The Metabolic Syndrome and Sexual Problems in Women

Summarized by Robert W. Griffith, MD
August 3, 2005

Introduction

Men are more likely to have erectile dysfunction (ED) if they are overweight, or diabetes. These represent components of the metabolic syndrome, and so Italian researchers have examined women with female sexual dysfunction (FSD) to see if they have a greater likelihood of having the syndrome.

FSD consists of diminished desire, arousal, and orgasms, with increased pain on intercourse. It's estimated that up to 43% of women in the USA have such symptoms, if questioned, but only 24% actually complain of FSD as a distressing disorder (see first link below). The researchers decided, therefore, to use self-reporting techniques to assess the presence of FSD in women with the metabolic syndrome, and compare their findings with controls in the general population. Their results are published in the International Journal of Impotence Research, and are summarized here.

What was done

Premenopausal women with the metabolic syndrome were identified among those attending the University of Naples Hospital. The metabolic syndrome was defined as the presence of at least 3 of the following:

• Abdominal obesity - waist circumference greater than 102 cm (40 inches) in men, or 88 cm (35 inches) in women
• Blood triglyceride level 150 mg/dL or above (1.69 mmol/L or above)
• HDL-cholesterol 40 mg/dL (1.03 mmol/L) or below in men, or 50 mg/dL (1.29 mmol/L) or below in women
• High blood pressure - 130/85 mm Hg or higher, or taking blood pressure medication
• High fasting glucose level - 110 mg/dL (6.1 mmol/L) or above

(If you want to see if you may have the metabolic syndrome, go to the second link below.)

Women with diabetes, cardiovascular disease, and other major conditions were excluded. A control group of 100 women without the metabolic syndrome were enrolled as controls, having been carefully matched to the first group with regard to age, smoking status, and premenopausal status.

Sexual function was assessed using the Female Sexual Function Index (FSFI), a recognized 19-item questionnaire. The maximum score for this scale is 36. Sexual function was considered good if the score was 30 or above, intermediate if between 23 and 29, and poor if below 23.

Lab tests included blood lipids and C-reactive protein (CRP), which serves as a marker for inflammatory processes in the body.

What was found

There were 120 women with the metabolic syndrome, and 80 'matched control' women without the syndrome. Their average age was 40.

Compared with the control group, women with the metabolic syndrome averaged lower FSFI scores: 23.2 vs. 30.1 for the controls. The percentage of women in the three scoring levels 'good', 'intermediate' and 'poor' are shown in the table below:

FSFI Scores	Metabolic Syndrome	Controls
Good: 30 or over	56%	79%
Intermediate: 23 to 29	37%	19%
Poor: less than 23	9%	2%

In addition to the significant differences in FSFI scores, the women with metabolic syndrome had, on average, higher CRP levels than the controls: 2.2 vs. 0.8 mg/L.

What this means

Although it's tempting to equate the metabolic syndrome sexual findings in men with those in women, it would be wrong. Erectile dysfunction is usually related to vascular, neurological, or medication-induced factors affecting the small arteries supplying the penis. FSD, on the other hand, is much more complex, with many possible causes; often there is a strong emotional component.

The role of raised CRP levels in these women with FSD is interesting. The researchers believe it may play an important part - in which case one might expect that sildenafil (Viagra^®) would be an effective therapy, which it's not, in fact. It's likely that the emotional factors in women have a more prominent function that overrules any benefits that Viagra might bring.

Having the metabolic syndrome may mean the patient has one of the 'factors' - a waist size over 35 inches. If this is the case, correcting it (by diet and exercise) will help improve the woman's appearance, and may thus contribute to a more satisfactory sex life. In any case, fighting all the metabolic syndrome factors is beneficial for a longer life, and well worth doing. An improved sex life would be an added bonus.

Source

• The metabolic syndrome: a cause of sexual dysfunction in women. K. Esposito, M. Ciotola, R. Marfella,  et al., Int J Impot Res, 2005, vol. 17, pp. 224--226

Related Links
Just How Common Are Sex Problems in Women?
Do You Have the Metabolic Syndrome?
Loss of Sexual Desire in Women

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