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Original Investigation |

Changes in Sexual Functioning and Sex Hormone Levels in Women Following Bariatric Surgery

David B. Sarwer, PhD1,2; Jacqueline C. Spitzer, MSEd1; Thomas A. Wadden, PhD1; James E. Mitchell, MD3; Kathryn Lancaster, BA3; Anita Courcoulas, MD, MPH4; William Gourash, MSN, CRNP4; Raymond C. Rosen, PhD5; Nicholas J. Christian, PhD6
[+] Author Affiliations
1Department of Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
2Department of Surgery, Division of Plastic Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
3Neuropsychiatric Research Institute and the University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
4University of Pittsburgh Medical Center, Pennsylvania
5New England Research Institutes, Watertown, Massachusetts
6Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
JAMA Surg. 2014;149(1):26-33. doi:10.1001/jamasurg.2013.5022.
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Importance  Obesity has been associated with impairments in sexual function and untoward changes in reproductive hormones in women. Relatively few studies have investigated changes in these domains following bariatric surgery.

Objective  To investigate changes in sexual functioning, sex hormone levels, and relevant psychosocial constructs in women who underwent bariatric surgery.

Design, Setting, and Participants  A prospective cohort study of 106 women from phase 2 of the Longitudinal Assessment of Bariatric Surgery who underwent bariatric surgery (median [interquartile range] body mass index, 44.5 [41.4-49.7]). Assessments were completed between 2006 and 2012.

Interventions  Bariatric surgery was performed by a surgeon certified by the Longitudinal Assessment of Bariatric Surgery (85 women underwent a Roux-en-Y gastric bypass, and 21 women underwent laparoscopic adjustable gastric banding).

Main Outcomes and Measures  Sexual functioning was assessed by use of the Female Sexual Function Index. Hormones were assessed by use of a blood assay. Quality of life, body image, depressive symptoms, and marital adjustment were assessed by use of validated questionnaires.

Results  Women lost a mean 32.7% (95% CI, 30.7%-34.7%) of initial body weight at postoperative year 1 and a mean 33.5% (95% CI, 31.5%-35.6%) at postoperative year 2. Two years following surgery, women reported significant improvements in overall sexual functioning and specific domains of sexual functioning: arousal, lubrication, desires, and satisfaction. They also experienced significant changes at 2 years in all hormones of interest. Women reported significant improvements in most domains of quality of life, as well as body image and depressive symptoms, within the first year after surgery, with these improvements being maintained through the second postoperative year.

Conclusions and Relevance  Women who underwent bariatric surgery had significant improvements in overall sexual functioning, in most reproductive hormones of interest, and in psychosocial status. Improvements in sexual health can be added to the list of health benefits associated with bariatric surgery.

Trial Registration  clinicaltrials.gov Identifier: NCT00670098

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Figure 1.
Recruitment and Retention of Study Participants
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Figure 2.
Female Sexual Function Index Total Score by Trajectory Group
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