Infertility and Sexual Dysfunction and Weight Loss Surgery
Sexual dysfunction is perhaps one of the most frequently overlooked complications of obesity by doctors and patients alike. In reality, sexual dysfunction and decreased sex drive remains very prevalent amongst individuals who suffer from obesity. Some studies have noted that a sexual dysfunction is perhaps one of the more common reasons why men seek weight loss surgery. The causes of sexual dysfunction in obese individuals, remains multi-factorial. Many of the diseases inherent in patients who are overweight often contribute as much if not more to sexual dysfunction than obesity itself. These diseases include diabetes and peripheral vascular disease. Hormonal imbalances have also been noted in individuals who are overweight. In addition, medications that patients take for high blood pressure, diabetes, cholesterol and other ailments related to obesity often reduce sex drive and reduce sexual function secondary to side effects of these medications.
It is now well noted that individuals who are overweight have an imbalance related to hormones. Hormonal imbalances are noted in women and men.
Infertility and/or Sexual Dysfunction
The hormonal imbalances seen in women are best described by polycystic ovarian syndrome, a condition noted for infertility. Clinical signs of PCOS include:
- menstrual dysfunction
- hirsutism (for example facial hair in women)
- increased libido
- high rate of miscarriage
Dr. Schauer’s group from Pittsburgh evaluated 24 women with PCOS and evaluated them after gastric bypass surgery. After 1 year, all of the women resumed normal menstruation and up to 80% of the women had improvement or resolution of their hirsutism. Surgery for Obesity and Related Diseases 1 (2005) 77–80). In addition, five women were able to conceive after surgery despite having been infertility prior to surgery. This study demonstrates two things:
1. It is important for patients who suffer from infertility not to underestimate the power of weight loss surgery in improving fertility.
2. Two forms of contraception are recommended in the early postoperative period even if you think you are not able to get pregnant.
Texas Bariatric Specialists is proud to share with you the babies of our practice where multiple women share their successes after having their infertility conquered by weight loss surgery.
Similarly in obese men, testosterone levels and semen can be decreased thus leading to infertility. With weight loss surgery, these issues improve in both men and women. With these improvements, there is a noted improvement in quality of life. Dr. Adams group from the University of North Dakota reported that obesity was associated with the lack of enjoyment of sexual activity, lack of sexual desire and difficulties in sexual performance. Sexual quality of life was most impaired for women with morbid obesity and patients seeking gastric bypass surgery. Their studies also showed that weight-loss dramatically improved sexual performance (Obesity (2006) 14, 472–479; doi: 10.1038/oby.2006.62).
A recent study evaluating this in males comes from the University of Utah by Dr. Hammond. Obese males in the study were linked to have low testosterone levels and high levels of estrogen. Infertility and perceived sexual quality of life were also looked at. When they investigated these patients further, 22 patients underwent gastric bypass surgery and they compared them to patients who didn’t. After two years of follow-up, the men who had weight loss surgery had dropped an average of nearly 17 points off their BMI, estrogen levels had fallen significantly, and testosterone levels increased. All of the men under-going weight loss surgery showed improvements on each of the measures for sexual quality of life that the researchers looked at and evaluated.
Dr. Smith and researchers in Boston and Philadelphia demonstrated that gastric bypass surgery improved all qualities of sexual measure including sexual drive, erectile function, sexual satisfaction and problem assessment. As a result, it is a clear conclusion that weight loss surgery dramatically improves sexual function in males and infertility in females.