• Mustafa Suat Bolat, Fatih Kocamanoglu, Mustafa Latif Ozbek, Recep Buyukalpelli, and Ramazan Asci.
• Urology Clinic, Gazi State Hospital, Samsun, Turkey. Electronic address: msbolat@gmail.com.
• J Sex Med. 2020 Oct 1; 17 (10): 1926-1933.

BackgroundTo our knowledge, there is no study in the literature that has investigated a cutoff value of the visceral adiposity index (VAI) for erectile dysfunction (ED) in men.AimTo show a possible relationship between ED and VAI levels representing adipose tissue dysfunction and to identify a cutoff value of the VAI for ED.MethodsThis prospective cross-sectional study included 276 participants in 5 groups: non-ED, mild ED, mild-moderate ED, moderate ED, and severe ED. The VAI was calculated. Fasting glucose, triglyceride, high-density lipoprotein, testosterone (T), prolactin, and estradiol were measured. Erectile function, sexual satisfaction, orgasm, desire, and general satisfaction scores were recorded using the International Index of Erectile Dysfunction 1-15 questionnaire. The participants were divided into BMI1 (<25.0), BMI2 (25-29.9), and BMI3 (>30.0) categories based on body mass index (BMI) and WC1 (<94 cm), WC2 (94-102 cm), and WC3 (>102 cm) categories based on waist circumference (WC).OutcomesThe VAI was investigated as an independent risk factor for ED, compared with BMI and WC.ResultsThe median VAI progressively increased, but a marked increase was recorded in groups 4 and 5 (P = .001). A significant increase in ED was observed for a VAI score higher than 4.33 (P = .001). Each integer increase of the VAI was associated with a 1.3-fold increased risk of ED. The odds ratio of ED for the VAI = 4.33 was 4.4 (P < .001). The WC and BMI significantly increased as the degree of ED increased (P = .001), but statistical analysis showed a significant decrease only in moderate and severe ED groups (P < .05). Starting from non-ED patients, serum triglyceride increased and high-density lipoprotein decreased progressively in all ED groups (P = .001). T/E2 slightly reduced as the severity of ED increased (P > .05). T decreased in ED groups (P = .022). Regardless of the ED level, other sexual subdomains decreased in ED patients (P = .001). The ED rates in 3 increasing BMI and WC categories were similar (P > .05). For VAI = 4.33, BMI ≥ 30.0 kg/m2, and WC > 102 cm, sensitivity and specificity were 61.2% and 73.8%, 31.6% and 90.5%, and 54.3% and 69.0%, respectively.Clinical ImplicationsThe VAI should be considered as a reliable independent risk factor for ED as a predictor of visceral adipose dysfunction.Strengths & LimitationsThe main strength is that this is the first study to investigate the association between the VAI and sexual dysfunction in men. The low number of participants is the limiting factor.ConclusionThe findings suggest that the VAI can be used as a reliable independent risk factor marker for ED as a predictor of visceral adipose dysfunction. Bolat MS, Kocamanoglu F, Ozbek ML, et al. Can High Visceral Adiposity Index Be a Risk Factor for Sexual Dysfunction in Sexually Active Men? J Sex Med 2020;17:1926-1933.Copyright © 2020. Published by Elsevier Inc.

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