Dr. Priyanka Wali: Insulin Resistance and Sexual Health

Dr. Priyanka Wali, MD, divides her time between clinical practice, various other medical advisory roles, and stand-up comedy. In this presentation, delivered at a CrossFit Health event on Dec. 15, 2019, she focuses on the relationship between metabolic and sexual health.

Wali’s primary argument is: “Any person presenting with any signs of sexual dysfunction should consider screening for insulin resistance.”

While she acknowledges there are few rigorous randomized controlled studies on this topic, she insists sexual dysfunction is a potential indicator of an underlying metabolic issue.

“Sexual dysfunction, by definition, is any disturbance in sexual desire and in the psycho-physiologic changes associated with the sexual-response cycle in men and women,” Wali explains. Moreover, the condition is “quite prevalent,” she says. As many as “40 to 50% of women have sexual dysfunction, irrespective of age.”

Wali bends a critical eye toward the industries that have been built up around sexual dysfunction. “The pharmaceutical male sexual enhancement industry is a multimillion dollar industry,” she observes. “Men are sold this idea that you can just take a pill and you can improve the odds of having an erection, but I’m here to tell you, yes the odds are good, but the goods are still odd, because erectile dysfunction is a sign of cardiovascular disease (CVD).”

The relationship between erectile dysfunction (ED) and CVD has been extensively studied and is well known. What is not as well known but is equally important, Wali claims, is that ED is also a sign of metabolic disorder.

A 2015 study analyzed the association of ED with undiagnosed diabetes, hypertension, and hypercholesterolemia. The study found, “Erectile dysfunction was strongly associated with undiagnosed diabetes in both the adjusted and unadjusted analyses.”

Wali also notes that a study of 800 men in Italy found “there was a progressive decline in penile blood flow velocity both at baseline and at peak blood flow as the number of metabolic syndrome components increased.”

These studies indicate doctors need to reexamine how they react to cases of sexual dysfunction among their male patients, Wali suggests. “Right now, drugs like Cialis, Viagra, they’re all getting prescribed a lot,” she says. “But I think before providing anyone with a prescription for these medications, if someone is complaining — if a man is complaining of erectile dysfunction, they must absolutely be screened for diabetes and other secondary causes of insulin resistance before being prescribed vasodilatory medications.”

Similar claims can be made regarding the treatment of sexual dysfunction among women. Studies have found “clitoral vascular resistance, or essentially impaired blood flow to the clitoris, is positively associated with metabolic syndrome and insulin resistance, and it leads to decreases in sexual arousal. It also leads to psychological issues like body image concerns,” Wali explains. “So just like in men, women should also be screened for endocrine disorders when complaining of sexual dysfunction.”

Wali concludes: “I think it’s really important to understand that patients with metabolic syndrome are suffering from significant sexual distress, and it’s our duties as physicians to address this.”

To read a complete transcript of Wali’s presentation, click here.

To learn more about the CrossFit Physicians Network, click here.