ABSTRACT: More than 50% of women who present for bariatric surgery report impairments in sexual function, decreased sexual satisfaction, and significant psychosocial distress. Several studies have found a relationship between excess body weight and abnormal levels of female reproductive hormones. Relatively few studies have investigated changes in sexual functioning and sex hormone levels in women following weight loss resulting from lifestyle modification or bariatric surgery. The limited data available suggest that weight loss in these women is associated with significant improvements in sexual functioning.
This prospective cohort study was designed to investigate changes in sexual functioning, reproductive sex hormone levels, and relevant psychosocial variables in women following bariatric surgery. Data were obtained for women enrolled in phase 2 of the Longitudinal Assessment of Bariatric Surgery (LABS) who had undergone bariatric surgery between 2006 and 2012. The median body mass index of the participants was 44.5 kg/m2 (interquartile range, 41.4–49.7 kg/m2). A LABS-certified surgeon performed the surgery. Among the 106 women with baseline data who met study criteria, 85 underwent a Roux-en-Y gastric bypass, and 21 underwent laparoscopic adjustable gastric banding. The Female Sexual Function Index was used to assess sexual functioning as well as several specific domains of sexual functioning. Fasting blood samples were collected for analysis of hormone levels. Participants completed validated questionnaires that evaluated their quality of life, body image, marital relationship satisfaction, and depressive symptoms.
At postoperative year 1, mean weight loss was 32.7% (95% confidence interval, 30.7%–34.7%) of initial body weight; at postoperative year 2, mean weight loss was 33.5% (95% confidence interval, 31.5%–35.6%). At 2 years, women reported significant improvements in overall sexual functioning and several specific domains: arousal, lubrication, desires, and satisfaction. There was also significant improvement at 2 years in all hormones of interest. With respect to psychosocial functioning, within the first year after surgery, women reported significant improvements in most domains of quality of life and in body image and depressive symptoms; improvements were maintained through the second postoperative year.
These findings show that women in this population who underwent bariatric surgery experienced significant improvements in overall sexual functioning, as well as in most sex hormones of interest and in psychosocial functioning. The data suggest that improvements in sexual health can be added to the list of benefits associated with weight loss following bariatric surgery.
Department of Psychiatry, Center for Weight and Eating Disorders (D.B.S., J.C.S., T.A.W.), and Department of Surgery, Division of Plastic Surgery (D.B.S.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Neuropsychiatric Research Institute and the University of North Dakota School of Medicine and Health Sciences, Fargo, ND (J.E.M., K.L.); University of Pittsburgh Medical Center, Pittsburgh, PA (A.C., W.G.); New England Research Institutes, Watertown, MA (R.C.R.); and Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA (N.J.C.)