Changes in Sexual Functioning in Women and Men in the 5 Years 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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