Corona Giovanni, Rastrelli Giulia, Filippi Sandra, Vignozzi Linda, Mannucci Edoardo, Maggi Mario
Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy.
Asian J Androl. 2014 Jul-Aug;16(4):581-91. doi: 10.4103/1008-682X.126386.
Erectile dysfunction (ED) is a frequent complication of obesity. The aim of this review is to critically analyze the framework of obesity and ED, dissecting the connections between the two pathological entities. Current clinical evidence shows that obesity, and in particular central obesity, is associated with both arteriogenic ED and reduced testosterone (T) levels. It is conceivable that obesity-associated hypogonadism and increased cardiovascular risk might partially justify the higher prevalence of ED in overweight and obese individuals. Conversely, the psychological disturbances related to obesity do not seem to play a major role in the pathogenesis of obesity-related ED. However, both clinical and preclinical data show that the association between ED and visceral fat accumulation is independent from known obesity-associated comorbidities. Therefore, how visceral fat could impair penile microcirculation still remains unknown. This point is particularly relevant since central obesity in ED subjects categorizes individuals at high cardiovascular risk, especially in the youngest ones. The presence of ED in obese subjects might help healthcare professionals in convincing them to initiate a virtuous cycle, where the correction of sexual dysfunction will be the reward for improved lifestyle behavior. Unsatisfying sexual activity represents a meaningful, straightforward motivation for consulting healthcare professionals, who, in turn, should take advantage of the opportunity to encourage obese patients to treat, besides ED, the underlying unfavorable conditions, thus not only restoring erectile function, but also overall health.
勃起功能障碍（ED）是肥胖常见的并发症。本综述的目的是批判性地分析肥胖与ED的框架，剖析这两种病理实体之间的联系。目前的临床证据表明，肥胖，尤其是中心性肥胖，与动脉源性ED和睾酮（T）水平降低有关。可以想象，肥胖相关的性腺功能减退和心血管风险增加可能部分解释了超重和肥胖个体中ED患病率较高的原因。相反，与肥胖相关的心理障碍似乎在肥胖相关ED的发病机制中不起主要作用。然而，临床和临床前数据均显示，ED与内脏脂肪堆积之间的关联独立于已知的肥胖相关合并症。因此，内脏脂肪如何损害阴茎微循环仍不清楚。这一点尤为重要，因为ED患者的中心性肥胖将个体归类为心血管高风险人群，尤其是最年轻的患者。肥胖患者中ED的存在可能有助于医护人员说服他们启动一个良性循环，即性功能障碍的纠正将是改善生活方式行为的回报。不满意的性活动是咨询医护人员的一个有意义、直接的动机，反过来，医护人员应利用这个机会鼓励肥胖患者除了治疗ED外，还要治疗潜在的不利状况，从而不仅恢复勃起功能，还能恢复整体健康。
