Gastric bypass can reduce sexual dysfunction

Gastric bypass surgery leads to significant improvement in the sexual dysfunction experienced by many morbidity obese men, according to a recent study.

The effects of surgical weight loss on sexual function are not well studied, although dramatic improvements in diabetes, hypertension, and cardiovascular disease risk have been associated with gastric bypass surgery in previous studies.

The reason this is newsworthy is we have an increasing problem with obesity worldwide. One of the problems that arise[s] with morbid obesity is sexual dysfunction.

The decrease in sexual function can be considerable, “A male obese or morbidity obese — has the same amount of sexual dysfunction as a male 20 year older.”

Participants had substantially lower sexual function score before surgery than did normal-weight men. The researchers used sexual function score from a reference group of normal-weight men who participated in a previous study.

Only 20% of patients seeking [gastric bypass surgery] treatment are men. They think there are more social pressures for women. We believe sex life is important to men, so this will be an incentive for men to seek gastric bypass.

With lead author, a bariatric surgeon and their associates, assessed sexual function among 95 morbidly obese men before and after Roux-en-Y gastric bypass surgery. Their mean body mass index was 51k/m2 and the mean age was 48 years. No participant was taking a phosphodiesterase type 5 inhibitor.

Participants rated their preoperative and postoperative sexual function using the 11-question Brief Sexual Inventory. This instrument addresses multiple domains including sexual drive, erectile dysfunction, and overall sexual satisfaction.

Postoperative assessment was conducted at a mean of 19 months after surgery. Overall, in all sexual domain, all improved. This is what we expected to find, but “the degree to which they improve exceeded our expectations.”

Sexual drive scores, for example, improved from 3.9 to 5.4 (scale of 0-8) in a bivariate analysis. Erectile dysfunction scores improved from 6.3 to 8.9 (scale of 0.12), ejaculatory function improved from 4.9 to 6.3 (scale of 0-8), and sexual satisfaction improved from 1.6 to 2.2 (scale of 0-4). All of these changes were statistically significant.

The amount of weight loss predicted the enhancement in all sexual function domains in a multivariate analysis that controlled for age, presence of diabetes and hypertension, and cigarette smoking.

On average, participants had a 67% excess weight loss after one year. Their mean weight decreased from 155 kg (342 pounds) to 105kg (225 pounds). Because the researchers controlled for con-founders, “weight alone was responsible for sexual dysfunction [preoperatively], and weight loss alone was responsible for improvement in scores.

Sexual dysfunction should be considered one of the numerous reversible conditions in the morbidly obese, adding that this is the first study to look at sexual function in men after Roux-enY gastric bypass. Previous research assessed only nonsurgical weight loss options, with inconsistent results.

Another coauthor of the study said that we are fortunate to have one of the few academic bariatric surgery centers that keeps a large database and was willing to work with urologists. The findings will be easy to verify.

Not stratifying patients according to prior use of PDE5 inhibitors is a potential limitation of the study. They did not account for psychogenic impotence, which is supposed to be about 20% in all (impotent) men, but could be higher in obese men because body image plays a role.

The researchers plan to assess the impact of gastric bypass surgery on sexual dysfunction in females as well.