Obesity Surgery

, Volume 30, Issue 2, pp 493–500 | Cite as

Health-Related Quality of Life, Sexuality and Hormone Status after Laparoscopic Roux-En-Y Gastric Bypass in Women

  • Rebecca PaulEmail author
  • Ellen Andersson
  • Mikael Wirén
  • Jessica Frisk
Original Contributions



Few studies have been carried out concerning the influence of bariatric surgery on female sexuality and hormones, particularly utilizing hormone-based questionnaires. The effect of bariatric surgery on sex hormone levels, sexual function and health-related quality of life (HRQL) in women was analyzed in this study. Participants were included in a single-center study at a regional hospital in Sweden, with a duration of one-year follow-up.


One hundred non-smoking women, undergoing laparoscopic Roux-en-Y gastric bypass, were included in the study. Blood assay for sex-hormone binding globulin (SHBG), testosterone, estrogen, progesterone, follicle-stimulating hormone (FSH) and luteinizing hormone (LH) was analyzed. Participants completed the Female Sexual Function Index (FSFI), Women’s Health Questionnaire (WHQ) and Psychological General Well-being Inventory (PGWB) parallel to lab testing.


At one-year follow-up, several significant results were found concerning hormones and questionnaires. Testosterone decreased and SHBG increased, N = 68/100. Desire, arousal, orgasm, satisfaction and total score domains for the FSFI increased after one year, N = 53/100. WHQ domains concerning depressed mood, somatic symptoms, memory, anxiety, sexual behavior and attractiveness improved after one year, N = 47/100. All domains in the PGWB (N = 52), including anxiety, depressed mood, positive well-being, self-control, general health, vitality and total score improved at follow-up. Spearman’s Rho coefficient analysis found correlation between testosterone/WHQ-sexual problems (0.3), SHBG/WHQ-general health (0.3) and SHBG/FSFI-arousal (−0.3).


Bariatric surgery normalizes levels of sex-hormones in women, and results in improved sexual function, health-related quality of life and psychological well-being.


Obesity Hormones Bariatric surgery Women Sexual function 



We would like to extend our deep appreciation to Annelie Villaume, R.N. and Annika Kaiser R.N., for carrying out administration duties. And our gratitude to Mats Fredriksson for assistance in statistical analysis.

Funding Information

This work was supported by a grant from Linkoping Medical Faculty Grant Board (LIO-309361), and grants from Region Ostergotland (LIO-421541, LIO-601561, LIO-507021, LIO-342321).

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Statement

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and /or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Consent Statement

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Tchernof A, Despres JP. Pathophysiology of human visceral obesity: an update. Physiol Rev. 2013;93(1):359–404.CrossRefGoogle Scholar
  2. 2.
    Tchernof A, Despres JP. Sex steroid hormones, sex hormone-binding globulin, and obesity in men and women. Horm Metab Res. 2000;32(11–12):526–36.CrossRefGoogle Scholar
  3. 3.
    Gosman GG, King WC, Schrope B, et al. Reproductive health of women electing bariatric surgery. Fertil Steril. 2010;94(4):1426–31.CrossRefGoogle Scholar
  4. 4.
    Sarwer DB, Spitzer JC, Wadden TA, et al. Changes in sexual functioning and sex hormone levels in women following bariatric surgery. JAMA Surg. 2014;149(1):26–33.CrossRefGoogle Scholar
  5. 5.
    Kolotkin RL, Binks M, Crosby RD, et al. Obesity and sexual quality of life. Obesity (Silver Spring). 2006;14(3):472–9.CrossRefGoogle Scholar
  6. 6.
    Sarwer DB, Lavery M, Spitzer JC. A review of the relationships between extreme obesity, quality of life, and sexual function. Obes Surg. 2012;22(4):668–76.CrossRefGoogle Scholar
  7. 7.
    Esposito K, Ciotola M, Giugliano F, et al. Association of body weight with sexual function in women. Int J Impot Res. 2007;19(4):353–7.CrossRefGoogle Scholar
  8. 8.
    Steffen KJ, King WC, White GE, et al. Sexual functioning of men and women with severe obesity before bariatric surgery. Surg Obes Relat Dis. 2017;13(2):334–43.CrossRefGoogle Scholar
  9. 9.
    Malik SM, Traub ML. Defining the role of bariatric surgery in polycystic ovarian syndrome patients. World J Diabetes. 2012;3(4):71–9.CrossRefGoogle Scholar
  10. 10.
    Tan O, Carr BR. The impact of bariatric surgery on obesity-related infertility and in vitro fertilization outcomes. Semin Reprod Med. 2012;30(6):517–28.CrossRefGoogle Scholar
  11. 11.
    Bond DS, Wing RR, Vithiananthan S, et al. Significant resolution of female sexual dysfunction after bariatric surgery. Surg Obes Relat Dis. 2011;7:1):1–7.CrossRefGoogle Scholar
  12. 12.
    Sarwer DB, Wadden TA, Spitzer JC, et al. 4-year changes in sex hormones, sexual functioning, and psychosocial status in women who underwent bariatric surgery. Obes Surg. 2018;28(4):892–9.CrossRefGoogle Scholar
  13. 13.
    Meczekalski B, Katulski K, Czyzyk A, et al. Functional hypothalamic amenorrhea and its influence on women's health. J Endocrinol Investig. 2014;37(11):1049–56.CrossRefGoogle Scholar
  14. 14.
    Pasquali R, Vicennati V, Gambineri A. Adrenal and gonadal function in obesity. J Endocrinol Investig. 2002;25(10):893–8.CrossRefGoogle Scholar
  15. 15.
    Botwood N, Hamilton-Fairley D, Kiddy D, et al. Sex hormone-binding globulin and female reproductive function. J Steroid Biochem Mol Biol. 1995;53(1–6):529–31.CrossRefGoogle Scholar
  16. 16.
    Boonchaya-Anant P, Laichuthai N, Suwannasrisuk P, et al. Changes in testosterone levels and sex hormone-binding globulin levels in extremely obese men after bariatric surgery. Int J Endocrinol. 2016;2016:1416503.CrossRefGoogle Scholar
  17. 17.
    Rosen R, Brown C, Heiman J, et al. The female sexual function index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther. 2000;26(2):191–208.CrossRefGoogle Scholar
  18. 18.
    Wiklund I, Karlberg J, Lindgren R, et al. A Swedish version of the Women's health questionnaire. A measure of postmenopausal complaints. Acta Obstet Gynecol Scand. 1993;72(8):648–55.CrossRefGoogle Scholar
  19. 19.
    Hunter M. The women's health questionnaire: a measure of mid-aged women's perceptions of their emotional and physical health. Psychol Health. 1992;7(1):45–54.CrossRefGoogle Scholar
  20. 20.
    Dupuy HJ. The psychological general well-being (PGWB) index. New York: Le Jacq Publishing, Inc; 1984.Google Scholar
  21. 21.
    Kjaer MM, Madsbad S, Hougaard DM, et al. The impact of gastric bypass surgery on sex hormones and menstrual cycles in premenopausal women. Gynecol Endocrinol. 2017;33(2):160–3.CrossRefGoogle Scholar
  22. 22.
    Ernst B, Wilms B, Thurnheer M, et al. Reduced circulating androgen levels after gastric bypass surgery in severely obese women. Obes Surg. 2013;23(5):602–7.CrossRefGoogle Scholar
  23. 23.
    Wei S, Schmidt MD, Dwyer T, et al. Obesity and menstrual irregularity: associations with SHBG, testosterone, and insulin. Obesity (Silver Spring). 2009;17(5):1070–6.CrossRefGoogle Scholar
  24. 24.
    Turkmen S, Ahangari A, Backstrom T. Roux-en-Y gastric bypass surgery in patients with polycystic ovary syndrome and metabolic syndrome. Obes Surg. 2016;26(1):111–8.CrossRefGoogle Scholar
  25. 25.
    Steffen KJ, King WC, White GE, et al. Changes in sexual functioning in women and men in the 5 years after bariatric surgery. JAMA Surg. 2019;154:487–98.CrossRefGoogle Scholar
  26. 26.
    Lynch A. "when the honeymoon is over, the real work begins:" gastric bypass patients' weight loss trajectories and dietary change experiences. Soc Sci Med (1982. 2016;151:241–9.CrossRefGoogle Scholar
  27. 27.
    Biron S, Biertho L, Marceau S, et al. Long-term follow-up of disease-specific quality of life after bariatric surgery. Surg Obes Relat Dis. 2018;14(5):658–64.CrossRefGoogle Scholar
  28. 28.
    Mazer LM, Azagury DE, Morton JM. Quality of life after bariatric surgery. Curr Obes Rep. 2017;6(2):204–10.CrossRefGoogle Scholar
  29. 29.
    Kolotkin RL, Davidson LE, Crosby RD, et al. Six-year changes in health-related quality of life in gastric bypass patients versus obese comparison groups. Surg Obes Relat Dis. 2012;8(5):625–33.CrossRefGoogle Scholar
  30. 30.
    Heiman JR, Rupp H, Janssen E, et al. Sexual desire, sexual arousal and hormonal differences in premenopausal US and Dutch women with and without low sexual desire. Horm Behav. 2011;59(5):772–9.CrossRefGoogle Scholar
  31. 31.
    Cappelletti M, Wallen K. Increasing women's sexual desire: the comparative effectiveness of estrogens and androgens. Horm Behav. 2016;78:178–93.CrossRefGoogle Scholar
  32. 32.
    Chidi-Ogbolu N, Baar K. Effect of estrogen on musculoskeletal performance and injury risk. Front Physiol. 2018;9:1834.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Surgery and Department of Clinical and Experimental MedicineLinkoping UniversityNorrkopingSweden
  2. 2.Department of SurgeryVrinnevi HospitalNorrkopingSweden
  3. 3.Department of Clinical and Experimental MedicineLinkoping UniversityNorrkopingSweden

Personalised recommendations