ORIGINAL RESEARCH—WOMEN’S SEXUAL HEALTH Sexuality and Psychopathological Aspects in Premenopausal Women with Metabolic Syndrome Stefania Alvisi, MD,* Maurizio Baldassarre, PhD, † Martina Lambertini, MD,* Valentina Martelli, MD,* Marta Berra, MD,* Simona Moscatiello, MD, ‡ Giulio Marchesini, MD, ‡ Stefano Venturoli, MD,* and Maria Cristina Meriggiola, MD, PhD* † *Gynecology and Physiopathology of Human Reproduction, University of Bologna and S.Orsola-Malpighi Hospital, Bologna, Italy; † Center for Applied Biomedical Research (CRBA), Department of Surgical and Medical Sciences, University of Bologna and S.Orsola-Malpighi Hospital, Bologna, Italy; ‡ Unit of Metabolic Diseases and Clinical Dietetics, University of Bologna and S.Orsola-Malpighi Hospital, Bologna, Italy DOI: 10.1111/jsm.12585 ABSTRACT Introduction. Metabolic syndrome (MetS) is a cluster of cardiovascular risk factors that have been suggested to impact female sexual function. Aims. This study aims to assess the prevalence of female sexual dysfunction (FSD) in premenopausal women with MetS compared with healthy controls (HC). Psychopathological aspects and the relationship to FSD were also evaluated in both groups. Methods. Two hundred four premenopausal women, of whom 98 had diagnosis of MetS, were asked to complete the Female Sexual Function Index (FSFI), the Female Sexual Distress Scale (FSDS), and the Middlesex Hospital Questionnaire (MHQ). Routine laboratory tests and anthropometric measurements were routinely performed. Main Outcome Measures. FSFI and FSDS questionnaires, prevalence of FSD, and MHQ scores. Results. In the MetS group compared with the HC group, we found: a lower global FSFI score (P = 0.005), higher prevalence of pathological scores compared with HC group, and lower scores in the desire, arousal, lubrication, and orgasm domains. An inverse correlation between the FSFI score and the number of risk factors for MetS was detected. MetS women reported significantly higher total scores in the somatization and depression domains when compared with the HC group. The logistic regression showed that high triglycerides (odds ratio [OR] 3.097; 95% confidence interval [CI] 1.272–7.542; P = 0.026) and somatization (OR 7.068; CI 95% 2.291–21.812; P = 0.001) are independently associated with FSD in premenopausal women. Conclusions. Our results indicate a higher prevalence of sexual dysfunction in MetS women. A number of risk factors for MetS are positively associated with FSD and higher triglycerides seem to be the strongest predictors of sexual dysfunction. Psychopathological dimensions such as somatization are strongly associated with sexual dysfunction. Alvisi S, Baldassarre M, Lambertini M, Martelli V, Berra M, Moscatiello S, Marchesini G, Venturoli S, and Meriggiola MC. Sexuality and psychopathological aspects in premenopausal women with metabolic syn- drome. J Sex Med 2014;11:2020–2028. Key Words. Metabolic Syndrome; Female Sexual Dysfunction (FSD); Female Sexual Function Index (FSFI); Female Sexual Distress Scale (FSDS); Middlesex Hospital Questionnaire (MHQ) Introduction F emale sexual dysfunction (FSD) has become a worldwide public health problem. FSD is con- sidered a disorder of sexual desire, orgasm, arousal, and sexual pain that results in significant personal distress [1], thereby having a big impact on personal relationships and the quality of a woman’s life [2]. Many physiological factors can affect female sexual response. Indeed, a recent report by the 2020 J Sex Med 2014;11:2020–2028 © 2014 International Society for Sexual Medicine