The epidemic of obesity has been linked to erectile dysfunction by medic the world over, a condition which decreases the quality of life of more than 30 million middle-aged men in the United States alone. This connection has been shown in many epidemiological studies where obese people often register a high frequency of difficulty with sexual activities. Such studies have established that, men with increased Body Mass Index have a higher risk of erectile dysfunction (ED) than men with normal weight. And quit interestingly, 4 out of 5 people who report symptoms of ED are also overweight or obese. It has been estimated that the sexual dysfunction of a morbidly obese man is the same as a normal weight man 20 years older.
Now the pertinent question is why is obesity a risk factor for erectile dysfunction? Despite the increasing evidence that obesity is connected to impotence, it is still not well understood how exactly carrying extra weight leads to decreased sexual performance. However scientists and medical experts have suggested that the following mechanisms mediate obesity’s negative effects on sexual function.
Obese men usually feel uncomfortable with their body. Many men dealing with obesity have a lower self-esteem. Obese people are also encountered with discrimination and prejudice in social situations. This combination of negative body image and social stigmatization may indirectly pose social and psychological barriers to having sexual functions performed satisfactorily. Anxiety, emotional distress and depression are common feelings among obese people with depression being a risk factor for erectile dysfunction therefore depression can cause ED, which may increase the severity of depressive symptoms. Meanwhile the social and psychological obstacles that obese men face are not the only factors causing sexual problems. Studies have shown that erectile dysfunction in obese men has a direct biological origin.
The relationship between obesity and erectile dysfunction becomes apparent if one understands two things; how important blood flow is for normal sexual function and how obesity affects the vascular system.
Penile erection is the result of increased blood flow. The increase in blood flow required for erection is comparable to the quantity your entire body would need from your heart when you engage in rigorous physical activity. This therefore makes the ability of a man to develop and maintain penile erection to depend on the health of his circulatory system i.e. the vessels that carry our blood. In other words, inability of the penis to get erected has to do with how healthy the penile vasculature is. Any condition like blocked vessels, etc. that disturbs blood flow interferes with normal erectile function.
Key to the normal function of the vascular system is the endothelium—the thin layer of cells that line the interior surface of all blood vessels, from the heart to the tiniest capillary. Any factor that contributes to endothelial dysfunction reduces the vascular hemodynamics and impairs the normal erectile physiology.
Obesity is a major risk factor for vascular disease and endothelial dysfunction and it happens this way fat tissue is an endocrine organ that secretes many bioactive substances (adipokines). The concentration of these molecules in the blood is higher the more obese a person is. There is evidence that adipokines secreted from fat stores surrounding penile vessels cause inflammation that has a damaging effect on the vascular endothelium, contributing to ED.
Obesity leads to atherosclerosis—the buildup of a waxy plaque on the interior of blood vessels. When atherosclerosis occurs in the penile artery with a small diameter of 1-2mm the blood flow decreases or gets blocked, diminishing erectile function. This harmful effect of obesity on the circulatory system can be irreversible and it implies that obesity can have a lasting detrimental effect on the penile vasculature of middle-age men.
Hypogonadism is when the production of male hormones (androgens) by the testes is below normal. A low level of testosterone, the main androgen, is a condition prevalent in obese men. How does hypogonadism relate to ED? Testosterone is a hormone that increases sexual interest and sexual activity. Studies have shown that low levels of testosterone plays a critical role in erectile dysfunction. Animals where the testicles have been removed, and therefore can no longer produce testosterone, are unable to achieve erections. In hypogonadic men, testosterone therapy has been shown in many cases to restore erectile function. Obesity is a risk factor for androgen deficiency and this directly affects the function of the male sexual organ.
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