World J Mens Health.  2019 May;37(2):138-147. 10.5534/wjmh.180026.

Obesity and Erectile Dysfunction: From Bench to Clinical Implication

Affiliations
  • 1Department of Urology, Yeungnam University College of Medicine, Daegu, Korea.
  • 2Department of Physiology, Yeungnam University College of Medicine, Daegu, Korea. ywkim@med.yu.ac.kr

Abstract

Obesity is a major public health issue worldwide and is frequently associated with erectile dysfunction (ED). Both conditions may share an internal pathologic environment, also known as common soil. Their main pathophysiologic processes are oxidative stress, inflammation, and resultant insulin and leptin resistance. Moreover, the severity of ED is correlated with comorbid medical conditions, including obesity. Therefore, amelioration of these comorbidities may increase the efficacy of ED treatment with phosphodiesterase 5 inhibitors, the first-line medication for patients with ED. Although metformin was originally developed as an insulin sensitizer six decades ago, it has also been shown to improve leptin resistance. In addition, metformin has been reported to reduce oxidative stress, inflammatory response, and body weight, as well as improve ED, in animal and human studies. Moreover, administration of a combination of metformin and phosphodiesterase 5 inhibitors improves erectile function in patients with ED who have a poor response to sildenafil and are insulin resistant. Thus, concomitant treatment of metabolic derangements associated with obesity in patients with ED who are obese would improve the efficacy and reduce the refractory response to penile vasodilators. In this review, we discuss the connecting factors between obesity and ED and the possible combined treatment modalities.

Keyword

Erectile dysfunction; Metformin; Obesity; Phosphodiesterase 5 inhibitors

MeSH Terms

Animals
Body Weight
Comorbidity
Erectile Dysfunction*
Humans
Inflammation
Insulin
Leptin
Male
Metformin
Obesity*
Oxidative Stress
Phosphodiesterase 5 Inhibitors
Public Health
Sildenafil Citrate
Soil
Vasodilator Agents
Insulin
Leptin
Metformin
Phosphodiesterase 5 Inhibitors
Sildenafil Citrate
Soil
Vasodilator Agents
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