Abstract
Background
The relative contribution of anthropometric, hormonal, and metabolic changes after bariatric surgery (BS) on sexual function (SF) in severely obese subjects is not well established.
Methods
Prospective observational case series study of 39 men undergoing BS. SF was assessed by means of the international index of erectile function (IIEF) before and at 1 year after surgery. At the same time points, anthropometric (body mass index, waist circumference), hormonal (testosterone, sex hormone binding globulin, estradiol, gonadotropins, inhibin B, prolactin, leptin), and metabolic parameters (insulin sensitivity, C-reactive protein, lipid profile, hemoglobin A1c, presence of hypertension or sleep apnea) were assessed.
Results
BS was associated with marked weight loss (77.18 % excess weight loss), improved IIEF score (baseline: 54.85 ± 16.59, 1 year: 61.21 ± 14.10; p < 0.01), gonadal function (testosterone: baseline 256.36 ± 120.98, 1 year: 508.01 ± 161.90; p < 0.001), and improved metabolic profile. However, on multivariate regression analysis whereas changes in body mass index (beta: −0.677, p = 0.001), and baseline IIEF score (beta: −0.397, p = 0.023), were independent predictors of the changes in the IIEF score at 1 year after surgery, changes in hormonal and metabolic factors were not. Variables in the model accounted for 66 % of the postsurgical variation in the IIEF score. Similar results were found when the different IIEF-sexual domains were evaluated, except for intercourse satisfaction for which no independent predictor was identified.
Conclusions
Weight loss’s beneficial effects on SF occurring after BS are beyond the parallel improvement in gonadal and metabolic profiles.
Similar content being viewed by others
References
Bacon CG, Mittleman MA, Kawachi I, Giovannucci E, Glasser DB, Rimm EB (2003) Sexual function in men older than 50 years of age: results from the health professionals follow-up study. Ann Intern Med 139:161–168
Feldman HA, Johannes CB, Derby CA, Kleinman KP, Mohr BA, Araujo AB, McKinlay JB (2000) Erectile dysfunction and coronary risk factors: prospective results from the Massachusetts male aging study. Prev Med 30:328–338
Han TS, Tajar A, O’Neill TW, Jiang M, Bartfai G, Boonen S, Casanueva F, Finn JD, Forti G, Giwercman A, Huhtaniemi IT, Kula K, Pendleton N, Punab M, Silman AJ, Vanderschueren D, Lean ME, Wu FC (2011) Impaired quality of life and sexual function in overweight and obese men: the European Male Ageing Study. Eur J Endocrinol 164:1003–1011
Mulligan T, Frick MF, Zuraw QC, Stemhagen A, McWhirter C (2006) Prevalence of hypogonadism in males aged at least 45 years: the HIM study. Int J Clin Pract 60:762–769
Dandona P, Dhindsa S (2011) Update: hypogonadotropic hypogonadism in type 2 diabetes and obesity. J Clin Endocrinol Metab 96:2643–2651
Esposito K, Giugliano D (2011) Obesity, the metabolic syndrome, and sexual dysfunction in men. Clin Pharmacol Ther 90:169–173
Hammoud AO, Walker JM, Gibson M, Cloward TV, Hunt SC, Kolotkin RL, Adams TD, Meikle AW (2011) Sleep apnea, reproductive hormones and quality of sexual life in severely obese men. Obesity (Silver Spring) 19:1118–1123
Sarwer DB, Lavery M, Spitzer JC (2012) A review of the relationships between extreme obesity, quality of life, and sexual function. Obes Surg 22:668–676
Rao SR, Kini S, Tamler R (2011) Sex hormones and bariatric surgery in men. Gend Med 8:300–311
Esposito K, Giugliano F, Di PC, Giugliano G, Marfella R, D’Andrea F, D’Armiento M, Giugliano D (2004) Effect of lifestyle changes on erectile dysfunction in obese men: a randomized controlled trial. JAMA 291:2978–2984
Dallal RM, Chernoff A, O’Leary MP, Smith JA, Braverman JD, Quebbemann BB (2008) Sexual dysfunction is common in the morbidly obese male and improves after gastric bypass surgery. J Am Coll Surg 207:859–864
Hammoud A, Gibson M, Hunt SC, Adams TD, Carrell DT, Kolotkin RL, Meikle AW (2009) Effect of Roux-en-Y gastric bypass surgery on the sex steroids and quality of life in obese men. J Clin Endocrinol Metab 94:1329–1332
Ranasinghe WK, Wright T, Attia J, McElduff P, Doyle T, Bartholomew M, Hurley K, Persad RA (2011) Effects of bariatric surgery on urinary and sexual function. BJU Int 107:88–94
Reis LO, Favaro WJ, Barreiro GC, de Oliveira LC, Chaim EA, Fregonesi A, Ferreira U (2010) Erectile dysfunction and hormonal imbalance in morbidly obese male is reversed after gastric bypass surgery: a prospective randomized controlled trial. Int J Androl 33:736–744
Reis LO, Zani EL, Saade RD, Chaim EA, de Oliveira LC, Fregonesi A (2012) Bariatric surgery does not interfere with sperm quality—a preliminary long-term study. Reprod Sci 19(10):1057–1062
Globerman H, Shen-Orr Z, Karnieli E, Aloni Y, Charuzi I (2005) Inhibin B in men with severe obesity and after weight reduction following gastroplasty. Endocr Res 31:17–26
Mechanick JI, Kushner RF, Sugerman HJ, Gonzalez-Campoy JM, Collazo-Clavell ML, Spitz AF, Apovian CM, Livingston EH, Brolin R, Sarwer DB, Anderson WA, Dixon J, Guven S (2009) American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic and Bariatric Surgery medical guidelines for clinical practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Obesity (Silver Spring) 17(Suppl 1):S1–S70
Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A (1997) The International Index of Erectile Function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology 49:822–830
Morinigo R, Casamitjana R, Delgado S, Lacy A, Deulofeu R, Conget I, Barcelo-Batllori S, Gomis R, Vidal J (2007) Insulin resistance, inflammation, and the metabolic syndrome following Roux-en-Y gastric bypass surgery in severely obese subjects. Diabetes Care 30:1906–1908
Vermeulen A, Verdonck L, Kaufman JM (1999) A critical evaluation of simple methods for the estimation of free testosterone in serum. J Clin Endocrinol Metab 84:3666–3672
Vidal J, Ibarzabal A, Nicolau J, Vidov M, Delgado S, Martinez G, Balust J, Morinigo R, Lacy A (2007) Short-term effects of sleeve gastrectomy on type 2 diabetes mellitus in severely obese subjects. Obes Surg 17:1069–1074
Vidal J, Morinigo R, Codoceo VH, Casamitjana R, Pellitero S, Gomis R (2005) The importance of diagnostic criteria in the association between the metabolic syndrome and cardiovascular disease in obese subjects. Int J Obes (Lond) 29:668–674
Ridker PM (2007) Inflammatory biomarkers and risks of myocardial infarction, stroke, diabetes, and total mortality: implications for longevity. Nutr Rev 65:S253–S259
Rosen RC, Seftel AD (2008) Validated questionnaires for assessing sexual dysfunction and BPH/LUTS: solidifying the common pathophysiologic link. Int J Impot Res 20(Suppl 3):S27–S32
Heneghan HM, Meron-Eldar S, Brethauer SA, Schauer PR, Young JB (2011) Effect of bariatric surgery on cardiovascular risk profile. Am J Cardiol 108:1499–1507
du Plessis SS, Cabler S, McAlister DA, Sabanegh E, Agarwal A (2010) The effect of obesity on sperm disorders and male infertility. Nat Rev Urol 7:153–161
Håkonsen LB, Thulstrup AM, Aggerholm AS, Olsen J, Bonde JP, Andersen CY, Bungum M, Ernst EH, Hansen ML, Ernst EH, Ramlau-Hansen CH (2011) Does weight loss improve semen quality and reproductive hormones? Results from a cohort of severely obese men. Reprod Health 8:24
Acknowledgments
The authors acknowledge Gemma Yago, Pilar Ara, Gloria Martín and Pilar Arahuete for technical help.
Disclosures
M. Mora, G. B. Aranda, A. de Hollanda, L. Flores, M. Puig-Domingo, and J. Vidal have no conflicts of interest or financial ties to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Mora, M., Aranda, G.B., de Hollanda, A. et al. Weight loss is a major contributor to improved sexual function after bariatric surgery. Surg Endosc 27, 3197–3204 (2013). https://doi.org/10.1007/s00464-013-2890-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-013-2890-y