Sexual Satisfaction a Secondary Benefit of Bariatric Surgery

Gains in sexual satisfaction were seen in about half of individuals who underwent bariatric surgery, according to 5-year postoperative data.

In a subanalysis of the multicenter Longitudinal Assessment of Bariatric Surgery-2 study, 70% of women and 74% of men with obesity reported being unsatisfied with their sexual life before undergoing bariatric surgery. Only 1 year after surgery, however, 56% of these women and 49% of men reported a clinically meaningful improvement with their sex life, found Kristine Steffen, PharmD, PhD, of North Dakota State University in Fargo, and colleagues.

These improvements were also maintained for at least 5 years after surgery, the group wrote in JAMA Surgery.

The observational analysis included data on over 2,000 patients — nearly 80% of whom were women — who completed a questionnaire with questions taken from the Sexual Function Questionnaire, the Program to Reduce Incontinence by Diet and Exercise sexual function questionnaire, and the Female Sexual Function Index.

In addition to satisfaction with their sex life, other domains of sexual function also improved after bariatric surgery for both men and women.

Just 1 year after surgery, women had experienced significant improvement in all of the domains measured compared with their pre-surgical sexual functioning (P<0.001 for all) as follows:

• Frequency of sexual desire: aOR 1.50 (95% CI 1.23-1.82)

• Frequency of sexual activity: aOR 1.53 (95% CI 1.25-1.86)

• Degree to which physical health limited sexual activity: aOR 3.70 (95% CI 2.83-4.82)

• Satisfaction with sex life: aOR 2.11 (95% CI 1.72-2.60)

Similar improvements were also seen among men 1 year after surgery:

• Frequency of sexual desire: aOR 1.57 (95% CI 1.06-2.34)

• Frequency of sexual activity: aOR 1.53 (95% CI 1.04-2.23)

• Degree to which physical health limited sexual activity: aOR 3.97 (95% CI 2.47-6.37)

• Satisfaction with sex life: aOR 2.37 (95% CI 1.61-3.49)

Interestingly, depression was the one independent factor that was tied to a higher chance of improvement across all four of these sexual functioning domains, the researchers reported. Specifically, having fewer depressive symptoms — defined as a five-point decrease on the Beck Depression Inventory scale — was significantly associated with an improvement in frequency of sexual desire, sexual activity, degree to which physical health limits sexual activity such as pain or functional issues, and sex life satisfaction among women.

Having fewer depressive symptoms were also tied to improvement of all these domains for men as well, except for an improvement in frequency of sexual desire.

Although over 70% of the participants underwent Roux-en-Y gastric bypass, type of surgery was not tied to post-op sexual functioning, the researchers noted.

Calling this study “unique and timely,” the authors of an accompanying commentary praised the study for focusing on “nontraditional measures of improvement” from bariatric surgery.

“The correlation of sexual dysfunction with diminished quality of life and psychosocial distress, particularly in women, underscores the importance of the study, which demonstrates the ability for patients to attain durable improvements in sexual function after bariatric surgery,” wrote Nabeel Obeid, MD, of Michigan Medicine in Ann Arbor, and colleagues. In addition, they said, the study is clinically useful in finding that patients with sexual dysfunction are likely to benefit from bariatric surgery.

However, Obeid and co-authors also noted that the small percentage of men included in the study “limits the ability to evaluate biological sex as a variable in sexual dysfunction.”

The commentators suggested that sexual dysfunction should be considered as an obesity-related comorbidity, “prompting recommendation of and qualification for bariatric surgery.”