Obesity Linked to Lower Number of Sexual Partners and Increased Unwanted Pregnancies

Emma Hitt, PhD

June 17, 2010

June 17, 2010 — Obese people appear to have fewer sexual partners than their normal-weight counterparts, and obese women may be at increased risk of unplanned pregnancies, a new study suggests.

Nathalie Bajos, PhD, from the Institut National de la Santé et de la Recherche Médicale, in Kremlin Bicêtre, France, and colleagues reported their findings in the British Medical Journal this week.

"Our hypothesis was that overweight individuals, especially obese people, could be at greater risk of negative sexual outcomes compared with normal weight individuals because of social stigma and lack of adequate medical follow-up," Dr. Bajos and colleagues note.

The study, based in France, included men and women aged 18 to 69 years surveyed in 2006. A total of 5535 women and 4635 men were randomly included in the analysis. Of those, 1010 women and 1488 men were overweight (body mass index [BMI], 25 to < 30 kg/m2), and 411 women and 350 men were obese (BMI > 30 kg/m2).

Obese women were less likely than normal-weight women to report having any sexual partners in the past 12 months (odds ratio [OR], 0.71; 95% confidence interval [CI], 0.51 - 0.97). Similarly, obese men were less likely than normal-weight men to report having more than 1 sexual partner in the same period (OR, 0.31; 95% CI, 0.17 - 0.57; P < .001). Obese men were also more than twice as likely as normal-weight men to report having erectile dysfunction. (OR, 2.58; 95% CI, 1.09 - 6.11; P < .05).

In women, a higher BMI was not related to sexual dysfunction, including lack of sexual desire, arousal, or painful intercourse; however, obese women younger than 30 years were less likely to use oral contraceptives (OR, 0.34; 95% CI, 0.15 - 0.78) or to seek healthcare services to attain contraceptives (OR, 0.37; 95% CI, 0.18 - 0.76). In addition, unintended pregnancy was more than 4 times as likely to occur in obese compared with normal-weight women (OR, 4.26; 95% CI, 2.21 - 8.23).

According to the researchers, the data show a marked sex effect. "The partners of obese men and women were more likely themselves to be obese, but the association was stronger for women than for men," the authors note.

"Prevention of unintended pregnancies among these women is a major reproductive health challenge," the researchers conclude. "Healthcare professionals need to be aware of sensitivities related to weight and gender in the provision of sexual health services," they add.

Interpret Contraception Results With Caution

Editorialist Sandy Goldbeck-Wood, MB, gynecologist and specialist in psychosexual medicine at Camden and Islington Mental Health Trust, in London, United Kingdom, indicates that the "most striking" findings of the study are that obese women aged 18 to 29 years were less likely to report use of oral contraception in the previous year and were 4.3 times more likely to have unintended pregnancies.

She notes that "the data on contraception need cautious interpretation...because they focus purely on oral contraception and condoms, ignoring long-acting reversible contraceptives."

Dr. Goldbeck-Wood states that long-acting reversible contraceptives are suitable for obese women, according to recommendations from the UK's National Institute for Health and Clinical Excellence. They carry lower risk for venous thromboembolism and problems with weight-related dosage, and they require patients to make fewer visits to the physician.

She suggests more studies need to be conducted in other populations to confirm these findings and to also determine why obese women who are having less sex are not using contraception and are having more unintended pregnancies.

In addition, Dr. Goldbeck-Wood indicates that physicians find it difficult to discuss sex and weight issues with patients and states that clinicians must be prepared to address these difficult subjects, which have such important effects on health and quality of life.

"We need to understand more about how obese people feel about their sex lives, and what drives the observed behaviours and attitudes," she writes in a news release.

"In public health terms, the study lends a new slant to a familiar message: that obesity can harm not only health and longevity, but your sex life. And culturally, it reminds us as clinicians and researchers to look at the subjects we find difficult."

The survey was supported by the French National Agency of Aids Research. The Fondation de France, the Institut National de la Prévention et d'Éducation pour la Santé, and the Direction de la Recherche des Études Économiques et Sociale also contributed to support. The authors and commentator have disclosed no relevant financial relationships.

BMJ. 2010;340:c2573.

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