Materials and Methods
After obtaining the Institutional Board approval of the XXX Local Ethics
Committee, this prospective study was conducted among patients at
outpatient urology clinics at four centers (A Hospital, B University, C
Hospital and D City Hospital). Written informed consent was obtained.
After a power analysis, a total of 285 sexually active men with complete
data from 298 participants were included in the study. Patients with
incomplete data (n = 3), active neurological disorders (n = 4),
unwilling to participate (n = 1), end-stage renal failure (n = 1), those
with a history of total thyroidectomy (n = 2) and patients with
urogenital cancer surgery (n = 2) were excluded from the study. Patients
with sexual dysfunction who met or did not meet the MeTS criteria, those
who applied to the urology clinic with complaints of sexual dysfunction
and those who were referred from Internal Medicine and Endocrinology
clinics were included in the study. Participants were given the
Turkish-validated 15-items long-form of the International Index of
Erectile Dysfunction (IIEF) questionnaire to fill under a urologist’s
supervision. Erectile function was assessed using the IIEF 1-5 and 15th
items; sexual satisfaction, orgasmic function, sexual desire and general
satisfaction were assessed using the IIEF 6-8th, 9-10th, 11-12th 13-14th
items, respectively. Participants with IIEF 1–5 and 15 scores ≥26 were
defined as non-ED patients, those with IIEF 1–5 and 15 score = 22–25
were mild ED, IIEF 1–5 and 15 scores = 17–21 were mild-to-moderate ED,
IIEF 1–5 and 15 scores = 11–16 were moderate ED, and IIEF 1–5 and 15
scores = 0–10 were defined as severe ED. The BMI was calculated using
the kg/m2 formula. Waist circumference measurement was performed at the
level of the umbilicus. The mean age of the patients and comorbidities,
including hypertension and diabetes mellitus, medications, smoking and
alcohol habits, and ED duration, were recorded. The VAI was calculated
using [(WC / 39.68) + (1.88 x BMI)] x TG / 1.03 x 1.31 / HDL male
sex-specific formula [9]. The mean sexual satisfaction, orgasm,
desire and general satisfaction scores were calculated. Among the
participants, 96 patients with MeTS criteria were defined as Group 1 and
189 with no MeTS criteria were defined as Group 2. Using the
enzyme‐linked immunosorbent assay (ELISA), single hormonal analysis for
total testosterone (T), prolactin (PRL), estradiol (E2) tests were
performed from morning fasting venous blood samples when needed.
Aromatase activity was calculated using the T/E2 formula where available
[11]. The mean VAI, erectile function score, sexual satisfaction,
orgasm, desire and overall satisfaction scores were statistically
compared between the groups.