Sexual Dysfunction in MASLD- Experience at Tertiary Care Center of Northeren India

Background: MASLD (Metabolic dysfunction associated steatotic Liver Disease) is strongly linked to sexual dysfunction. In men, this often manifests as erectile dysfunction, testosterone deficiency, and reduced libido. In women, it is tied to reduced sexual desire, poor arousal, and irregular menstrual cycles. These issues are primarily driven by shared metabolic conditions like insulin resistance and hormonal imbalances. MASLD and sexual dysfunction share the same underlying metabolic drivers like insulin Resistance, hormonal Imbalance, Obesity & Systemic Inflammation. The most effective treatment is adopting lifestyle interventions like a Mediterranean-style diet, eliminating alcohol, and getting regular exercise to reduce liver fat and improve insulin sensitivity. For men with severe testosterone deficiency, testosterone replacement may be an option, provided it is closely monitored by an endocrinologist. Treatments for erectile dysfunction (e.g., sildenafil) are generally safe for mild to moderate MASLD, though dosages should be adjusted in patients with severe hepatic impairment. The aim of study is to estimate prevalence of sexual dysfunction in Metabolic dysfunction associated fatty liver disease (MASLD) patients at tertiary care center of Northern India. Material and Methods: This study was conducted at Medical Gastroenterology Department at PGIMS, Rohtak. It was a prospective study done over two years, from 01.05.2025 to 30.04.2026, during which 200 confirmed patients of MASLD were enquired for any kind of sexual dysfunction. For better understanding 100 patients each of F0-F3 fibrosis and cirrhosis were enrolled. All 200 MASH patients were males, in 20-50 yrs age group and were sexually active. Patient with past history of sexual dysfunction, anxiety, depression, alcohol intake, hepatitis B, C and HIV which can cause sexual dysfunction were not included in the study. All patients underwent biochemical tests include liver & renal function tests, complete hemogram, thyroid profile, blood sugar, HbA1C, autoimmune and Wilson’s disease profile Fibroscan, ultrasonogram and upper gastro-intestinal endoscopy. Fibrosis was graded by Fibroscan readings- <6 Kpa- F0, 6-7 Kpa- F1-F2, 7-12.2 Kpa- F3 and > 12.2 Kpa- F4 or cirrhosis. The written informed consent was taken before enrollment in the study. Results: Our department is seeing MASLD patients regularly for last 16 years and daily at least 8-10 MASLD patients, including new and old come for consultation. All the biochemical tests, Fibroscan, ultrasonogram abdomen, Endoscopy, ultrasonogram abdomen and treatment are available free of cost which increases regular follow-up and compliance of patients. On prospective analysis of 200 confirmed MASLD patients, all were males. Out of total pool of 200 patients, 100 patients each of F0-F3 fibrosis and cirrhosis were enrolled in the study. The sexual dysfunction was seen in 28 patients (14 %) of total MASLD patients. Out of these 28 patients, 6 (21.44 %) were in F0-F3 and 22 (78.56 %) were having cirrhosis. Most common kind of sexual dysfunction was erectile impotence (22 patients, 78.56 %) followed by and loss of libido (4 patients, 14.28 %) and premature ejaculation (2 patients, 7.14 %). Out of 100 patients of MASLD cirrhotic patients, sexual dysfunction was seen in 22 patient (78.56 %) and out of them 19 (86.36 %) had erectile impotence, 2 (9.09%) had loss of libido and 1 (4.54 %) had premature ejaculation and. In group of 100 patients of F0-F3 fibrosis with SD, total 6 patients (21.42 %) had sexual dysfunction. In them, 3 patients (50 %) had erectile impotence, 2 (33.33 %) had loss of libido and 1 (16.67 %) had premature ejaculation. Conclusion: In MASLD patients, the main thrust of treating health care professionals goes on hepatic impairment and its extra-hepatic manifestations but sexual dysfunctions are usually missed. Sexual dysfunction is important arm of extra-hepatic impact of MASLD which is rarely discussed by both doctor, patient and family members, most likely due to inhibition and male ego. Hence whenever treating an MASLD patient, sexual history must be evaluated in detail and impact of same should be scientifically assessed and treated accordingly.

Keywords: MAFLD, MASH, Cirrhosis, Loss of libido, Erectile impotence, Premature ejaculation.