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Meta-analysis: Bariatric surgery improves sexual function in men, but not women
Men with obesity who underwent bariatric surgery reported an increase in sexual function and experienced an increase in sex hormone levels in the months after the procedure; however, a reported increase in sexual function among women with obesity who underwent surgery did not rise to significance, according to findings from a meta-analysis.
“After bariatric surgery, insulin sensitivity is improved by weight loss, and the sexual function is expected to improve,” Jun-Ping Wen, MD, PhD, associate professor at Fujian Provincial Hospital and Fujian Medical University in Fuzhou, China, and colleagues wrote. “Some studies have shown that the sexual function in obese patients is expected to improve. However, one study has shown no improvement in sexual function following [laparoscopic gastric banding surgery], in addition to deterioration of erectile index and orgasmic function when adjusted for time. Furthermore, a study has suggested that surgeons should be cautious when regarding the benefits of bariatric surgery, as the incidence of long-term complications following surgery is high, especially for [laparoscopic gastric banding surgery].”
Wen and colleagues analyzed data from 36 studies including 1,273 patients with obesity who underwent bariatric surgery between January 1990 and December 2016 and were followed for a minimum of 6 months (time to postoperative follow-up ranged from 1 to 115 months). Included studies reported on sexual function using the female sexual function index (FSFI) and the international index of erectile dysfunction (IIEF) and assessed at least one sex hormone level, including total testosterone, free testosterone, estradiol, luteinizing hormone (LH), follicle-stimulating hormone (FSH), sex hormone-binding globulin (SHBG) or insulin.
In five studies reporting on IIEF scores in men before and after surgery (n = 154), a fixed-effects model showed an increase in IIEF score (mean difference, 4.84; 95% CI, 2.92-6.75). In seven studies reporting on FSFI scores in women before and after surgery, a random-effects model showed an increase in score that did not rise to statistical significance (mean difference, 4.1; 95% CI, –0.28 to 8.48).
In random-effects models, men who underwent bariatric surgery also saw an increase in levels of total testosterone (mean difference, 8.3; 95% CI, 9.92-9.68), free testosterone (mean difference, 16.06; 95% CI, 9.33-22.79), and a decrease in estradiol (mean difference, –4.49; 95% CI, –6.97 to –2.02), as well as an increase in LH (mean difference, 1.14; 95% CI, 0.75-1.52), FSH (mean difference, 1.07; 95% CI, 0.75-1.4) and SHBG (mean difference, 22.32; 95% CI, 16.12-28.51). Insulin levels also markedly decreased in men followed surgery (mean difference, –138.97; 95% CI, –181.82 to –96.12).
For women who underwent surgery, random-effects models experienced decreases in levels of total testosterone (mean difference, –0.71; 95% CI, –0.84 to –0.58), a decrease in free testosterone that did not reach significance (mean difference, –13.65; 95% CI, –28.82 to 1.53), and a decrease in estradiol levels (mean difference, –25.13; 95% CI, –36.93 to –13.32). Women who underwent surgery also saw increases in levels of LH (mean difference, 5.73; 95% CI, 0.15-11.3), FSH (mean difference, 3.79; 95% CI, 0.71-6.88) and SHBG (mean difference, 31.84; 95% CI, 20.24-43.44). Insulin levels also fell for women in the months after surgery (mean difference, –93.36; 95% CI, –119.86 to –66.86).
“The normalization of sex hormones may be one of the mechanisms contributing to the advantageous effects of surgery in morbid obesity patients,” the researchers wrote, noting that the relationship between the improvement of sexual dysfunction and the sex hormone changes did not achieve consensus.
“Our meta-analysis suggested that bariatric surgery is related to increased insulin sensitivity in both sexes, which may be one of the factors contributing to the improvement of sex hormone levels,” the researcher wrote. – by Regina Schaffer
Disclosures: The authors report no relevant financial disclosures.