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Menopause Live - IMS Updates
InFocus

Date of release: 19 December, 2016

Obesity and sexuality in the menopause

Weight gain is a common adverse event of menopause, and obesity becomes the most problematic disease of modern times. There is no need to detail the widely known cardiovascular and metabolic consequences of obesity. This week's commentary will highlight the link between increased weight or body mass index (BMI) and aspects of sexuality. Many studies have addressed the potential reasons for such associations and the role of psychological, hormonal or metabolic factors in weight-related sexuality disturbances. Simoncig Netjasov and colleagues from Serbia investigated the hormonal profile of 73 menopausal women (age range 50–65 years) [1]. They were divided into obese (mean BMI 35.9 kg/m2) and non-obese controls (mean BMI 22.5 kg/m2). The McCoy Female Sexuality Questionnaire (MFSQ) was completed by the participants. The results showed that obese women had less frequent pain during sexual intercourse, on the one hand, but, on the other hand, they reported less enjoyable sexual intercourse, they were less excited and had less frequent orgasms than controls, and tended to be less satisfied with their partner. While testosterone levels were similar in both groups, its value in the obese women showed a positive correlation with arousal, frequency of orgasm and vaginal lubrication. Although estradiol levels were higher in the obese group, there were no correlations between estradiol and the sexuality parameters.

Comment

The association of sexual functioning and obesity in midlife has been investigated in several large-scale studies, most of which showed a clear relationship between obesity and lower levels of sexual functioning, especially in regard to erectile dysfunction in men [2]. The data in women are not so abundant despite the fact that it is estimated that 20–30% of adult females experience sexual desire disorder, 15% suffer from arousal disorder, and 25% demonstrate difficulty with orgasm [3]. While some studies concluded that high BMI had no effect, others demonstrated a significant linkage [4]. In the SWAN study, sexual functioning variables were measured using a 20-item self-administered questionnaire designed to address sexual activity and function in midlife women. Analyses included a total of 2528 women (mean age 46 years, mean BMI 27.7 kg/m2) who were followed for an average period of 8 years. In adjusted models, higher baseline BMI was associated with participants reporting lower frequency of intercourse (p = 0.003). No associations were found between baseline BMI and baseline levels of desire, arousal, or ability to climax. While BMI increased with time and reached an average of 29.1 kg/m2, overall changes in desire, arousal, frequency of intercourse, or ability to climax were not associated with overall change in BMI across the study period. However, the extent to which each participant’s BMI in a given year deviated from their expected BMI, based on their individual trajectory, came up as a predictor of sexual dysfunction. In another study on individuals recruited for a weight loss program, there was little decrease in the score obtained from a Sexual Functioning Questionnaire with increasing BMI, especially after adjustment for covariates [5]. However, the authors noted that the sample consisted only of obese individuals with BMIs between 30 and 50 kg/m2, perhaps masking the true relationship between BMI and sexual functioning had the data included a wider BMI range. Another study, which included extreme obese persons (BMI 30–100 kg/m2), reached a definitive conclusion that higher BMI was associated with greater impairments in sexual quality of life [6]. Interestingly, a survey in various European countries revealed a significant effect of country on frequency of sexual intercourse with highest weekly rates in France (1.96) and lowest in Austria (1.19) [7]. In addition, frequency of sexual intercourse correlated with BMI as well. Obesity is one component of the metabolic syndrome (MetS). Evaluating the outcomes of MetS concerning sexuality pointed at the fact that prevalence of Italian women with sexual dysfunction was higher in MetS women than in health controls (39/103 [37.9%] vs. 20/105 [19%], p = 0.003) [8]. Sexual dysfunction in this study was determined by the Female Sexual Function Index questionnaire, and the Female Sexual Distress Scale.

Distorted body image and weight dissatisfaction are associated with sexual problems but are not necessarily related to BMI [9]. Yet, if weight gain and obesity may cause sexuality difficulties, then the opposite process may reverse them. Perhaps looking at the impact on sexuality of weight loss is best witnessed in patients undergoing bariatric surgery. Indeed, data show that such patients are prone to sexual dysfunction, but the post-operation period is characterized by improved sexuality [10]. Recent publications stress the differences in study cohorts, methodology, co-morbidities and complexity of the association between obesity and sexuality that explain the array of results obtained for women. Sexuality is a mixture of emotional and physiological parameters which may also be affected by cultural, socioeconomic and environmental factors. One thing is clear – as a general rule of thumb, obesity is bad for health, while weight reduction promotes better health and is much desired.

Comentario

Amos Pines


Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel



    References

  1. Simoncig Netjasov A, Tancic-Gajic M, Ivovic M, Marina L, Arizanovic Z, Vujovic S. Influence of obesity and hormone disturbances on sexuality of women in the menopause. Gynecol Endocrinol 2016;32:762-66


    http://www.ncbi.nlm.nih.gov/pubmed/27871199

  2. Kolotkin RL, Zunker C, Ostbye T. Sexual functioning and obesity: a review. Obesity (Silver Spring) 2012;20:2325-33


    http://www.ncbi.nlm.nih.gov/pubmed/22522887

  3. Palacios S, Castano R, Grazziotin A. Epidemiology of female sexual dysfunction. Maturitas 2009;63:119-23


    http://www.ncbi.nlm.nih.gov/pubmed/19482447

  4. Nackers LM, Appelhans BM, Segawa E, Janssen I, Dugan SA, Kravitz HM. Associations between body mass index and sexual functioning in midlife women: the Study of Women's Health Across the Nation. Menopause 2015;22:1175-81


    http://www.ncbi.nlm.nih.gov/pubmed/25803669

  5. Ostbye T, Kolotkin RL, He H, et al. Sexual functioning in obese adults enrolling in a weight loss study. J Sex Marital Ther 2011;37:224-35


    http://www.ncbi.nlm.nih.gov/pubmed/21512941

  6. Kolotkin RL, Binks M, Crosby RD, Ostbye T, Gress RE, Adams TD. Obesity and sexual quality of life. Obesity (Silver Spring) 2006;14:472-9


    http://www.ncbi.nlm.nih.gov/pubmed/16648619

  7. Dennerstein L, Lehert P. Women's sexual functioning, lifestyle, mid-age, and menopause in 12 European countries. Menopause 2004;11:778-85


    http://www.ncbi.nlm.nih.gov/pubmed/15543029

  8. Martelli V, Valisella S, Moscatiello S, et al. Prevalence of sexual dysfunction among postmenopausal women with and without metabolic syndrome. J Sex Med 2012;9:434-41


    http://www.ncbi.nlm.nih.gov/pubmed/22023878

  9. Sarwer DB, Steffen KJ. Quality of life, body image and sexual functioning in bariatric surgery patients. Eur Eat Disord Rev 2015;23:504-8


    http://www.ncbi.nlm.nih.gov/pubmed/26608946

  10. Wingfield LR, Kulendran M, Laws G, Chahal H, Scholtz S, Purkayastha S. Change in sexual dysfunction following bariatric surgery. Obes Surg 2016;26:387-94


    http://www.ncbi.nlm.nih.gov/pubmed/26487651