11 - Obesity and Sexual Dysfunction in Men

Abstract

Prevalence of obesity has been rising over last several decades. Link between increased risk of diabetes mellitus (DM), hypertension (HTN), cardiovascular events and obesity has been well established. Recently it has been recognised that obesity can have negative impact on testosterone levels, erectile function, sex drive and orgasmic function. Long-lasting complications of obesity such as DM, HTN and peripheral vascular disease are better predictors of sexual dysfunction than body mass index itself. Endothelial dysfunction, pro-inflammatory state and low testosterone are common denominators of sexual dysfunction and cardiovascular events in obese men. Therapy should focus on aggressive reduction of weight, exercise and tight glycaemic control. Testosterone replacement therapy may be considered in hypogonadism. Oral 5-phospodiesterase inhibitors are effective in improving erectile dysfunction in obese men. Further research is needed to better understand pathophysiology and to develop optimal treatment algorithms for obese men who suffer from sexual dysfunction.