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Top of pageAbstractTo explore the prevalence and risk factors of female sexual dysfunction (FSD) in Iran. In prior posts, I have described the results of countless research, including my own studies which suggest that independent of how much you weigh – the location of that excess storage is a key determinant of your health risk. Additionally, it has also been known that for a given size of your belly – the smaller your hips or thighs, the greater your risk of a number of diseases.
All this evidence is often simplistically summed up as the difference between apple (android) or pear-shaped (gynoid) obesity, with the latter being largely benign. A very recent study published in the British Medical Journal has investigated the influence of thigh circumference on prospective risk of cardiovascular disease and death, and the results are making quite a few headlines. In the study, Heitmann and Frederiksen assessed longitudinal (over time) data on 1436 men and 1380 women looking for occurrence of cardiovascular disease and mortality. Over the approximately 10 years of follow-up, 257 men and 155 women died while 263 men and 140 women developed cardiovascular disease.
The authors found that for a given body mass index (BMI) or waist circumference, men and women with smaller thighs had an increased risk of dying and of developing cardiovascular disease compared to those with larger thighs. The explanation for why smaller thighs may predispose someone to a risk of cardiovascular disease or mortality is still up in the air.
However, there is another plausible explanation for these findings, which the authors did not at all explore. In other words, our results suggest that the risk of disease and death associated with a small thigh circumference in the recent study, can be explained by increased storage of the dangerous visceral fat.
To get future posts delivered directly to your email inbox or to your RSS reader, be sure to subscribe to Obesity Panacea. My brother-in-law (who works with me) has such skinny legs that I'll often show them to medical residents rotating through my practice.
I am skinny overall, I am a girl, I have a thin waist and skinny legs, does this mean I'm at risk too??
Travis is an obesity researcher, Certified Exercise Physiologist, public speaker, writer and distance runner.
Peter is a published researcher, university lecturer, freelance writer, and general health enthusiast. We are PhD students in the School of Kinesiology and Health Studies at Queen's University in Kingston, Ontario. The opinions expressed here belong only to Peter and Travis and do not reflect the views of any organization.
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Treating Diabetes Video What Eat Did Gestational immediately following diagnosis your veterinarian may ask you to check your pet’s urine glucose 1 to 3 times a day Diabetes mellitus of both types I and II is The individual may complain of frequent skin infections that are slow to heal itching blurred vision tingling numbness and pain in the arms and legs. Academy of Nutrition and Dietetics New York State Dietetic Association Long Island Dietetic Association American Association of Diabetes Educators American Diabetes Association. This toxic glucose is like sludge in the bloodstream clogging Free Diabetic Monitor Competition: diabetes there is one particular diabetic test that most doctors prefer to use above all others to make the most accurate diagnosis possible. A few things I no longer eat: butter pecan ice cream fresh Though genetics play a role in determining Treating Diabetes Video What Eat Did Gestational whether you develop type 2 diabetes I was diagnosed with gestational diabetes. But the young mum was actually suffering from Type 1 diabetes and died as a result of not getting treatment for the undiagnosed Treating Diabetes Video What Eat Did Gestational condition. A total of 2626 women aged 20–60 years old were interviewed by 41 female general practitioners and answered a self-administered questionnaire on several aspects of FSD including desire, arousal, pain and orgasmic disorders (OD). Sexual dysfunction is a taboo subject in many countries that negatively affects quality of life and may often be responsible for psychopathological disturbances. No differences between ethnicity and response to FSFI questions could be demonstrated (P=0.32). Report of the international consensus development conference on female sexual dysfunction: definitions and classifications. Indeed, over the last couple of years I have published 2 separate studies which show that regardless of your weight, having a big belly (being apple shaped) can increase your risk of type-2 diabetes (men and women) as well as erectile dysfunction among men (see all pertinent studies discussed in this post below). However, there was a threshold for this effect, such that only people with thigh circumferences below approximately 60cm were at increased risk of dying. The two schools of thought suggest the problem lies in either not enough muscle mass or too little fat mass in the lower body. It would seem that if the body can't store your excess calories in the legs (where the health risk is minimal) it stores it in more dangerous depots, such as inside your belly, where the excess fat is more likely to cause trouble. Click here to subscribe to Obesity Panacea and have future stories delivered regularly to your email account or your RSS reader. Body mass index and hip and thigh circumferences are negatively associated with visceral adipose tissue after control for waist circumference.
Our research focuses on the relationships between obesity, physical activity, and health risk. However, it should be recognized that MetS itself is a poor indicator of absolute short-term CV risk because it does not contain key determinants of short-term CV risk such as age, serum cholesterol, gender, and smoking status [1]. Association between erectile dysfunction and coronary artery disease: Matching the right target with the right test in the right patient.
Erectile dysfunction prevalence, time of onset and association with risk factors in 300 consecutive patients with acute chest pain and angiographically documented coronary artery disease. The artery size hypothesis: a macrovascular link between erectile dysfunction and coronary artery disease.
Association of hypogonadism and type II diabetes in men attending an outpatient erectile dysfunction clinic. Difficulties in achieving vs maintaining erection: organic, psychogenic and relational determinants. Organic, relational and psychological factors in erectile dysfunction in men with diabetes mellitus.
Do impotent men with diabetes have more severe erectile dysfunction and worse quality of life than the general population of impotent patients? Incidence of metabolic syndrome and insulin resistance in a population with organic erectile dysfunction. NCEP-ATPIII-defined metabolic syndrome, type 2 diabetes mellitus, and prevalence of hypogonadism in male patients with sexual dysfunction.
A comparison of NCEP-ATPIII and IDF metabolic syndrome definitions with relation to metabolic syndrome-associated sexual dysfunction. Erectile dysfunction as a predictor of the metabolic syndrome in aging men: results from the Massachusetts Male Aging Study. Androgens regulate phosphodiesterase type 5 expression and functional activity in corpora cavernosa. Combining testosterone and PDE5 inhibitors in erectile dysfunction: basic rationale and clinical evidences. Androgens and diabetes in men: results from the Third National Health and Nutrition Examination Survey (NHANES III).
Testosterone restores diabetes-induced erectile dysfunction and sildenafil responsiveness in two distinct animal models of chemical diabetes.
Testosterone replacement therapy improves insulin resistance, glycaemic control, visceral adiposity and hypercholesterolaemia in hypogonadal men with type 2 diabetes. NCEP-defined metabolic syndrome, diabetes, and prevalence of coronary heart disease among NHANES III participants age 50 years and older. Assimilation and mobilization of triglycerides in subcutaneous abdominal and femoral adipose tissue in vivo in men: effects of androgens. Relation of the "hypertriglyceridemic waist" phenotype to earlier manifestations of coronary artery disease in patients with glucose intolerance and type 2 diabetes mellitus.

Effects of testosterone on body composition, bone metabolism and serum lipid profile in middle-aged men: a meta-analysis. Want to make homemade ice cream but don’t have the right equipment lying around the kitchen?
Find patient medical information for POMEGRANATE on WebMD including its uses effectiveness See what your medical symptoms could mean and learn about possible erectile dysfunction (ED) diabetes and a complication called acidosis bleeding and HIV disease. In many societies, such discussions are almost taboo; hence, these problems are often not volunteered.
Owing to different racial residents in a specific geographic area, a simultaneous ethnicity, geographical location and FSD analysis was not possible. Jen Kuk and Bob Ross, I had previously shown in another study that for a given amount of belly fat, having more fat in the buttocks, hips, and thighs was actually associated with a healthier metabolic profile among both men and women. People with thigh circumferences higher than 60cm didn’t seem to get any additional benefit from having bigger thighs. Indeed, as I briefly mentioned above, all else being equal, those with less lower body fat tend to be less healthy than those with more. Jen Kuk and I were interested in seeing what exactly a large hip or thigh circumference was predicting in reference to someone’s body composition, when other measures such as their BMI or waist circumference are also considered. Does Waist Circumference Predict Diabetes and Cardiovascular Disease Beyond Commonly Evaluated Cardiometabolic Risk Factors? Is the reduction of lower-body subcutaneous adipose tissue associated with elevations in risk factors for diabetes and cardiovascular disease? This blog is our attempt to consider the many "cures" for obesity that we read about on a daily basis. Accordingly, an attempt to use MetS for risk assessment to estimate for the short-term CV risk is a clear misuse of the syndrome [1]. Results from the Exploratory Comprehensive Evaluation of Erectile Dysfunction (ExCEED) database.
Arch Gen Psychiatry -- Early Coadministration of Clonazepam With Sertraline for Panic Disorder, July 2001, Goddard et al. Adequate treatment of diabetes as well as increased emphasis on blood pressure control and lifestyle factors such as not smoking and maintaining a healthy body weight may improve the risk profile of most of the chronic complications. The latest management recommendations for cats and dogs with nonketotic diabetes mellitus by Audrey K. If female sexuality is disturbed, the consequences it might lead to include familial discord and divorce,5 and reproduction is also affected. Prevalence of sexual dysfunction in women: Results of a survey study of 329 women in an outpatient gynecological clinic.
In a study we published in the American Journal of Clinical Nutrition, we showed that while a large hip or thigh predicts more lower body fat mass and muscle mass, it was also a predictor of LESS visceral fat – the fat inside your belly, that has been shown repeatedly to be the strongest predictor of health risk. On the other hand, the diagnosis of MetS in subjects at low-to-moderate CV risk should alert clinicians that such people deserve a more intensive lifestyle therapy at an early stage to delay progression to higher risk category [1]. FSD prevalence may vary according to cultural, racial and health variables among countries. The first looked at race effects within one geographical location and the second analysis looked at geographical effects between all 28 counties. In addition, epidemiological data represent an invaluable tool for the development of strategies and the allocation of adequate resources necessary for providing assistance for populations. Several studies have been conducted in various countries worldwide to determine the prevalence of FSD.5, 6, 7, 8 Nevertheless, few series were population based and used probabilistic samples representative of the general population. Prevalence of sexual dysfunction in new heterosexual attenders at a central London genitourinary medicine clinic in 1998.
Thirty-seven percent reported OD, 35% desire disorders (DD) and 30% arousal disorders (AD), all of which increased significantly with age. Sample sizes were determined for the 95% confidence interval (CI) with a design effect of 1.1. Table 6 shows the associations of categories of sexual dysfunction with emotional and physical satisfaction with sexual partner and with feelings of general happiness.
With a projected subject dropout rate of 10%, the total number of subjects required for study was determined to be 2626.A two-stage cluster random sampling design was used, with stratification of the primary sampling units. It accounts for about 97% of the population in this age range – roughly 70 million Iranians.
There was not a dose response in the three domains of quality of life examined with increasing severity of the latent class.
The prevalence of female sexual dysfunction and potential risk factors that may impair sexual function in Turkish women.
The primary sampling units were census sections, the secondary sampling units were dwellings, and the final sampling units were subjects.
Low level of satisfaction with partner relationship is closely associated with manifest distressing dysfunction of sexual interest, lubrication and orgasm.
Prevalence of sexual dysfunctions and correlated conditions in a sample of Brazilian women – results of the Brazilian study on sexual behavior (BSSB). The secondary sampling units or dwellings were selected using the random route procedure and a computerized generated random number list.
For many women it has been physically disconcerting, emotionally distressing and socially disruptive. Female sexual function was evaluated with a detailed 19-item questionnaire (Female Sexual Function Index (FSFI)) described by Rosen et al.10 The entire questionnaire is presented in Appendix A. This standardized questionnaire evaluates six domains of female sexual functioning during the last 4 weeks: desire, arousal, lubrication, orgasm, satisfaction and pain during sexual intercourse. The domain of female sexual AD was assessed in terms of frequency, level, confidence and satisfaction with eight questions, which was further divided into two separate domains of lubrication (four items) and arousal (four items). The female sexual function index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. In particular, it is widely recognized that T is a clear determinant of sex drive and of the motivation to seek sexual contact.
This breakdown will assess both the peripheral (lubrication) as well as the central (subjective arousal and desire) components. Several controlled and uncontrolled studies in hypogonadal men demonstrated an unequivocal role for T substitution in restoring sexual desire, spontaneous sexual thoughts, and attractiveness to erotic stimuli (see reviews [19,20]). Other domains assessed include pain (three items), orgasm (three items) and satisfaction (three items).
They may reflect medical and psychological factors, particularly in the setting of possible socioeconomic, cultural and racial differences, the clinical definition used for each dysfunction, type of trial performed (self-applicable questionnaire, mailed questionnaire, interview by phone, personal interview) and the characteristic of samples (general population vs sexuality clinics) studied.Population prevalence data are scarcer.
On the other hand, androgens act at the penile level playing an important role not only in the formation of the main relaxing factor, cGMP by regulating NOS activity, but also in the integrity of erectile apparatus [19,20]. A scoring algorithm was devised to assess each domain and a composite score, thus, generated. By adding the scores of the individual items that comprise the domain and multiplying the sum by the domain factor, individual domain scores were obtained.
This line of evidence suggests that PDE5is do not work if the target enzyme (PDE5) is lacking, explaining the necessity to overcome androgen deficiency to obtain the full responsiveness [19,20,22]. FSD was present in 49% of women, lack of sexual desire reported by 26.7%, pain during sexual intercourse by 23% and orgasmic dysfunction by 21%. Scores <65% of maximum achievable score in each domain were considered as sexual dysfunction in that domain. Castelo-Branco et al.16 assessed FSD in 534 healthy women (526 years) living in Santiago de Chile by the Laumann's test (DSM-IV).
Sexual function problems and help seeking behavior in Britain: national probability sample survey.
People living in-group quarters such as barracks and college dormitories were excluded from the study.Concerning medical history, whenever useful, information given by the patient was checked by his general practitioner with medical records. In general, our data correlate well with the above-mentioned studies.Some studies reported low prevalence of FSD. Interviewers matched respondents on various social attributes in an interview averaging 45 min.
Prevalence of sexual dysfunction in a cohort of middle-aged women: influences of menopause and hormone replacement therapy. This fact supports the role of social and cultural factors and the interrelation with the partner in the development of this dysfunction. The study protocol did not include any clinical or diagnostic procedures.Analyses performed in this study were made by the use of logistic and multinomial logistic regression.

However, a direct comparison between different studies is hampered by the lack of a uniform validated FSD questionnaire, characteristics of the study population, the method of assessment (self-applicable questionnaire, personal interview, phone interview, mailed surveys) and definitions of FSD. For assessing the prevalence of symptoms across demographic characteristics, we performed logistic regressions for each symptom. After the sample was weighted by the specified design, the percent or prevalence and population estimates of the degree of sexual dysfunction in the population and the corresponding standard errors were obtained to construct the 95% CI. A major limitation of Çayan's study is the fact that standard epidemiological sampling did not generate study population and the women were chosen from the same city, Mersin, Turkey.
To test a difference for the age categories, we used from 2 test to assess whether we have differences in the number of women who belong to each category group. On the other hand, in the Brazilian study, the studied group comprised women with an educational level (high school and college degree) higher than that of the average Brazilian woman and subjects were chosen from among weekend visitors to beaches, parks and shopping malls, and therefore the studied sample is not representative of general population.A major methodological problem when studying FSD is using the internationally accepted FSD questionnaires.
A latent class analysis (LCA) was used to evaluate the syndromal clustering of individual sexual symptoms.
Quite surprisingly, in a consecutive series of 1,134 patients with ED we demonstrated that, diabetes per se, independently of MetS, was not associated with hypogonadism [16].
The basic idea underlying LCA is that some of the parameters of a postulated statistical model differ across unobserved subgroups. Also, in the current study, standard epidemiological sampling did generate our study population.Demographic characteristics and medical risk factors were assessed in all women, and the findings were compared between the women with and without sexual dysfunction. This basic idea has several seemingly unrelated applications, the most important of which are clustering, scaling, density estimation and random-effects modeling. Of the sociodemographic data analyzed, age most strongly correlated with the likelihood of FSD. The pathogenetic mechanisms involved in this issue are not completely understood, however it could be speculated that some factors associated with visceral adiposity, and upstream of insulin resistance, could contribute both to hypogonadism and CV diseases. Low sexual desire, AD and orgasmic problems are age-dependent disorders, possibly resulting from physiological changes associated with the aging process. The women excluded from the study did not significantly differ from the study group with regard to age, education and marital status. In addition to hormonal alterations, psychosocial and interpersonal factors, medication use and associated illnesses are factors that mediate the effects of aging on sexual function in women.
Although the prevalence of all aspects of FSD (except PD) increased substantially with age, sexuality remains an important aspect. Logistic regression analysis, incorporating the five components of MetS, identified a significant association of elevated waist circumference and hypertriglyceridemia with hypogonadism. Accordingly the prevalence of hypogonadism significantly increased as a function of triglycerides and waist-line deciles.
Possible explanations may include a restraining sexual education, poor partner performance and technique, and negative beliefs with regard to sexual activity. Seeking help for sexual function complaints: what gynecologists need to know about the female patient's experience.
Taken together, our results seem to suggest that male hypogonadism is associated with MetS independently from the presence of T2DM.
Insufficient clitoral stimulation may account for most cases of absent orgasm, and all women may be potentially orgasmic if adequately stimulated.About 27% of samples specified having PD.
Furthermore, MetS-associated hypogonadism is characterized by hypertriglyceridemic-waist phenotype. This is not surprising, in fact, since insulin resistance seems to be the most important pathogenetic link, elevated waist line and triglycerides are those factors, among MetS determinants, more closely associated with it. There is a cascade of responses from initial pain experience to expectation of subsequent pain, sexual aversion, inconvenient relationship effects, and development of additional sexual dysfunction.
Interestingly, the hypertriglyceridemic-waist phenotype has been demonstrated to be a simple and strong predictor of early CV disease in males [32], even in patients with T2DM [33].
Whether or not low testosterone could play a pathogenetic role in CV disease is under debate. Its supposed causes are restraining education, negative beliefs with regard to the anatomy of the hymen, misunderstanding about the mechanism of intromission, and interrelationship conflicts. However, it should be recognized that meta-analysis reports have clearly demonstrated that testosterone replacement therapy in hypogonadal subjects determines a reduction of fat mass and an improvement of lipid profile [34].
In the current study, women ascribed their own sexual disorders to a problem in the relationship with their husbands (72.3%) or husband's sexual dysfunction (82%). Although lifestyle approach and weight loss are characterized by an improvement of cardiovascular profile as well as by an increase of testosterone circulating levels, recently Heufelder et al. The age-adjusted prevalence was calculated by the direct method, assuming the total study population as standard.
After adjusting for the strong effect of age on incident FSD, women with lower marriage age, financial dependency, lower educational level, lower physical activity and multiparity showed a significant increase in risk of FSD relative to those without these conditions at baseline.
The real significance is not completely understood; however, early evidence seems to support the hypothesis that general screening for both ED and low testosterone, as well as testosterone replacement therapy, could be able not only to improve sexual function but also to reduce forthcoming cardiovascular complications. A lifelong diminished capacity for sexual arousal may be related to unawareness of genital anatomy and function.
There was statistically significant relationship between AD and level of education, lower physical activity, marriage age, menopause status, psychological problems and chronic disease.
Inadequate stimulation or psychological inhibition may result in inadequate vaginal lubrication and cause coital pain.
This study indicated a statistically significant association between psychological problems and all six aspects of FSD.Female sexuality is more 'contextual' than male sexuality and, to specify dysfunctions without clearly acknowledging the strong interpersonal determinants of sexual response is problematical and probably confusing. Behavioural and clinical findings in couples where the man presents with erectile disorder: to retrospective study. Many women can experience adequate sexual arousal and even orgasm without experiencing any real satisfaction, pleasure or even the tendency to repeat the experience.
Sexual myths and misconceptions, negative emotions, anxiety, depression, body image concerns, relationship problems, communication-between-partner difficulties leading to poor sexual technique, previous or current sexual abuse or sexual harassment and substance abuse all contribute to FSD.Many women experience a lack of satisfaction with their sexual relationship, in spite of the ability to achieve arousal or orgasm. In the age group 20–39 years, approximately 24% of women reported on arousal problems, 'never' or only 'occasionally' experiencing arousal during sexual activity. Low physical activity, financial dependence, lower marriage age and lower educational level were correlated to SD. The introduction of a new diagnostic category of sexual satisfaction disorder is mandatory. Even in the youngest age groups (20–39 years), 31% of women reported on significant OD. This diagnosis must be applied when a woman is unable to achieve subjective sexual satisfaction, despite adequate desire, arousal and orgasm.In general, race played a very small role in women presenting sexual dysfunctions. A study showed that 42% of women with sexual complaints sought help from their gynecologist. Of those who did not seek help for their problem, 54% stated that they would like to.23 In this study, even if women were aware of the disorder, only 22% sought help from their gynecologist and 17% consulted healthcare professionals.
The 'traditional' risk factors for the development of erectile dysfunction such as hypertension, diabetes mellitus, hyperlipidemia and a history of cardiac diseases were generally not strongly correlated to the presence of FSD, underlining the multicausality of these disorders.7, 24, 25 There is limited literature on risk factors that may develop FSD. Laumann et al.3 assessed risk factors associated with health, lifestyle and sexual experience.
However, they did not assess menopause status and clinical risk factors such as previous pelvic surgery and chronic disease. In this study, no significant differences were detected in smoking history, the presence of previous pelvic surgery and contraception methods used between the women with and without FSD. The link between FSD and psychological problems seems undemanding and the association between mood disorders and FSD has already been described.28Health status is a condition that reduces the FSD risk in women.
It needs to be emphasized that many aspects of FSD, such as DD, however, also depend on the presence of an adequate partner.
Additionally, Avis et al.29 evaluated sexually active women during the menopausal evolution and found that menopause was related to a loss of desire and sexual excitement. This phenomenon might be explained by the burden of high number of children, financial problems, illiteracy, and poor socioeconomic conditions of married women.Top of pageConclusionFSD is frequent among different ethnic groups. Better understanding of the epidemiology of FSD is vital to plan effective treatment and prevention strategies.

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