OBESITY AND SEXUALITY
Obesity is a global epidemic that negatively affects the physical, emotional and psychosocial well-being of individuals. The number of people affected by this epidemic is increasing. Diabetes, heart disease, hypertension, urinary incontinence and various types of cancer are linked to obesity. In addition to these diseases, it can also cause sexual problems. There are studies that show that losing weight improves sexual functions.
Is obesity itself the cause of sexual dysfunction; It is not yet clear whether sexual dysfunction develops due to diseases caused by obesity.
The relationship between obesity and sexual function
Sexual function is multidimensional and there are many sexual problems that are influenced by psychological, physical and physiological factors in the individual. Disorders in sexual function usually affect at least one of the three phases of the sexual response cycle: desire, arousal, and orgasm.
In men, the most common problem with the arousal phase is the inability to achieve and/or difficulty maintaining an erection; Common problems with the orgasmic phase include premature ejaculation and delayed or obstructed ejaculation.
In women, common problems with the arousal phase of desire include low desire, lack of lubrication, and insufficient psychological arousal; The most common problem in the orgasm phase is the inability or difficulty to achieve orgasm. Obesity has the potential to affect each of these areas. For example, obesity is linked to depression, anxiety, poor body image and low self-esteem, which affect sexual function. Diseases caused by obesity such as dyslipidemia, insulin resistance, hypertension, hyperglycemia, cardiovascular diseases and chronic inflammation negatively affect sexual function. Obesity can negatively affect sexual relationships by reducing partner attraction and/or sexual intercourse.
Evidence linking obesity to sexual dysfunction
Sexual problems that appear in obese individuals occur more often and have a greater effect on women. In a study of more than 200 sexually active obese women, 48.3% had problems with desire, 35.9% with arousal, 45.0% with lubrication, and 42.9% experienced pain. Another study investigating the obesity-sexuality link in 553 women who answered questions about weight, current sexual partner status, and frequency of intercourse found that obese women were 30% less likely to report sexual activity over 12 years. last than women of average weight. Other similar studies have shown that overweight women experience greater problems with arousal, lubrication, orgasm and sexual satisfaction. Studies on sexual dysfunction in men have shown that body weight is an independent risk factor for erectile dysfunction. Body dissatisfaction, sexual feelings, erotic images, and sexual dysfunction were compared in 30 obese and 30 normal-weight men; More sexual dysfunction and dissatisfaction in sexual desire, erotic fantasy, and energy or motivation for sexual proposals were seen in obese men. In addition, obese men reported less sexual satisfaction because they were afraid of hurting their partner.
Obesity and sexual function
Obesity represents the accumulation of fat in the body. Adipose tissue can affect various biochemical processes in men and women, which can directly affect sexual function. The biochemical consequences of excess adipose tissue can cause endocrine changes that produce different effects between the sexes.
In women, fat is stored as subcutaneous adipose tissue, especially in the hips and thighs.
Visceral (intra-abdominal) fat is more visible in men. Visceral fat is associated with higher rates of insulin resistance, type 2 diabetes, dyslipidemia, and cardiovascular disease. As women enter menopause, their fat storage patterns become more similar to those of men. Differences in the way fat is stored in men and women suggest that obesity may affect sexual dysfunction in different ways in both sexes.
Endocrine Function of Adipose Tissue
Adipose tissue has historically been known only as a fat depot. However, today we know that adipose tissue acts as an endocrine organ. Adipose tissue is responsible for almost all circulating estrogen and about 50% of testosterone in postmenopausal women. Adipose tissue contains the enzymes necessary for the activation of steroid hormones; allows androgens to be converted to estrogens. Adipose tissue is important for the production and secretion of steroid sex hormones. This indicates that adipose tissue is directly related to sexual response. However, since different sex steroids are different in men and women, their effects will differ between the sexes.
Male sexual function
In men, erectile function is the aspect of sexual response most affected by obesity. Neuromodulators such as testosterone, estrogen and nitric oxide (NO), which are known to have a role in sexual response, and circulating andorgens and estrogens may play a role between obesity and erectile function. Specifically, obese men tend to have lower sex hormone-binding globulin concentrations. Serum concentrations of testosterone levels are lower with hypogonadism. Male hypogonadism reduces sexual sensitivity by affecting sexual desire and erectile response. Because obese men often have increased estrogen, some researchers have suggested that increased estrogen activity may harm male sexual sensitivity. NO (Nitric oxide) is a neurotransmitter that contributes to penile erection by relaxing smooth muscles and facilitating vasodilation. As a result of obesity, the amount of enzyme responsible for NO synthesis decreases in nerve and vascular tissue.
Female Sexual Function
Hormonal responses that affect sexuality in men and are associated with obesity are less clear in women. It is unclear whether obesity has significant effects on sex steroids in women. Increased estrogen and androgen levels in obese women may in some cases contribute to sexual desire and sensitivity, but may have ambiguous effects. In women, the effects of sex steroids and nitric oxide levels on female sexuality are much less clear. Direct endocrine effects from adipose tissue may have little or no effect on women’s sexual function. While obesity itself can cause sexual dysfunction, diseases that accompany obesity can also cause sexual dysfunction and it is difficult to distinguish it. Although the precise role of obesity in sexual response is unclear, men with a waist circumference greater than 120 cm have the highest degree of erectile dysfunction.
Increase in visceral adiposity and metabolic syndrome severity in men increases erectile dysfunction. In addition, high glucose and triglyceride levels negatively affect erectile function. Structural abnormalities of the clitoral cavernous tissue have been observed in premenopausal women with diabetes. These data suggest that the mechanisms underlying genital tissue vasocongestion and thus sexual function are likely impaired in men and women with diabetes and/or metabolic syndrome.
Obesity yields a variety of psychological consequences that are known to affect sexual function. Given the sociocultural pressures on physical appearance on women, these factors may affect them more than men. In the current “thin” culture, obese individuals often experience stigma, which is manifested through comments about weight, discrimination, and ridicule, resulting in poor self-image and low self-esteem. Sexual dysfunctions are often associated with increased anxiety and depression due to marked personal distress and poor quality of life.
It has been observed that weight loss can provide positive effects on sexual function. Weight loss can improve sexual response in multiple ways:
• Positive biochemical (eg endocrine) effects resulting from reduced adipose tissue
• May improve overall health and reduce the harmful effects of co-morbidities such as cardiovascular diseases, diabetes and metabolic syndrome
• It can affect psychological parameters such as self-esteem, confidence, body image, depression and anxiety, leading to greater sexual interest, more positive feelings about sex, and increased desire for intercourse and sexual intercourse.
- Rowland DL, McNabney SM, Mann AR. Sexual Function, Obesity, and Weight Loss in Men and Women.Sex Med Rev. 2017 Jul;5(3):323-338. doi: 10.1016/j.sxmr.2017.03.006. Epub 2017 Apr 26.PMID: 28456610
- M. Temel, N. E. Boyacıoğlu, S. Çaynak, M Çaynak. Psychosocial and Sexual Life in Morbidly Obese Individuals Following Bariatric Surgery: A Qualitative Study. 7 Jul 2022https://doi.org/10.1089/bari.2022.0016
