title: Sexual functioning and sex hormones in persons with extreme obesity and seeking surgical and nonsurgical weight loss.
abstract: BACKGROUND
  Many individuals with obesity are motivated to lose weight to improve weight-related co-morbidities or psychosocial functioning, including sexual functioning. Few studies have documented rates of sexual dysfunction in persons with obesity. This study investigated sexual functioning, sex hormones, and relevant psychosocial constructs in individuals with obesity who sought surgical and nonsurgical weight loss.
  
  
  METHODS
  One hundred forty-one bariatric surgery patients (median BMI [25th percentile, 75th percentile] 44.6 [41.4, 50.1]) and 109 individuals (BMI = 40.0 [38.0, 44.0]) who sought nonsurgical weight loss participated. Sexual functioning was assessed by the Female Sexual Function Index (FSFI) and the International Index of Erectile Function (IIEF). Hormones were assessed by blood assay. Quality of life, body image, depressive symptoms, and marital adjustment were assessed by validated questionnaires.
  
  
  RESULTS
  Fifty-one percent of women presenting for bariatric surgery reported a sexual dysfunction; 36% of men presenting for bariatric surgery reported erectile dysfunction (ED). This is in contrast to 41% of women who sought nonsurgical weight loss and reported a sexual dysfunction and 20% of men who sought nonsurgical weight loss and reported ED. These differences were not statistically significant. Sexual dysfunction was strongly associated with psychosocial distress in women; these relationships were less strong and less consistent among men. Sexual dysfunction was unrelated to sex hormones, except for sex hormone binding globulin (SHGB) in women.
  
  
  CONCLUSIONS
  Women and men who present for bariatric surgery, compared with individuals who sought nonsurgical weight loss, were not significantly more likely to experience a sexual dysfunction. There were few differences in reproductive hormones and psychosocial constructs between candidates for bariatric surgery and individuals interested in nonsurgical weight loss.
authors.affiliation: Department of Psychiatry, Center for Weight and Eating Disorders, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Surgery, Division of Plastic Surgery, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: dsarwer@mail.med.upenn.edu.
authors.forename: David B
authors.initials: DB
authors.lastname: Sarwer
authors.forename: Jacqueline C
authors.initials: JC
authors.lastname: Spitzer
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Wadden
authors.forename: Raymond C
authors.initials: RC
authors.lastname: Rosen
authors.forename: James E
authors.initials: JE
authors.lastname: Mitchell
authors.forename: Kathy
authors.initials: K
authors.lastname: Lancaster
authors.forename: Anita
authors.initials: A
authors.lastname: Courcoulas
authors.forename: William
authors.initials: W
authors.lastname: Gourash
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Christian
mesh_terms: D000328:Adult; D000367:Age Factors; D050110:Bariatric Surgery / Q000379:methods* / Q000706:statistics & numerical data; D001828:Body Image; D015992:Body Mass Index; D015331:Cohort Studies; D004038:Diet, Reducing; D007172:Erectile Dysfunction / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D012739:Gonadal Steroid Hormones / Q000097:blood*; D006801:Humans; D015994:Incidence; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000175:diagnosis / Q000178:diet therapy / Q000601:surgery*; D011584:Psychology; D011788:Quality of Life; D018570:Risk Assessment; D012737:Sex Factors; D020018:Sexual Dysfunctions, Psychological / Q000175:diagnosis / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D015431:Weight Loss
chemical_list: D012739:Gonadal Steroid Hormones
keywords: Obesity; Quality of life; Sexual functioning