DISCUSSION
Sexual dysfunction in women has a multifactorial etiology, including
psychosocial factors and the difficulty of marital relationships, but
the relationship between sexual function and obesity remains
unclear.18 Female sexual dysfunction is reported in
40% of women in the United States.19 However, the
prevalence of FSD in women of reproductive age may vary due to different
geographical and cultural factors. In Turkey, previous studies reported
the FSD prevalence between 46.9% and 53.2%.20
Consistent with these reports, a slightly higher rate of FSD with 56.9%
was reported in this study. Obesity is generally assessed using
anthropometric measurements such as WC and BMI. Considering the WC, only
several reports investigated the impact of increased WC levels on female
sexual function. We recently showed that WC was not a reliable marker
for erectile dysfunction in sexually active men. In that report, the WC
failed to show the real burden of body fat because it only measures the
subcutaneous adipose tissue.21 Unlike many studies in
men, only a few conflicting reports have been reported investigating the
relationship between WC and FSD in women. The present study showed that
the WC was not a good predictor for all the subdomains of FSD in women
with a sensitivity of 53.3% and specificity of 54.4%, as shown in Fig.
1 and Table 5 (OR=1.019, p=0.318). Data provided by Paningbatan et al.
similarly showed that greater WC than 35 inches was not associated with
FSD.22
Contrary to these reports, Trompeter et al. stated that women with high
WC were more sexually inactive than those with low
WC.23 In another report, the WC was shown to decrease
vaginal orgasm.24
In our opinion, only a few studies with limited data have been conducted
in the literature showing the relationship between WC and FSD.
Therefore, further studies are needed to reach satisfactory results in
this regard.
BMI’s sensitivity and specificity are low due to individual differences
such as age, gender, race, muscle mass, and fluid intake
habits.25 Our results showed that BMI did not affect
the female sexual function index (OR=0.983, p=0.742). Conflicting data
have been published regarding the BMI and FSD. Some authors reported
significant relationships between the BMI and the
FSD.26
Besides, some authors stated that the BMI affected some of the
subdomains of female sexual function. Rabeipoor et al. stated that BMI
only affected sexual satisfaction but did not impair sexual function in
overweight or obese women.27 Another study showed that
the BMI impaired arousal, lubrication, orgasm and satisfaction, whereas
the desire and pain scores remained stable28. However,
some authors reported similar FSFI scores between the obese women and an
age-matched control group.29
When interpreting data on BMI and FSD, one should keep in mind that BMI,
as an anthropometric measure, may cause different results in different
individuals for various reasons.
Recent reports showed a significant correlation between visceral
adiposity index and male sexual function.13 Although
many disciplines other than andrology carried out numerous studies on
VAI, as far as we know, the current study is the first in the English
literature investigating the relationship between the FSD and VAI.
Studies previously conducted in our clinic showed that each integer
increase of VAI in men increased the likelihood of erectile dysfunction
by 1.4 times. The VAI, especially in those with metabolic syndrome, was
two-fold higher than those without metabolic
syndrome.21
Considering the VAI level of less than or greater than 4.45; our results
showed that arousal, satisfaction and pain scores remained stable,
whereas desire, lubrication and orgasm scores were lower (Table 5).
Although the VAI scores were similar in both groups, a significant
decrease in the arousal, satisfaction and pain scores did not reach a
statistical significance in the logistic regression analysis in
individuals with higher VAI values regardless of the groups. This
study was conducted based on anthropometric (such as WC, BMI, VAI) and
biochemical parameters. Besides the low number of participants, one of
the reasons the logistic regression analysis could not show the VAI as a
risk factor can be attributed to its anthropometric basis. In this
context and the psychogenic situation, the lack of consideration of
various factors such as parity, number of births, birth type, partner
characteristics, comfort during the sexual relationship, and privacy
issues can be perceived as limiting factors. Although it may be
considered a limiting factor, providing the parameters mentioned above
is challenging, especially in populations where sexual privacy is at the
forefront. Multiparity was associated with less orgasmic and pain
problems compared to nulliparity.30 With psychological
and biological aspects, childbirth has an essential impact on female
sexual function.31
Female sexual dysfunctions related to MeTS may be a messenger of severe
conditions such as cardiovascular and cerebrovascular
diseases.32 The relationship between the MeTS and FSD
has been studied in several studies. Di Francesco et al. showed that
MeTS was associated with a higher prevalence of low sexual desire,
orgasm and satisfaction than those without MeTS.33Metabolic syndrome has been reported to cause reduced vaginal
engorgement via neuropathy and pelvic vascular
injury.34 Excessive adipose tissue accumulation is
strongly associated with MeTS. As a continuous process, adipogenesis
works not only for energy storage but also for immune and endocrine
functions. Therefore increased adipogenesis may result in inflammatory,
immune and cardiovascular disorders secondary to
MeTS.33
Based on this, it is thought that MeTS may affect female sexual function
by disrupting oxygenation by reducing pelvic blood flow through chronic
vascular inflammation, oxidative stress and atherosclerosis that can
explain the higher rate of FSD in postmenopausal and premenopausal
relatively older women.35
In the present study, logistic regression analysis showed that the Odds
ratio between MeTS and FSD was 2.27, which could not reach statistical
significance (p = 0.153). This finding can be explained by the
relatively young patients in this study and the relatively low number of
participants (six were in Group 1 group (8.8% and 19 were in Group 2
(17.8%). Unlike other anthropometric variables such as BMI and WC, our
opinion is that the significant decrease in desire, lubrication and
orgasm scores is remarkable considering the VAI> 4.45.
Nevertheless, although the presence of MetS was not reached statistical
significance in this study, it may have a higher impact on FSD compared
to other possible risk factors in a higher cohort of participants.