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Changes in Sexual Functioning in Women and Men in the 5 Years After Bariatric Surgery

Educational Objective To identify to what extent impairment in sexual functioning is improved in the 5 years after bariatric surgery in both men and women.
1 Credit CME
Key Points

Question  What percentage of adults with impairment in sexual functioning report durable improvements in the 5 years after bariatric surgery?

Findings  In this cohort study of adults with impairment in sexual functioning before bariatric surgery, more than half of women experienced meaningful postsurgical improvements in the degree to which physical health limited sexual activity (74%) and satisfaction with sexual life (52%) 5 years after surgery, and more than one-third of women had improvements in frequency of sexual desire (41%) and sexual activity (35%) 5 years after surgery. At least half of men experienced improvements in all 4 domains in year 5.

Meaning  In this study, a considerable portion of adults experienced durable improvements in several domains of sexual functioning 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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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Accepted for Publication: February 17, 2018.

Corresponding Author: Kristine Steffen, PharmD, PhD, Pharmaceutical Sciences, North Dakota State University, Department 2665, PO Box 6050, Fargo, ND 58108-6050 (kristine.steffen@ndsu.edu).

Published Online: February 20, 2019. doi:10.1001/jamasurg.2018.1162

Author Contributions: Drs King and White had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Steffen, Subak, Mitchell, Flum, Huang.

Acquisition, analysis, or interpretation of data: Steffen, White, Subak, Mitchell, Courcoulas, Flum, Strain, Sarwer, Kolotkin, Pories, Huang.

Drafting of the manuscript: Steffen, White, Flum, Huang.

Critical revision of the manuscript for important intellectual content: Steffen, White, Subak, Mitchell, Courcoulas, Flum, Strain, Sarwer, Kolotkin, Pories, Huang.

Statistical analysis: White.

Obtained funding: Subak, Mitchell, Flum.

Administrative, technical, or material support: Subak, Courcoulas, Flum, Kolotkin, Pories.

Supervision: Sarwer, Huang.

Conflict of Interest Disclosures: Dr Steffen reports having received grant funds from the National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Alcohol Abuse and Alcoholism, Shire Pharmaceuticals, and Sanford Profile North Dakota State University. Dr Coucourlas reports having received research grants from the National Institute of Diabetes and Digestive and Kidney Diseases and Patient-Centered Outcomes Research Institute. Dr Subak reports having received a research grant from Astellas. Dr Sarwer reports acting as a consultant for BAROnova, Ethicon, Medtronic, and Novo Nordisk and receiving a grant from the National Institute for Diabetes and Digestive and Kidney Disease (grant R01-DK108628-01). Dr Kolotkin reports receiving royalties from Duke University for the development of the Impact of Weight on Quality of Life–Lite. Dr Huang has received funding from Pfizer Inc via contracts with the University of California San Francisco to conduct research unrelated to bariatric surgery or urinary incontinence. No other disclosures were reported.

Funding/Support: LABS-2 was funded by a cooperative agreement by the National Institute of Diabetes and Digestive and Kidney Diseases (grants U01 DK066557 [Data Coordinating Center], U01-DK66667 [Columbia-Presbyterian], UL1-RR024996 [Columbia-Presbyterian in collaboration with Cornell University Medical Center Clinical and Translational Science Center], U01-DK66568 [University of Washington], M01RR-00037 [University of Washington in collaboration with the Clinical and Translational Research Center], U01-DK66471 [Neuropsychiatric Research Institute], U01-DK66526 [East Carolina University], U01-DK66585 [University of Pittsburgh Medical Center], UL1-RR024153 [University of Pittsburgh Medical Center in collaboration with the Clinical and Translational Research Center]), and U01-DK66555 [Oregon Health & Science University]).

Role of the Funder/Sponsor: Scientists from the National Institute of Diabetes and Digestive and Kidney Diseases contributed to the design and conduct of the study, which included collection and management of data. The project scientist from the Diabetes and Digestive and Kidney Diseases served as a member of the steering committee, along with the principal investigator from each clinical site and the data coordinating center. The data coordinating center housed all data during the study and performed data analyses according to a pre-specified plan developed by the data coordinating center biostatistician and approved by the steering committee and independent data and safety monitoring board. The decision to publish was made by the Longitudinal Assessment of Bariatric Surgery-2 steering committee, with no restrictions imposed by the sponsor.

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