PATIENTS AND METHODS
Following the local ethics board’s approval (B.30.2.ODM.0.20.08/501), of the 213 heterosexual sexually active women of reproductive age, 158 were included in the study. Women with the following conditions were excluded from the study: neurological (n=19), psychiatric (n=9), hormonal (n=17), gynecological surgery including bilateral oophorectomy (n=9), and malignant gynecological disease (n=4). Patients were informed about the study, and informed consent was obtained. Sexual function was evaluated using the Turkish-version of the Female Sexual Function Index (FSFI), which consists of 17 questions provided by the Turkish Society of Andrology. According to the FSFI, higher the FSFI scores indicate better sexual functioning that includes 19 questions on six topics, including sexual desire (first two questions), arousal (questions 3 to 6), lubrication (questions 7 to 10), orgasm (questions 11 to 13), satisfaction (questions 14 to 16), and pain (questions 17 to 19). The lowest score is 2, and the highest score is 36. The total FSFI score under 26.55 was accepted as FSD.16 Women with BMI <25 kg/m2 were considered healthy weight (BMI-1), those between 25.0-29.9 kg/m2 were overweight (BMI-2) and those with a BMI greater than 30 kg/m2obese (BMI-3). The WC was measured at the level of the umbilicus in cm. The WC lower than 90 cm was considered healthy (WC-1), and WC > 90 cm was considered an obesity-related condition (WC-2). The VAI was calculated using the formula WC / (36.58 + (1.89 x BMI) x (TG / 0.81) x (1.52 / HDL).16 Regarding the individual domains, a domain score of zero indicates that the respondent reported having no sexual activity. Different ”factors” have been created for all domains. The factors for desire, arousal, and lubrication and orgasm, satisfaction and pain are 0.6, 0.3, and 0.4, respectively. Individual scores of the domains were multiplied by the corresponding domain factor. The total FSFI score varies from 2 to 36, and scores equal to or higher than 26.55 show normal female sexuality, and when a respondent’s total scale score was below 26.55, FSD is considered. Sixty-eight women with normal sexual function were included in Group 1 group, and 90 women with sexual dysfunction were assigned to Group 2. Age, length, body weight, body mass index (BMI), waist circumference (WC), comorbidities such as hypertension, diabetes and coronary artery disease, hormonal disease, drug use, smoking in pack/year, and alcohol consumption were recorded. Serum high-density lipoprotein (HDL) and triglyceride (TG) levels were recorded. Total FSFI measured the sexual function, and individual scores of sexual desire, arousal, lubrication, orgasm, satisfaction and pain subdomains were calculated.
MeTS criteria are described according to the National Cholesterol Education Program.17
A waist circumference of greater than 102 cm,
  1. Triglyceride level higher than 150 mg/dL, or receiving treatment for hypertriglyceridemia,
  2. HDL cholesterol of less than 40 mg/dL,
  3. Systolic blood pressure higher than 130 mm Hg, or diastolic blood pressure higher than 85 mm Hg, or receiving antihypertensive treatment
  4. Fasting glucose level greater than 100 mg/dL, or receiving treatment for hyperglycemia.