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Original Investigation
February 20, 2019

Changes in Sexual Functioning in Women and Men in the 5 Years After Bariatric Surgery

Author Affiliations
  • 1Department of Pharmaceutical Sciences, North Dakota State University, Fargo, North Dakota
  • 2Neuropsychiatric Research Institute, Fargo, North Dakota
  • 3Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
  • 4Department of Surgery, University of Pittsburgh Medical Center
  • 5University of California, San Francisco
  • 6Now with Department of Obstetrics and Gynecology, Stanford University, Stanford, California
  • 7Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
  • 8Department of Surgery, University of Washington, Seattle
  • 9Cornell University Medical Center, New York, New York
  • 10College of Public Health, Temple University, Philadelphia, Pennsylvania
  • 11Duke University Medical Center, Durham, North Carolina
  • 12Faculty of Health Studies, Western Norway University of Applied Sciences, Førde, Norway
  • 13Department of Surgery, Førde Central Hospital, Førde, Norway
  • 14Førde Hospital Trust, Førde, Norway
  • 15Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg, Norway
  • 16Department of Surgery, East Carolina University, Greenville, North Carolina
JAMA Surg. 2019;154(6):487-498. doi:10.1001/jamasurg.2018.1162
Key Points

Question  What percentage of adults with impairment in sexual functioning report durable improvements in the 5 years after bariatric surgery?

Findings  In this cohort study of adults with impairment in sexual functioning before bariatric surgery, more than half of women experienced meaningful postsurgical improvements in the degree to which physical health limited sexual activity (74%) and satisfaction with sexual life (52%) 5 years after surgery, and more than one-third of women had improvements in frequency of sexual desire (41%) and sexual activity (35%) 5 years after surgery. At least half of men experienced improvements in all 4 domains in year 5.

Meaning  In this study, a considerable portion of adults experienced durable improvements in several domains of sexual functioning after bariatric surgery.

Abstract

Importance  Short-term improvements in sexual functioning are reported after bariatric surgery, but to our knowledge, little is known about the durability of these improvements.

Objective  To determine the percentage of adults with impairment in sexual functioning who experience durable improvements in sexual functioning after bariatric surgery and to identify factors associated with improvements.

Design, Setting, and Participants  The Longitudinal Assessment of Bariatric Surgery-2 is an observational cohort study conducted at 10 hospitals in 6 US clinical centers. Adults undergoing their first bariatric procedure were recruited from 2005 through 2009, data were collected through August 2014. Data analysis was conducted from 2016 to April 2018.

Interventions  Participants completed assessments before the procedure and annually thereafter for 5 years.

Main Outcomes and Measures  A self-administered questionnaire was used to assess clinically meaningful differences before and after surgery in past-month sexual satisfaction, desire, and activity and physical health limitations to sexual activity among subgroups who reported sexual functioning at less than domain-specific thresholds before surgery.

Results  Of 2215 participants eligible for sexual function follow-up, 2036 (91.9%) completed 1 or more follow-up assessment (1431 [64.6%] at year 5), of whom 1607 (78.9%) were women. At the presurgery assessment, median (interquartile range) age was 47 (37-55) years, and the median (interquartile range) body mass index was 45.8 (41.7-51.3). Among those who were not satisfied with their sexual life before surgery (1015 of 1456 women [69.7%]; 304 of 409 men [74.3%]), 56.0% of women (95% CI, 52.5%-59.5%) and 49.2% of men (95% CI, 42.4%-55.9%) experienced clinically meaningful improvements at year 1; these percentages did not significantly differ during further follow-up. Among those who reported physical limitations to sexual activity at baseline (892 of 1490 women [59.9%] and 267 of 406 men [65.8%]), the percentage experiencing improvement in this domain decreased during follow-up, but 73.6% (95% CI, 69.3%-78.0%) of women and 67.6% (95% CI, 59.6%-75.6%) of men continued to report improvements at year 5. Greater postsurgical reduction in depressive symptoms was independently associated with improvement in 4 domains of sexual life among women (frequency of sexual desire: adjusted relative risk [aRR] per 5-point decrease in Beck Depression Inventory score, 1.12 [95% CI, 1.07-1.18]; P < .001; frequency of sexual activity: aRR, 1.13 [95% CI, 1.08-1.18]; P < .001; the degree to which physical health limited sexual activity: aRR, 1.19 [95% CI, 1.14-1.23]; P < .001; and satisfaction with sexual life: aRR, 1.25 [95% CI, 1.19-1.31]; P < .001) and 2 domains among men (physical health limitations: aRR, 1.14 [95% CI, 1.04-1.26]; P = .008 and satisfaction with sexual life: aRR, 1.55 [95% CI, 1.33-1.81]; P < .001). Surgical procedure was not associated with improvement.

Conclusions and Relevance  Per this study, approximately half of women and men who were not satisfied with their sexual life prior to bariatric surgery experienced improvements in satisfaction in 5 years of follow-up.

Trial Registration  ClinicalTrials.gov Identifier: NCT00465829

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