Corona_Cardiology_book_temp 15/03/2010 12:32 Page 73
Erectile Dysfunction
Obesity and Erectile Dysfunction
Giovanni Corona,
1,2
Giulia de Vita,
1
Alessandra Sforza
2
and Mario Maggi
1
1. Sexual Medicine and Andrology Unit, Department of Clinical Physiopathology, University of Florence; 2. Endocrinology Unit, Maggiore-Bellaria Hospital, Bologna
Abstract
Even though obesity and erectile dysfunction (ED) are often co-morbid, the association between obesity and ED has not been completely
clarified. The aim of this article is to review the role of obesity in the pathogenesis of ED. Obesity and obesity-related morbidities may influence
erectile function, impairing penile vascular flow and testosterone production. Obesity-associated hypogonadism can further exacerbate ED,
adding typical symptoms such as hypoactive sexual desire. In addition, mood disturbances, frequently associated with obesity, can play an
important role. Current evidence supports the concept that obesity-related co-morbidities can affect erectile function more than obesity itself.
Conversely, fat mass represents an independent risk factor for male hypogonadism, although low testosterone levels could contribute to the
accumulation of excess fat, thus establishing a vicious cycle. Recognising, through ED, underlying conditions such as hypogonadism and/or
diabetes/metabolic syndrome may be a useful motivation for men to improve their health-related lifestyle choices. Encouraging changes in
lifestyle, such as diet or physical exercise, can improve not only men’s overall health but also their sexual health.
Keywords
Obesity, erectile dysfunction, hypogonadism, structured interview on erectile dysfunction (SIEDY)
Disclosure: The authors have no conflicts of interest to declare.
Received: 25 October 2009 Accepted: 15 December 2009
m.maggi@dfc.unifi.it
A recent comprehensive review of population-based studies (40 Until the last decade, the risk associated with overweight and obesity
separate cohorts) on the prevalence and/or incidence of the most had been widely underestimated. Large prospective epidemiological
common endocrine and metabolic disorders in the US indicates that investigations, including the Framingham,
6
National Health and Nutrition
obesity and erectile dysfunction (ED) are at the top of the list for Examination Surveys
7
and Prospective Cardiovascular Munster
8
studies,
men.
1
Even though obesity and ED are often co-morbid, the true have clearly demonstrated that overweight and obesity are independent
dimensions and direction of this association have yet to be defined. factors associated with increased mortality in men. They have shown that
While there are indicators that obesity may cause ED, it is still this is due largely to coronary arteriosclerosis or other cardiovascular
unknown whether ED might cause obesity.
2
These points will be diseases. Moreover, the same studies have shown that the prevalence of
discussed in more detail below. obesity has dramatically increased in both the US
6,7
and Europe,
8
creating
a new, important burden for the medical community.
Obesity and Associated Morbidities
Obesity is defined as an excess of body fat in relation to other body Besides cardiovascular diseases, obesity can have detrimental health
components. For adults, obesity and overweight have been defined by effects on almost every major organ system, including an increased
the National Institutes of Health by using weight and height to risk for certain cancers.
9
In the last 40 years, obesity rates in the US
calculate the body mass index (BMI, measured in kg/m
2
).
3
According to have more than doubled,
7
suggesting that current efforts to prevent it
BMI scores, normal weight is 18.5–24.9, overweight is 25.0–29.9, class have been unsuccessful. Given the rapid increase in the prevalence of
I obesity is 30.0–34.9, class II obesity is 35–39.9 and class III obesity is obesity, and its consequent burden on the individual as well as on
≥40.0.
3
Patients with class III obesity, or class II in the presence of at society, the focus should be on how to prevent the obesity epidemic.
least one other significant comorbidity, are also classified as affected The authors strongly believe that emphasising the link between male
by morbid obesity.
3
potency and obesity will help to induce profound lifestyle changes,
including increased physical activity and dietary modification to eat
Obesity is a problem that nowadays has reached epidemic healthier food, ultimately leading to weight reduction.
proportions, with more than two-thirds of the US adult population
estimated to be overweight or obese.
4
Although obesity should be Obesity and Erectile Dysfunction
considered as a global problem, it is important to note that it is The link between obesity and male potency dates back to the Byzantine
unequally distributed among and within countries. In fact, obesity is era, when it was thought that a large stomach impaired a man’s ability
more common among socially disadvantaged groups in upper-income to have sexual intercourse.
10
So far, however, the association between
economies, with an inverse distribution in low-income countries.
5
obesity, sedentary lifestyle and ED has not been completely clarified.
11,12
© TOUCH BRIEFINGS 2009 73
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92 |
Page 93 |
Page 94 |
Page 95 |
Page 96 |
Page 97 |
Page 98 |
Page 99 |
Page 100