Published reports have consistently shown that obesity impairs quality of life (QOL) and can contribute to depression as well as body image dissatisfaction. “Weight loss typically improves most aspects of QOL, but one aspect that is often overlooked in clinical research is sexual health,” says David B. Sarwer, PhD. Some reports have found that more than half of obese women considering bariatric surgery have sexual dysfunction that is accompanied by significant psychosocial distress.
Exploring the Issue
Few studies have investigated changes in sexual function, sex hormone levels, and psychosocial variables in women who undergo bariatric surgery. Recently, Dr. Sarwer and colleagues had a study published in JAMA Surgery that sought to address this research need. The analysis involved 106 women who received bariatric surgery.
Overall, women lost an average of 32.7% of their initial body weight in the first year after surgery and 33.5% when assessed at the end of the second postoperative year. Women reported significant improvements in overall sexual function and satisfaction at 2 years after surgery. They also experienced significant changes in all hormones assessed in the study. Women also reported improvements in most domains of QOL—in addition to body image and depressive symptoms—1 and 2 years after surgery.
“Importantly,” says Dr. Sarwer, “women who reported having the poorest quality of sexual functioning before bariatric surgery had the greatest improvements in functioning after surgery. Their functioning was comparable to women who reported the highest quality of sexual functioning before surgery.” These improvements occurred within the first postoperative year—when patients lost the largest percentage of their weight—but persisted even when the rate of weight loss had slowed.
Opening the Dialogue
According to Dr. Sarwer, sexual functioning is often thought of as a “don’t ask, don’t tell” issue when talking with patients about their body weight and weight loss treatment options. “Our findings suggest that physicians who treat patients with obesity can add improvements in sexual health to the list of potential benefits of bariatric surgery,” he says. “Although talking about sexual behavior can be uncomfortable for some physicians, it’s an important issue to discuss with patients. These conversations may be of great help to patients who are considering these procedures.”
For future studies, Dr. Sarwer and colleagues recommend investigating if the changes they observed endure over longer periods of time. They also noted that the role of sexual function in men who undergo bariatric surgery should be analyzed.
Sarwer DB, Spitzer JC, Wadden TA, et al. Changes in sexual functioning and sex hormone levels in women following bariatric surgery. JAMA Surg. 2014;149:26-33. Available at: http://archsurg.jamanetwork.com/article.aspx?articleid=1764857.
Sarwer DB, Lavery M, Spitzer JC. A review of the relationships between extreme obesity, quality of life, and sexual function. Obes Surg. 2012;22:668-676.
Sarwer DB, Wadden TA, Fabricatore AN. Psychosocial and behavioral aspects of bariatric surgery. Obes Res. 2005;13:639-648.
Sarwer DB, Wadden TA, Moore RH, Eisenberg MH, Raper SE, Williams NN. Changes in quality of life and body image after gastric bypass surgery. Surg Obes Relat Dis. 2010;6:608-614.
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