Let’s talk about sex…
Obesity comes with its share of influences over health, among those are its effects on sexual function, body confidence, libido, and fertility.
So how does obesity actually affect our sex lives? It’s largely due to our metabolic health, hormonal balance and our perceptions of self.
Men and women both produce the sex hormones testosterone and oestrogen. The balance of these hormones is different between men and women, but it’s critical that these balances be maintained for good health.
In younger men, testosterone is produced at high levels in the testes, some also produced in the adrenal glands. As a man gets older, these levels gradually decrease. Women also produce testosterone in the adrenal glands as well as some from the ovaries, but in much lower levels than men. Testosterone has many roles in the human body but is most well-known for its role in erectile function, sperm production, and sexual libido in men as well as sexual libido in women.
Oestrogen is produced predominantly in the woman’s ovaries. In men and postmenopausal women, most oestrogen is no longer produced in the sexual organs, but is produced in the body fat, through an enzyme called aromatase (although at much lower amounts than what is produced in pre-menopausal ovaries in women). Oestrogen controls women’s menstrual cycle and is involved in fertility and pregnancy, but also has roles in both genders in bone maintenance, brain function and heart health.
EFFECT OF OBESITY
Obesity is perhaps the greatest hindrance to maintaining a healthy hormone balance. The complex mechanisms underlying sex hormone impairment are still unclear but we do know that excess fat cells in men causes an imbalance by increasing circulating oestrogen and decreasing production of testosterone. Testosterone is also metabolised by fat cells into the female sex hormone estradiol lowering its effect. This can be found in men of all ages, including teenagers. Inadequate testosterone production is found in 75% of morbidly obese men (BMI >40 kg/m2). In women, obesity can lead to hyperandrogenism (excessive testosterone) due to a reduction in SHBG (sex hormone binding globulin) resulting in more free testosterone in addition to the excess oestrogen produced.
BARIATRIC SURGERY ON HORMONE IMBALANCE
Bariatric surgery induces significant weight loss which in turn can reverse the effects of hormone imbalance.
In one study of 75 obese men (BMI >30 kg/m2) visiting an obesity clinic between 2007 and 2010, 54 of them had signs and symptoms of androgen deficiency, 27 with low testosterone levels. The higher the BMI, the lower the testosterone levels were. Seventeen of the participants had bariatric surgery and after 12 months, had lost an average of 40kg and demonstrated testosterone levels back within normal range. This was associated with a global improvement in libido and sexual functioning.
Another study on postmenopausal women showed that 12-month of weight loss produced large and statistically significant reductions in estrogen, and free testosterone and increases in SHBG
Obesity can often cause erectile dysfunction or shortness of breath during intercourse, both of which contribute to poor sexual performance.
In addition to low testosterone, erection problems are largely caused by atherosclerosis (a hardening of the arteries), of which obesity is a major risk factor for. If damaged, the tiny blood vessels supplying the penis can no longer dilate to bring in the strong flow needed for a firm erection. Weight loss can help bring back the elasticity of the blood vessels and allow for plenty of blood flow to the genitals.
With bariatric surgery, weight loss and improved fitness, many patients report an increase in energy as less energy is required to carry around the body fat that they used to. That’s more energy that can be used in the bedroom. In one study, participants reported new positions could also be explored that could not be enjoyed prior to bariatric surgery and longevity improved because shortness of breath was no longer an issue.
RESOLUTION OF SLEEP APNOEA
Not all of the benefit comes from restoration of hormonal balance. Morbid obesity is associated with high levels of sleep apnoea which dramatically reduces libido.
As sleep apnoea nearly always significantly improves or resolves with weight loss this has an additional impact on restoring energy levels and libido. Read more about sleep apnoea.
Obese men and women may have difficulties establishing sexual relationships due to low esteem and body confidence.
With weight loss, many patients report improved self esteem, largely associated with their feelings towards their body. They are able to move easier, have access to a larger variety of clothes and spend more time not wearing any. This improved perception of self lends to a more eager attitude towards engaging in sexual activity.
In a study of 153 women, 12-18 months post surgery looking at female sexual function compared to a control group of women pre-bariatric surgery, it was found that the post surgery women had higher Sexual Quality of Life scores, likely as a result of an improvement in self-esteem, which in turn leads to greater interest in sex and more intense feelings of desire and arousal.
Though the complex connection is not yet understood, testosterone levels contribute greatly to sexual libido in both genders. The low levels associated with obesity, in conjunction with poor body confidence can therefore reduce desire to engage in sexual activities.
With the weight lost through bariatric surgery and the resulting correction of testosterone levels in men and women, weight loss surgery patients may find themselves with more energy and a greater sex drive
Obesity is associated with reduced male and female fertility. In men, obesity brings about reduced sperm concentration, diminishing their fertility. A significant fertility issue for obese women is anovulation (when the body does not release a ripened egg each month as a part of the menstrual cycle). Obesity also impacts on natural conception, miscarriage, pregnancy and the long term health of the children.
Evidence shows that weight loss can improve the likelihood and the outcome of fertility. In one study, Ninety-eight of 195 obese patients studied were considered “anovulatory” before surgery. Of the 98, 70 (71.4%) got back to a normal menstrual cycle following surgery. The 28 patients who remained anovulatory lost less weight than their fellow bariatric surgery patients, suggesting that closer attention to bariatric diet and weight loss surgery exercise to improve weight loss could increase the cured rate even more. In another study of 110 obese infertile women, 69 became pregnant following bariatric surgery. All 69 pregnancies moved forward with no complications and live births.
In addition to improvements in anovulation, weight loss results in improvements in other menstrual irregularities and polycystic ovarian syndrome along with a correction of sex hormone imbalances, all of which contribute to increased fertility.
MANAGING PREGNANCY AFTER WEIGHT LOSS SURGERY
There are some differences in managing pregnancy after weight loss surgery, but in general, pregnancy and childbirth are much safer following surgery than they are for obese women who do not have the surgery.
Our advice to all women in the fertile age is to avoid pregnancy in the first year after your bariatric surgery and to take active measures with regards to contraception even if you had considered yourself infertile for the years leading up to that decision.
There is unfortunately nothing like pregnancy to interrupt weight loss and you probably won’t achieve your expected peak weight loss if you conceive in this vital first year.
Also, when you eventually start trying to conceive, you should make sure that you are taking folate containing multivitamins at the time you conceive and throughout your pregnancy.
Improvements have been reported in confidence, sexual desire, arousal, lubrication, orgasm, and overall satisfaction It’s a whole new world after bariatric surgery. If you find that you experience an increase in sexual performance, or sexual quality of life, and you’re not intending on reproducing, remember to use contraceptives, because you might also be more fertile.
Mercy Bariatrics Perth
Contact us today to find out more about how bariatric surgery can improve the quality of your life on so many levels. Call 08 9272 0420.
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