Introduction
In men, sexual function is provided by the central and peripheral
nervous system’s harmonious work together with hormonal mechanisms and
vascular systems. The sexual function covers the erectile, orgasmic,
desire, ejaculatory components in addition to sexual and general
satisfaction. Although erectile dysfunction (ED) is managed as a sexual
problem, it can be a messenger of impending significant circumstances
such as coronary artery disease [1]. Some modifiable and
nonmodifiable risk factors, including increasing age and metabolic
syndrome (MeTS), may negatively affect sexual function [2,3]. The
current opinion in medicine is to take preventive measures before the
complications develop against diseases that can lead to lifelong
comorbidities [4]. The MeTS, which is associated with many
conditions, can also cause ED. For men, at least three of the modifiable
criteria are sufficient for the diagnosis of MeTS (Table 1) [5].
Increased fat accumulation without the diagnosis of MeTS also causes
sexual dysfunction in men by decreasing the quality of life and damaging
the vascular endothelial mechanism via increased amounts of inflammatory
products, including cytokines, adipokine, and fatty acids cause nitric
oxide insufficiency [6]. Although cavernous arteries are slowly
affected by the atherosclerotic process, early diagnosis of ED remains
important before irreversible damage develops [7]. Due to the body
mass index (BMI) and waist circumference (WC) cannot homogenously
compute the fat distribution [8], a decade ago, the gender-specific
visceral adiposity index (VAI) was first introduced by Amato et al. as
an indicator of adipose tissue dysfunction, which combines HDL
cholesterol, triglyceride, BMI and WC in a formula [9]. Based on the
limited number of studies investigating the relationship between VAI and
ED, we recently demonstrated a 1.3-fold increased risk of ED in response
to each integer increase of VAI [10]. However, a debate is still
open whether male sexual dysfunction could be recovered when the
correctable risk factors are adequately managed and when the VAI level
is decreased.
In this study, we aimed to show the impact of the MeTS on male sexual
functions based on VAI. We also aimed to highlight the importance of
seeking the urologists to receive comprehensive support from different
disciplines and professional partners to manage life-long or correctable
comorbidities that negatively affect erectile dysfunction.