Current Obesity Reports

, Volume 7, Issue 4, pp 301–307 | Cite as

Obesity and Sexual Functioning

  • David B. SarwerEmail author
  • Alexis J. Hanson
  • Jessica Voeller
  • Kristine Steffen
Psychological Issues (V Drapeau and S Sogg, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Psychological Issues


Purpose of the Review

Sexual functioning is an important, yet often overlooked, aspect of quality of life for many individuals with obesity.

Recent Findings

With the growing recognition of obesity as a significant, international public health issue, a developing body of research has investigated the relationship between obesity and sexual functioning. Several studies have found that obesity is associated with impairments in sexual functioning. The mechanisms of this relationship, whether physiological, psychosocial, or a combination of the two, are yet to be fully elucidated. Other studies have suggested that weight loss, whether induced by bariatric surgery or less intensive interventions, is associated with significant and clinically meaningful change in sexual functioning and relevant reproductive hormones.


This chapter reviews the research in these areas and provides recommendations for future research on these relationships.


Sexual dysfunction Obesity Bariatric surgery Body image 



The Section Editors wish to thank Drs. Valentina Ivezaj (Yale University) and David Rowland (Valparaiso University) for their gracious assistance in reviewing this article.

Compliance with Ethical Standards

Conflict of Interest

David B. Sarwer has received research support through grants from the National Institutes of Health (NIH) (grant no. R01-DK108628-01) and the Commonwealth of Pennsylvania, and has also received compensation from BAROnova and Novo Nordisk for service as a consultant.

Alexis J. Hanson declares that she has no conflict of interest.

Jessica Voeller declares that she has no conflict of interest.

Kristine Steffen has received research support through grants from the NIH, Shire, and Profile by Sanford; however, none of these grants relate to or have funded any aspect of this article.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.
    Kinsey AC, Pomeroy WB, Martin CE. Sexual behavior in the human male. Philadelphia: WB Saunders and Company; 1948.Google Scholar
  2. 2.
    Kinsey AC, Pomeroy WB, Martin CE, Gebhard PH. Sexual behavior in the human female. Philadelphia: WB Saunders and Company; 1953.Google Scholar
  3. 3.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013.Google Scholar
  4. 4.
    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
  5. 5.
    Sarwer DB, Steffen KJ. Quality of life, body image and sexual functioning in bariatric surgery patients. Eur Eat Disord Rev. 2015;23(6):504–8.CrossRefGoogle Scholar
  6. 6.
    Ware JE. SF-36 health survey: manual and interpretation guide. Boston, MA: The Health Institute; 1993.Google Scholar
  7. 7.
    Fontaine KR, Barofsky I. Obesity and health-related quality of life. Obes Rev. 2001;2(3):173–82.CrossRefGoogle Scholar
  8. 8.
    Kolotkin RL, Meter K, Williams GR. Quality of life and obesity. Obes Rev. 2001;2(4):219–29.CrossRefGoogle Scholar
  9. 9.
    Sarwer DB, Allison KC, Bailer BA, Faulconbridge LF. Psychosocial characteristics of bariatric surgery candidates. In: Still C, Sarwer DB, Blankenship J, editors. The ASMBS textbook of bariatric surgery: volume 2: integrated health. New York: Springer New York; 2014. p. 3–9.Google Scholar
  10. 10.
    Onyike CU, Crum RM, Lee HB, Lyketsos CG, Eaton WW. Is obesity associated with major depression? Results from the third National Health and nutrition examination survey. Am J Epidemiol. 2003;158(12):1139–47.CrossRefGoogle Scholar
  11. 11.
    Dong C, Li WD, Li D, Price RA. Extreme obesity is associated with attempted suicides: results from a family study. Int J Obes. 2006;30(2):388–90.CrossRefGoogle Scholar
  12. 12.
    van Hout GC, Verschure SK, van Heck GL. Psychosocial predictors of success following bariatric surgery. Obes Surg. 2005;15(4):552–60.CrossRefGoogle Scholar
  13. 13.
    Wee CC, Jones DB, Davis RB, Bourland AC, Hamel MB. Understanding patients' value of weight loss and expectations for bariatric surgery. Obes Surg. 2006;16(4):496–500.CrossRefGoogle Scholar
  14. 14.
    Munoz DJ, Chen E, Fischer S, Roehrig M, Sanchez-Johnson L, Alverdy J, et al. Considerations for the use of the Beck depression inventory in the assessment of weight-loss surgery seeking patients. Obes Surg. 2007;17(8):1097–101.CrossRefGoogle Scholar
  15. 15.
    Allegri C, Russo E, Roggi C, Cena H. Quality of life (QoL) and motivation for treatment: a female issue? Eat Weight Disord. 2008;13(1):e8–e13.CrossRefGoogle Scholar
  16. 16.
    Kolotkin RL, Head S, Hamilton M, Tse CK. Assessing impact of weight on quality of life. Obes Res. 1995;3(1):49–56.CrossRefGoogle Scholar
  17. 17.
    Kolotkin RL, Crosby RD, Kosloski KD, Williams GR. Development of a brief measure to assess quality of life in obesity. Obes Res. 2001;9(2):102–11.CrossRefGoogle Scholar
  18. 18.
    Boan J, Kolotkin RL, Westman EC, McMahon RL, Grant JP. Binge eating, quality of life and physical activity improve after roux-en-Y gastric bypass for morbid obesity. Obes Surg. 2004;14(3):341–8.CrossRefGoogle Scholar
  19. 19.
    Dymek MP, Le Grange D, Neven K, Alverdy J. Quality of life after gastric bypass surgery: a cross-sectional study. Obes Res. 2002;10(11):1135–42.CrossRefGoogle Scholar
  20. 20.
    Sarwer DB, Spitzer JC, Wadden TA, Rosen RC, Mitchell JE, Lancaster K, et al. Sexual functioning and sex hormones in persons with extreme obesity and seeking surgical and nonsurgical weight loss. Surg Obes Relat Dis. 2013;9(6):997–1007.CrossRefGoogle Scholar
  21. 21.
    Kolotkin RL, Davidson LE, Crosby RD, Hunt SC, Adams TD. 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
  22. 22.
    Kolotkin RL, Crosby RD, Wang Z. Health-related quality of life in randomized controlled trials of lorcaserin for obesity management: what mediates improvement? Clin Obes. 2017;7(6):347–53.CrossRefGoogle Scholar
  23. 23.
    Billy HT, Sarwer DB, Ponce J, Ng-Mak DS, Shi R, Cornell C, et al. Quality of life after laparoscopic adjustable gastric banding (LAP-BAND): APEX interim 3-year analysis. Postgrad Med. 2014;126(4):131–40.CrossRefGoogle Scholar
  24. 24.
    Pilone V, Mozzi E, Schettino AM, Furbetta F, di Maro A, Giardiello C, et al. Improvement in health-related quality of life in first year after laparoscopic adjustable gastric banding. Surg Obes Relat Dis. 2012;8(3):260–8.CrossRefGoogle Scholar
  25. 25.
    Lier HO, Biringer E, Hove O, Stubhaug B, Tangen T. Quality of life among patients undergoing bariatric surgery: associations with mental health- a 1 year follow-up study of bariatric surgery patients. Health Qual Life Outcomes. 2011;9:79.CrossRefGoogle Scholar
  26. 26.
    Kolotkin RL, Crosby RD, Gress RE, Hunt SC, Adams TD. Two-year changes in health-related quality of life in gastric bypass patients compared with severely obese controls. Surg Obes Relat Dis. 2009;5(2):250–6.CrossRefGoogle Scholar
  27. 27.
    Sarwer DB, Wadden TA, Moore RH, Eisenberg MH, Raper SE, Williams NN. Changes in quality of life and body image after gastric bypass surgery. Surg Obes Relat Dis. 2010;6(6):608–14.CrossRefGoogle Scholar
  28. 28.
    • 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. Examination of changes in sexual function and hormone profiles before and after bariatric surgery among women. CrossRefGoogle Scholar
  29. 29.
    • Sarwer DB, Spitzer JC, Wadden TA, et al. Sexual functioning and sex hormones in men who underwent bariatric surgery. Surg Obes Relat Dis. 2015;11(3):643–51. Examination of changes in sexual function and hormone profiles before and after bariatric surgery among men. CrossRefGoogle Scholar
  30. 30.
    Sjostrom L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351(26):2683–93.CrossRefGoogle Scholar
  31. 31.
    King WC, Chen J, Belle SH, et al. Change in pain and physical function following bariatric surgery for severe obesity. JAMA. 2016;315(13):1362–71.CrossRefGoogle Scholar
  32. 32.
    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):892–899.CrossRefGoogle Scholar
  33. 33.
    Sarwer DB, Polonsky HM. The psychosocial burden of obesity. Endocrinol Metab Clin N Am. 2016;45(3):677–88.CrossRefGoogle Scholar
  34. 34.
    • Kolotkin RL, Zunker C, Ostbye T. Sexual functioning and obesity: a review. Obesity (Silver Spring). 2012;20(12):2325–33. A comprehensive review of sexual functioning in obesity. CrossRefGoogle Scholar
  35. 35.
    Moore RH, Sarwer DB, Lavenberg JA, Lane IB, Evans JL, Volger S, et al. Relationship between sexual function and quality of life in obese persons seeking weight reduction. Obesity (Silver Spring). 2013;21(10):1966–74.CrossRefGoogle Scholar
  36. 36.
    • Bond DS, Vithiananthan S, Leahey TM, et al. Prevalence and degree of sexual dysfunction in a sample of women seeking bariatric surgery. Surg Obes Relat Dis. 2009;5(6):698–704. One of the first reports to show impaired sexual functioning in women prior to bariatric surgery. CrossRefGoogle Scholar
  37. 37.
    • Dallal RM, Chernoff A, O'Leary MP, Smith JA, Braverman JD, Quebbemann BB. Sexual dysfunction is common in the morbidly obese male and improves after gastric bypass surgery. J Am Coll Surg. 2008;207(6):859–64. One of the first reports to show impaired sexual functioning in men prior to bariatric surgery and improvement thereafter. CrossRefGoogle Scholar
  38. 38.
    • Steffen KJ, King WC, White GE, et al. Sexual functioning of men and women with severe obesity before bariatric surgery. Surg Obes Relat Dis. 2016; A large cohort study of sexual functioning prior to bariatric surgery and factors associated with various domains of functioning. Google Scholar
  39. 39.
    Du Plessis SS, Cabler S, McAlister DA, Sabanegh E, Agarwal A. The effect of obesity on sperm disorders and male infertility. Nat Rev Urol. 2010;7(3):153–61.CrossRefGoogle Scholar
  40. 40.
    Cabler S, Agarwal A, Flint M, du Plessis SS. Obesity: modern man's fertility nemesis. Asian J Androl. 2010;12(4):480–9.CrossRefGoogle Scholar
  41. 41.
    Brewer CJ, Balen AH. The adverse effects of obesity on conception and implantation. Reproduction. 2010;140(3):347–64.CrossRefGoogle Scholar
  42. 42.
    Doumas M, Tsakiris A, Douma S, Grigorakis A, Papadopoulos A, Hounta A, et al. Factors affecting the increased prevalence of erectile dysfunction in Greek hypertensive compared with normotensive subjects. J Androl. 2006;27(3):469–77.CrossRefGoogle Scholar
  43. 43.
    Dong J-Y, Zhang Y-H, Qin L-Q. Erectile dysfunction and risk of cardiovascular disease: meta-analysis of prospective cohort studies. J Am Coll Cardiol. 2011;58(13):1378–85.CrossRefGoogle Scholar
  44. 44.
    Yamada T, Hara K, Umematsu H, Suzuki R, Kadowaki T. Erectile dysfunction and cardiovascular events in diabetic men: a meta-analysis of observational studies. PLoS One. 2012;7(9):e43673.CrossRefGoogle Scholar
  45. 45.
    Nascimento ER, Maia AC, Pereira V, Soares-Filho G, Nardi AE, Silva AC. Sexual dysfunction and cardiovascular diseases: a systematic review of prevalence. Clinics (Sao Paulo). 2013;68(11):1462–8.CrossRefGoogle Scholar
  46. 46.
    DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey L. editors. Pharmacotherapy: A Pathophysiologic Approach. 9e New York, NY: McGraw-Hill; 2014.Google Scholar
  47. 47.
    Giuliano FA, Leriche A, Jaudinot EO, de Gendre AS. Prevalence of erectile dysfunction among 7689 patients with diabetes or hypertension, or both. Urology. 2004;64(6):1196–201.CrossRefGoogle Scholar
  48. 48.
    Weinberg AE, Eisenberg M, Patel CJ, Chertow GM, Leppert JT. Diabetes severity, metabolic syndrome, and the risk of erectile dysfunction. J Sex Med. 2013;10(12):3102–9.CrossRefGoogle Scholar
  49. 49.
    Giraldi A, Kristensen E. Sexual dysfunction in women with diabetes mellitus. J Sex Res. 2010;47(2):199–211.CrossRefGoogle Scholar
  50. 50.
    Mattar CN, Chong YS, Su LL, Agarwal AA, Wong PC, Choolani M. Care of women in menopause: sexual function, dysfunction and therapeutic modalities. Ann Acad Med Singap. 2008;37(3):215–23.PubMedGoogle Scholar
  51. 51.
    Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, Wein A. The standardisation of terminology of lower urinary tract function: Report from the standardisation sub-committee of the international continence society. Neurourol Urodyn. 2002;187(1):116–126.Google Scholar
  52. 52.
    Boyle P, Robertson C, Mazzetta C, Keech M, Hobbs R, Fourcade R, et al. The association between lower urinary tract symptoms and erectile dysfunction in four centres: the UrEpik study. BJU Int. 2003;92(7):719–25.CrossRefGoogle Scholar
  53. 53.
    Wein AJ, Coyne KS, Tubaro A, Sexton CC, Kopp ZS, Aiyer LP. The impact of lower urinary tract symptoms on male sexual health: EpiLUTS. BJU Int. 2009;103:33–41.CrossRefGoogle Scholar
  54. 54.
    Fecik SE. Drug-induced sexual dysfunction. Medical Update for Psychiatrists. 1998;3(6):176–81.CrossRefGoogle Scholar
  55. 55.
    Smith, S. Drugs that cause sexual dysfunction. Psychiatry. 2007;6(3):111–14CrossRefGoogle Scholar
  56. 56.
    Sarwer DB, Cohn NI, Gibbons LM, Magee L, Crerand CE, Raper SE, et al. Psychiatric diagnoses and psychiatric treatment among bariatric surgery candidates. Obes Surg. 2004;14(9):1148–56.CrossRefGoogle Scholar
  57. 57.
    Longitudinal Assessment of Bariatric Surgery C, Flum DR, Belle SH, et al. Perioperative safety in the longitudinal assessment of bariatric surgery. N Engl J Med. 2009;361(5):445–54.CrossRefGoogle Scholar
  58. 58.
    Cremieux PY, Ledoux S, Clerici C, Cremieux F, Buessing M. The impact of bariatric surgery on comorbidities and medication use among obese patients. Obes Surg. 2010;20(7):861–70.CrossRefGoogle Scholar
  59. 59.
    Segal JB, Clark JM, Shore AD, Dominici F, Magnuson T, Richards TM, et al. Prompt reduction in use of medications for comorbid conditions after bariatric surgery. Obes Surg. 2009;19(12):1646–56.CrossRefGoogle Scholar
  60. 60.
    Rowland DL, McNabney SM, Mann AR. Sexual function, obesity, and weight loss in men and women. Sex Med Rev. 2017;5(3):323–38.CrossRefGoogle Scholar
  61. 61.
    Kostis JB, Rosen RC, Brondolo E, Taska L, Smith DE, Wilson AC. Superiority of nonpharmacologic therapy compared to propranolol and placebo in men with mild hypertension: a randomized, prospective trial. Am Heart J. 1992;123(2):466–74.CrossRefGoogle Scholar
  62. 62.
    Rosen RC, Kostis JB, Brondolo E. Nondrug treatment approaches for hypertension. Clin Geriatr Med. 1989;5(4):791–802.CrossRefGoogle Scholar
  63. 63.
    Esposito K, Giugliano F, Di Palo C, et al. Effect of lifestyle changes on erectile dysfunction in obese men: a randomized controlled trial. JAMA. 2004;291(24):2978–84.CrossRefGoogle Scholar
  64. 64.
    Gosman GG, Katcher HI, Legro RS. Obesity and the role of gut and adipose hormones in female reproduction. Hum Reprod Update. 2006;12(5):585–601.CrossRefGoogle Scholar
  65. 65.
    Strain GW, Kolotkin RL, Dakin GF, Gagner M, Inabnet WB, Christos P, et al. The effects of weight loss after bariatric surgery on health-related quality of life and depression. Nutr Diabetes. 2014;4:e132.CrossRefGoogle Scholar
  66. 66.
    • 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. A post-surgical follow-up study assessing improvement in sexual functioning after bariatric surgery among women. CrossRefGoogle Scholar
  67. 67.
    Becnel JN, Zeller MH, Noll JG, Sarwer DB, Reiter-Purtill J, Michalsky M, et al. Romantic, sexual, and sexual risk behaviours of adolescent females with severe obesity. Pediatr Obes. 2017;12(5):388–97.CrossRefGoogle Scholar
  68. 68.
    Zeller MH, Noll JG, Sarwer DB, Reiter-Purtill J, Rofey DL, Baughcum AE, et al. Child maltreatment and the adolescent patient with severe obesity: implications for clinical care. J Pediatr Psychol. 2015;40(7):640–8.CrossRefGoogle Scholar
  69. 69.
    American Society of Plastic Surgeons. 2017 Plastic Surgery Statistics Report.

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • David B. Sarwer
    • 1
    Email author
  • Alexis J. Hanson
    • 2
  • Jessica Voeller
    • 3
  • Kristine Steffen
    • 4
  1. 1.College of Public HealthTemple UniversityPhiladelphiaUSA
  2. 2.School of Nursing, College of Pharmacy, Nursing, and Allied SciencesNorth Dakota State UniversityFargoUSA
  3. 3.Altru Retail PharmacyGrand ForkUSA
  4. 4.Department of Pharmaceutical Sciences, College of Pharmacy, Nursing, and Allied SciencesNorth Dakota State UniversityFargoUSA

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