Impact of Bariatric Surgery on Female Sexual Function in Obese Patients: a Meta-Analysis

Changes in Sexual Functioning in Women with Severe Obesity After Bariatric Surgery: Impact of Postoperative Adherence to Mediterranean Diet

BACKGROUND

This study analyzes the effects of bariatric surgery on female sexual function, assessed using the Female Sexual Function Index (FSFI), and explores the impact of adherence to the Mediterranean diet during the postoperative period.

PATIENTS AND METHODS

A retrospective observational study was conducted using a prospectively collected database, including heterosexual women with morbid obesity undergoing bariatric procedures. The FSFI questionnaire was applied before the intervention and 24 months after surgery. Adherence to the Mediterranean diet was evaluated using the PREDIMED questionnaire.

RESULTS

Among the 240 participants, 70.8% presented preoperative sexual dysfunction, which decreased to 20.5% two years post-surgery. Significant improvements were observed in all FSFI domains except for pain. Good adherence to the Mediterranean diet was associated with higher scores in the lubrication, orgasm, and satisfaction domains.

CONCLUSIONS

Bariatric surgery significantly improves female sexual function, with the Mediterranean diet enhancing these benefits during the postoperative period. Future studies must investigate additional variables such as psychological factors, physical activity, and other lifestyle changes that may also influence sexual function.

Impact of bariatric surgery on infertility in obese women: a systematic review and meta-analysis

Background

The prevalence of obesity is increasing worldwide, with several consequences, including reduced fertility in both men and women. One of the ways to reduce weight is bariatric surgery. The aim of this systematic review and meta-analysis study was to evaluate the effectiveness of bariatric surgery on weight loss and subsequent improvement of fertility in obese infertile women.

Methods

Several databases were searched using MESH terms to investigate the studies that evaluated the fertility rates after bariatric surgery in infertile obese women. Related data were obtained and analyzed using Stata software with a P-value ≤0.05, which was considered as significant.

Results

Of the 283 articles related to the purpose of this study, 9 articles, including 231 obese infertile women, were included in the study. BMI before surgery was 42.2 [95% CI= 39.2-45.2] and BMI after surgery was 31.9 (95% CI= 28.9-34.8), which shows the significance of weight loss after bariatric surgery. Conception rate after bariatric surgery weight loss was increased and was 67% (95% CI= 47-87%, P-value <0.05).

Conclusions

Bariatric surgery had a significant effect on the reduction of BMI and subsequent significant improvement of fertility in obese infertile women.

Rapid Lifestyle Recommendations to Improve Urologic, Heart and Overall Health

PURPOSE OF REVIEW

This literature review is intended to highlight recent correlations between urologic, heart and overall health by emphasizing healthy eating patterns, physical activity, alcohol minimization and tobacco elimination, healthy sleep, weight, cholesterol, blood sugar, blood pressure management, and mental health awareness.

RECENT FINDINGS

Meta-analyses, systematic reviews, and clinical studies espouse a unified message for prevention, reducing the risk of disease recurrence, progression, complementing conventional medical intervention efficacy, and mitigating treatment side effects. Limiting or eliminating alcohol consumption could be considered an independent recommendation and adding a mental health and miscellaneous (genetic risk and lifestyle, planetary health, HPV or other vaccination awareness, spirituality, etc.) category could allow for individualized educational opportunities, synergism appreciation, and self-improvement. Urologic healthcare professionals have the potential to strengthen the collective public health goal of improving the quality and quantity of the lives of patients able to adhere to these heart healthy recommendations.

Psychological symptoms and brain activity alterations in women with PCOS and their relation to the reduced quality of life: a narrative review

BACKGROUND

Polycystic ovary syndrome (PCOS) is the most common feminine endocrine disorder, characterized by androgen excess, ovulatory dysfunction, and polycystic ovarian morphology. The negative impact of symptoms on the quality of life (QoL) of patients is still not clear.

PURPOSE

The present review aimed at studying the impact of the symptoms, the psychological symptoms, and brain alterations in women with PCOS.

METHODS

A systematic search was undertaken for studies that assessed the impact of PCOS symptoms on QoL, psychological symptoms, and brain alterations in PCOS patients.

RESULTS

Most of the information about QoL came from psychometric studies, which used culture-based questionnaires. Alterations of sleep quality, body image, and mood disorders can negatively affect the QoL of the patients. Sexual satisfaction and desire were affected by PCOS. Brain imaging studies showed functional alterations that are associated with impairments of visuospatial working memory, episodic and verbal memory, attention, and executive function.

CONCLUSIONS

Several factors can negatively influence the quality of life of the patients, and they are directly related to hyperandrogenism and the risk of infertility. In particular, obesity, hirsutism, acne, and the fear of infertility can have a direct impact on self-esteem and sexual function. Metabolic and psychiatric comorbidities, such as mood, anxiety, and eating disorders, can affect the well-being of the patients. Moreover, specific cognitive alterations, such as impairments in attention and memory, can limit PCOS patients in a series of aspects of daily life.

Sexuality and self-concept of morbidly obese women who are sexually attracted to men after bariatric surgery: a phenomenological study

BACKGROUND

Morbid Obesity (MO) is a public health problem that affects a person's physical, psychological and sexual well-being. Women with MO are affected by their body image and self-concept, and obesity stigma may affect women in social and sexual relationships.

OBJECTIVE

To describe and understand the experiences of morbidly obese heterosexual women (who are sexually attracted to men) in relation to their body image and sexuality after bariatric surgery.

METHODOLOGY

Qualitative study using Merleau-Ponty's hermeneutic phenomenology as a philosophical framework. Data collection took place between 2020 and 2021 in a southern Spanish province. A total of 22 in-depth interviews were conducted using open-ended questions until data saturation was reached.

RESULTS

Two main themes were identified: (1) "Escaping from a cruel environment": weight loss to increase self-esteem; with the sub-themes: 'I love myself now', and 'Body image and social relationships; a vicious circle; (2) "Now, I am truly me": accepting my body to reclaim my sexuality, with the sub-themes: 'The body as the focal point of sexuality', and 'When regaining your sex drive reignites your sex life and relationship'.

CONCLUSION

Weight loss and body acceptance radically change morbidly obese women's sex lives after bariatric surgery. They rediscover their bodies, have increased self-esteem, and see improvements in their social relationships and sexuality. These women feel seen, loved and desired, and now value their body image and femininity. As they go through continuous improvements following bariatric surgery, they gradually regain self-esteem, acceptance of their bodies and control over their sex life. Even though the women's partners benefit from these improvements, they seem to be afraid of being left.

Obesity and female sexual dysfunctions: A systematic review of prevalence with meta-analysis

Obesity represents a major global health challenge. Female sexual dysfunctions have a negative impact on quality of life and overall health balance. A higher rate of female sexual dysfunctions in obese women has been suggested. This systematic review summarized the literature on female sexual dysfunction prevalence in obese women. The review was registered (Open Science Framework OSF.IO/7CG95) and a literature search without language restrictions was conducted in PubMed, Embase and Web of Science, from January 1990 to December 2021. Cross-sectional and intervention studies were included, the latter if they provided female sexual dysfunction rate data in obese women prior to the intervention. For inclusion, studies should have used the female sexual function index or its simplified version. Study quality was assessed to evaluate if female sexual function index was properly applied using six items. Rates of female sexual dysfunctions examining for differences between obese vs class III obese and high vs low quality subgroups were summarized. Random effects meta-analysis was performed, calculating 95% confidence intervals (CI) and examining heterogeneity with I2 statistic. Publication bias was evaluated with funnel plot. There were 15 relevant studies (1720 women participants in total with 153 obese and 1567 class III obese women). Of these, 8 (53.3%) studies complied with >4 quality items. Overall prevalence of female sexual dysfunctions was 62% (95% CI 55-68%; I2 85.5%). Among obese women the prevalence was 69% (95% CI 55-80%; I2 73.8%) vs 59% (95% CI 52-66%; I2 87.5%) among those class III obese (subgroup difference p=0.15). Among high quality studies the prevalence was 54% (95% CI 50-60%; I2 46.8%) vs 72% (95% CI 61-81%; I2 88.0%) among low quality studies (subgroup difference p=0.002). There was no funnel asymmetry. We interpreted that the rate of sexual dysfunctions is high in obese and class III obese women. Obesity should be regarded as a risk factor for female sexual dysfunctions.

Female sexual dysfunction after bariatric surgery in women with obesity: A systematic review and meta-analysis

BACKGROUND AND OBJECTIVE

Obesity is prevalent and has a negative impact on women's health, including sexual dysfunction. Recent review articles suggest improvement in Female Sexual Function Index (FSFI) and proportion of female sexual dysfunction (FSD) among women with obesity after bariatric surgery.

METHODS

We pooled data from 16 observational studies involving 953 women. The study outcomes were mean FSFI scores and proportion of FSD before and after bariatric surgery. We also sub-analyzed whether age and duration of follow-up affected these outcomes.

RESULTS

The mean age of the subjects was 39.4 ± 4.2 years. Body mass index (BMI) showed significant reduction postoperatively (p < 0.0001). Bariatric surgery led to significant improvement in total FSFI score (p = 0.0005), and all sexual domains except pain. Bariatric surgery reduced the odds of having FSD by 76% compared with those who did not undergo operation (OR 0.24, 95% CI = 0.17, 0.33, p < 0.0001). Our sub-analysis demonstrated a significant reduction in the proportion of FSD for patients <40 years of age. The improvement of total FSFI scores and reduction in proportion of FSD remained significant within the first 12 months after surgery. Univariate meta-regression showed that BMI was not a significant covariate for improvement of FSFI scores (β = 0.395, p = 0.1, 95% CI = 0.884, 0.095).

CONCLUSIONS

Bariatric surgery is shown to improve sexual function scores and prevalence of FSD. This is especially significant among women <40 years of age. This benefit remained significant within the first year after surgery. This appears to be an additional benefit for these patients.

Influence of Gastric Bypass on Obese Women Sexual Function-a Prospective Study

INTRODUCTION

Obesity may lead to hyperandrogenia and affect female sexual function. The study aims to evaluate female sexual function and androgenic profile in obese women after laparoscopic Roux-en-Y gastric bypass (LRYGB).

METHODS

Forty obese women with a mean age of 34 years were prospectively studied. Diabetes and psychiatric and pelvic disorders were the exclusion criteria. All patients underwent LRYGB. Total (TT) and free (FT) testosterone, androstenedione (AD), dehydroepiandrosterone (DHEA) and the Sexual Quotient - Female Version were evaluated, preoperatively, 6 and 12 months after the operation.

RESULTS

Preoperative incidence of sexual dysfunction was 10% and hyperandrogenia was 40%. At 6 months, sexual function was not different; and FT (0.49-0.33 ng/dl) and AD (2.0-1.3 ng/dl) decreased significantly. At 12 months, there was an improvement in female sexual function (77-84 points), related to desire and interest (22-25 points) and comfort (15.9-17.3 points) without case of sexual dysfunction at 12 months. Hyperandrogenia (40-8%), FT levels (0.5-0.3 ng/dl), and AD (2.0-1.4 ng/dl) decreased, while DHEA levels (3.4-4.2 ng/dl) increased. The percentage of weight loss was 22% and 31% at 6 and 12 months, respectively. Sexual function did not correlate with BMI, weight, or androgen levels in any period.

CONCLUSION

Female sexual function in obese women with no diabetes and psychiatric and pelvic disorders improved in patients undergoing LRYGB, especially in desire, interest, and sexual comfort, and this occured after 6 months of the operation and unrelated to BMI, percentage of weight loss, or androgen levels.

KEY POINTS

• In obese women with no diabetes and psychiatric and pelvic disorders the FSD improvement after LRYGB. • FSD no correlation with weight loss and BMI. • FSD no correlation with androgens levels.

Impact of Endourological procedures with or without double-J stent on sexual function: a systematic review and meta-analysis

BACKGROUND

Endourological procedures are widely used to treat benign urinary disorders and the double-J stent is routinely used. However, its potential impact on sexual function remains unclear. Therefore, we performed a quantitative systematic review to determine the relationship between endourological procedures with or without double-J stent and post-operative sexual function.

METHODS

We conducted a search of PubMed, EMBASE, Web of Science, and Cochrane Library databases up to December 2018 for studies that compared sexual function before and after endourological procedures. The quality of the included studies was evaluated using the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I). We performed subgroup analyses to explore heterogeneity. A random effects model was used to combine the results.

RESULTS

Five prospective studies involving 485 sexually active participants were identified. Pooled results showed that, in patients without a double-J stent, the change in sexual function after endourological procedures was not significant in men (mean difference [MD]: - 0.61, 95% confidence interval [CI]: - 1.43 to 0.22, p = 0.148) or women (MD: 0.53, 95% CI: - 0.52 to 1.57, p = 0.322). However, in patients with indwelling double-J stent, sexual function scores significantly declined after the procedure in both men (MD: -4.25, 95% CI: - 6.20 to - 2.30, p < 0.001) and women (MD: -7.17, 95% CI: - 7.88 to - 6.47, p < 0.001).

CONCLUSIONS

Our meta-analysis suggests that indwelling double-J stent after endourological procedures could be a crucial factor causing temporary sexual dysfunction post-operatively. Our results may be used to provide evidence-based advice to patients.

The advantages and disadvantages of sleeve gastrectomy; clinical laboratory to bedside review

Sleeve gastrectomy is a surgical technique and a leading method in metabolic surgery. Sleeve gastrectomy gained ever-increasing popularity among laparoscopic surgeons involved in bariatric surgery and has proved to be a successful method in achieving considerable weight loss in a short time. There are some disparate effects that patients may experience after sleeve gastrectomy including a reduction in BMI, weight, blood pressure, stroke, and cancer and also a significant remission in obesity-related diseases including type 2 diabetes (T2D), Non-alcoholic fatty liver (NAFLD), cardiovascular disease, obstructive sleep apnea, and craniopharyngioma-related hypothalamic obesity as well as non-obesity-related diseases such as gout, musculoskeletal problems, ovarian disorders and urinary incontinence. The most common complications of sleeve gastrectomy are bleeding, nutrient deficiencies, and leakage. There are several studies on the impact of gender and ethnic disparities on post-operative complications. This study collects state of the art of reports on sleeve gastrectomy. The aim of this study was to analyze recent studies and review the advantages and disadvantages of sleeve gastrectomy.