Marlene Busko

November 14, 2013

In a study of severely obese women who underwent bariatric surgery, about half had sexual dysfunction before the surgery, but 2 years later, about three quarters of them reported improved sexual satisfaction. In addition, their levels of reproductive hormones were significantly better at the 2-year follow-up, according to a report published online November 4 in JAMA Surgery and presented at Obesity Week 2013: The American Society for Metabolic and Bariatric Surgery and the Obesity Society Joint Annual Scientific Meeting.

"We can now add improvements in sexual health to the list of benefits seen with a massive weight loss achieved with bariatric surgery," lead author David B. Sarwer, PhD, from the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, told Medscape Medical News.

"It's encouraging to see that the patients report improvements in these domains after they lose the large amounts of weight with bariatric surgery," he continued. "I do think this is a reminder to all of us who work in healthcare that sexual behavior is part of quality of life for individuals and that we should be asking our patients questions about their sexual behavior."

Importantly, this study looked at both sexual health and reproductive hormones and is a reminder that sexual health is a reflection of both physiology and our thoughts and feelings, he observed.

Not Tonight, Dear

Sexual health is a key component of quality of life but is often overlooked in research studies of weight loss outcomes. The researchers found only 2 studies that reported outcomes in reproductive hormone levels after bariatric surgery, and both showed improvements associated with treatment.

Therefore, the investigators aimed to look at changes in sexual function, sex hormone levels, and relevant psychosocial variables in women who underwent bariatric surgery.

The participants consisted of 106 consecutive women undergoing bariatric surgery at 2 of the 10 Longitudinal Assessment of Bariatric Surgery centers from 2006 to 2009. All participants were older than 18 years and had been in a relationship for at least 12 months.

A total of 85 women underwent a Roux-en-Y gastric bypass, and 21 women underwent laparoscopic adjustable gastric banding. The women had a median age of 41 years (range, 25 - 60 years), a median weight of 123.6 kg (range, 95.5 - 172.7 kg), and a median body mass index of 44.5 kg/m2 (range, 36.4 - 66.5 kg/m2) at baseline.

At assessments before surgery and 1 and 2 years after the procedure, the women had blood drawn to determine levels of reproductive hormones, and responded to questionnaires about evaluate their health- and weight-related quality of life, body image, and satisfaction with body shape and their relationship, depression, and sexual function. The Female Sexual Function Index (FSFI) questionnaire was used to determine overall sexual satisfaction and, specifically, to look at desire, arousal, lubrication, orgasm, satisfaction, and pain.

The women lost a mean of 32.7% of their initial body weight at year 1 after the bariatric surgery, and they lost a mean of 33.5% by year 2.

Overall, from baseline to year 1, participants reported significant improvement in overall sexual function (total FSFI score) and in desire and satisfaction. By year 2, the women also reported significant improvement in arousal and lubrication.

Interestingly, similar to what has just been reported from another Longitudinal Assessment of Bariatric Surgery study (ie, women who undergo bariatric surgery have diverse trajectories of weight loss), in this study, the researchers identified 5 different trajectories in changes in sexual function after bariatric surgery:

  • Group 1 (13.4%) had the lowest sexual function but had dramatic improvements within the first year of surgery, which were maintained.

  • Group 2 (52.6%) had the highest baseline function, which remained high.

  • Group 3 (11.3%) had sexual dysfunction at baseline, which got worse and then rebounded at year 2.

  • Groups 4 (15.5%) and 5 (7.2%) had sexual dysfunction at baseline, which remained at the same level.

The women also reported statistically significant improvements in health- and weight-related quality of life, body image, depressive symptoms, and overall relationship satisfaction 1 and 2 years after their surgery.

Compared with the levels of sex hormones before surgery, the participants' levels of these hormones 2 years later were significantly better.

The improvements in total testosterone and estradiol (the female reproductive hormones most commonly associated with sexual behavior) agree with the changes seen in a recent study, Dr. Sarwer and colleagues write.

In addition, other hormone changes suggest that the weight loss seen after bariatric surgery may improve a woman's fertility. "Follicle-stimulating hormone, luteinizing hormone, and sex hormone–binding globulin are most commonly associated with female fertility rather than sexual functioning. The statistically significant improvements in these hormone levels provide indirect evidence of the potential impact of surgically induced weight loss on reproductive status, which, for some women, is a primary motivator for both surgical and nonsurgical weight loss," the researchers write.

Study Shines Light on Understudied Area

This study was the first to include such a comprehensive, multidimensional assessment of sexual health in women undergoing bariatric surgery, and the findings add to knowledge in this understudied area, according to Ronette L. Kolotkin, PhD, a consulting professor at Duke University School of Medicine in Durham, North Carolina.

She notes that all too often, the topic of sex is considered off-limits by both the patient and the healthcare provider. "My experience has been that persons living with obesity welcome the opportunity to discuss the effects of their weight on quality of life, including sexual quality of life," she told Medscape Medical News.

The study was supported by the National Institute of Diabetes and Digestive and Kidney Diseases. Dr Sarwer has served as a paid consultant for Allergan, BariMD, BAROnova, EnteroMedics, and Ethicon Endo-Surgery, which are manufacturers of products for nonsurgical weight loss treatment and bariatric surgery, and has served on the board of directors of the Surgical Review Corporation, which created the International Center of Excellence for Bariatric Surgery program to evaluate bariatric surgeons and hospitals around the world. Full conflict-of-interest information is available on the journal's Web site. Dr. Kolotkin has worked as a consultant for Abbott Laboratories, Amgen, Bristol-Myers Squibb, Eli Lilly, Foundation for Informed Medical Decision-Making, GlaxoSmithKline, Janssen, Knoll, Merck, Novo Nordisk, Orexigen, Oxford Outcomes, Pfizer, Procter and Gamble, QualityMetric, Roche, Ross Products, RTI International, sanofi-aventis, Schering-Plough, and Vivus.

JAMA Surg. Published online November 4, 2013. Full text

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