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.