bartolini, Radiology Unit of the University of Florence, for their helpful clinical collaboration during the course of the study. This study was partially supported by a grant from Centro di Ricerca Trasferimento ad Alta Formazione MCIDNENT of the University of Florence.
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G. Corona and M. Mannucci contributed equally to the paper.