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HomeSurgeryBariatric surgery may result in lasting improvement in sexual health

Bariatric surgery may result in lasting improvement in sexual health

Weight-loss surgery has more benefits than simply slimming a patient down, it may also result in lasting improvements to sexual functioning, Reuters Health reports a study suggests. In the multi-centre study that included more than 2,000 men and women who had problems with sexual functioning before surgery, researchers found that more than half reported improvements in their sex lives within a year of the surgery. The improved functioning continued for most of these patients through five years of follow-up, the study team reports.

“Satisfaction with sexual life is improved by one year after bariatric surgery, and this improvement is maintained in both men and women by five years post-surgery,” said the study’s lead author, Kristine Steffen of the School of Pharmacy at North Dakota State University in Fargo.

At the start of the study, the report says, the 1,607 women and 429 men included in the analysis had filled out questionnaires that asked about sexual function and satisfaction, and all had reported problems. The questions included whether, in the past month, the individual had “felt sexual desire or interest, that is, desire or interest to engage in any activity that is arousing to you, alone or with a partner,” as well as how often they had participated in sexual activity, how much their physical health had limited sexual activity, and how satisfied overall they were with their sex lives.

The questions were asked again one year and five years post-surgery. Prior to surgery 1,015 of 1,456 (69.7%) women and 304 of 409 (74.3%) said they were not satisfied with their sex lives. Among the participants who were dissatisfied, 56% of women and 49.2% of men experienced meaningful improvements at one year.

Specifically, the report says, men were 1.57 times more likely than they were before the surgery to experience improvements in the frequency of feeling sexual desire, 1.53 times more likely to experience improvements in the frequency of sexual activity, 3.97 times more likely to experience fewer physical limitations to having sex and 2.37 times more likely to experience improvements in satisfaction with their sex lives.

Women were 1.5 times more likely a year post-surgery than before their operations to experience improvements in the frequency of feeling sexual desire, 1.53 times more likely to experience improvements in the frequency of sexual activity, 3.7 times more likely to experience fewer physical limitations to having sex and 2.11 times more likely to experience improvements in satisfaction with their sex lives.

Many of these improvements lasted for a full five years. The report says for those who had improvements at year one in physical limitations, for instance, three quarters of the women and more than two thirds of the men continued to report improvement at year five. “There were significantly fewer women who had improvements in frequency of desire, frequency of activity and degree to which physical health limits sexual activity at year five post-surgery compared with year one post-surgery,” Steffen noted.

“In women, early improvement in satisfaction with sexual life was maintained by year five. In men dissatisfied before surgery, early improvements were maintained by year five in all domains except the degree to which physical health limits sexual activity.”
“(The new study) highlights the importance of looking beyond what we traditionally look at with bariatric surgery,” said Dr Kimberley Steele of Johns Hopkins Medicine in Baltimore. “Traditionally we’re looking at weight-loss outcomes and outcomes related to weight loss, such as diabetes, cholesterol, hypertension and sleep apnoea.”

The report says Steele, who wasn’t involved in the study, said she hopes it will raise awareness about “something that is not talked about that often: sexual function.” Almost 70% of women and 74.3% of men listed that as a problem for them pre-operatively, she noted.

“This was a nice way through validated surgery and a large cohort to show how weight loss through bariatric surgery improves sexual function and therefore quality of life,” Steele said. “More women than men seek bariatric surgery. By raising awareness that weight loss improved sexual dysfunction and therefore also quality of life, maybe this will encourage more men to consider the option of bariatric surgery.”

Importance: Short-term improvements in sexual functioning are reported after bariatric surgery, but to our knowledge, little is known about the durability of these improvements.
Objective: To determine the percentage of adults with impairment in sexual functioning who experience durable improvements in sexual functioning after bariatric surgery and to identify factors associated with improvements.
Design, Setting, and Participants: The Longitudinal Assessment of Bariatric Surgery-2 is an observational cohort study conducted at 10 hospitals in 6 US clinical centers. Adults undergoing their first bariatric procedure were recruited from 2005 through 2009, data were collected through August 2014. Data analysis was conducted from 2016 to April 2018.
Interventions: Participants completed assessments before the procedure and annually thereafter for 5 years.
Main Outcomes and Measures: A self-administered questionnaire was used to assess clinically meaningful differences before and after surgery in past-month sexual satisfaction, desire, and activity and physical health limitations to sexual activity among subgroups who reported sexual functioning at less than domain-specific thresholds before surgery.
Results: Of 2215 participants eligible for sexual function follow-up, 2036 (91.9%) completed 1 or more follow-up assessment (1431 [64.6%] at year 5), of whom 1607 (78.9%) were women. At the presurgery assessment, median (interquartile range) age was 47 (37-55) years, and the median (interquartile range) body mass index was 45.8 (41.7-51.3). Among those who were not satisfied with their sexual life before surgery (1015 of 1456 women [69.7%]; 304 of 409 men [74.3%]), 56.0% of women (95% CI, 52.5%-59.5%) and 49.2% of men (95% CI, 42.4%-55.9%) experienced clinically meaningful improvements at year 1; these percentages did not significantly differ during further follow-up. Among those who reported physical limitations to sexual activity at baseline (892 of 1490 women [59.9%] and 267 of 406 men [65.8%]), the percentage experiencing improvement in this domain decreased during follow-up, but 73.6% (95% CI, 69.3%-78.0%) of women and 67.6% (95% CI, 59.6%-75.6%) of men continued to report improvements at year 5. Greater postsurgical reduction in depressive symptoms was independently associated with improvement in 4 domains of sexual life among women (frequency of sexual desire: adjusted relative risk [aRR] per 5-point decrease in Beck Depression Inventory score, 1.12 [95% CI, 1.07-1.18]; P < .001; frequency of sexual activity: aRR, 1.13 [95% CI, 1.08-1.18]; P < .001; the degree to which physical health limited sexual activity: aRR, 1.19 [95% CI, 1.14-1.23]; P < .001; and satisfaction with sexual life: aRR, 1.25 [95% CI, 1.19-1.31]; P < .001) and 2 domains among men (physical health limitations: aRR, 1.14 [95% CI, 1.04-1.26]; P = .008 and satisfaction with sexual life: aRR, 1.55 [95% CI, 1.33-1.81]; P < .001). Surgical procedure was not associated with improvement.
Conclusions and Relevance: Per this study, approximately half of women and men who were not satisfied with their sexual life prior to bariatric surgery experienced improvements in satisfaction in 5 years of follow-up.

Kristine J Steffen; Wendy C King; Gretchen E White; Leslee L Subak; James E Mitchell; Anita P Courcoulas; David R Flum; Gladys Strain; David B Sarwer; Ronette L Kolotkin; Walter Pories; Alison J Huang

[link url=""]Reuters Health report[/link]
[link url=""]JAMA Surgery abstract[/link]
[link url=""]JAMA commentary[/link]

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