Effect of Bariatric Surgery on Male Sexual Function: A Meta-Analysis and Systematic Review

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Abstract

Introduction

Obesity is a worldwide public health issue with serious psychological and social impacts. Erectile dysfunction is also a common clinical condition, and obesity is one of its main risk factors.

Objective

The objective of this study was to systematically evaluate the effect of bariatric surgery on male sexual function.

Methods

A systematical research was carried out in Medline via PubMed, EMBASE, Cochrane Library, and Web of Science up to March 16, 2019, to identify published articles related to bariatric surgery and male sexual function in men. Two reviewers screened literature, extracted data, and assessed the quality of included studies. I ² index was applied to estimate the heterogeneity. All analyses were done using RevMan5.3 and Stata14.

Results

A total of 12 studies involving 420 participants were included. Analysis showed that bariatric surgery significantly reduced body mass index in morbidly obese patients (mean difference [MD] = -13.73; 95% CI -17.23 to -10.22; P < .00001). From 10 studies that reported the International Index of Erectile Function (IIEF) score, bariatric surgery led to a significant increase in IIEF-total score (MD = 8.2; 95% CI = 5.52−10.88; P < .00001), and erectile function score (MD = 3.76; 95% CI = 2.34−5.19; P < .00001), sexual desire (MD = 0.93; 95% CI = 0.55−1.32; P < .00001), sexual intercourse satisfaction (MD = 1.73; 95% CI = 0.43−3.03; P < .01), and total satisfaction (MD = 1.28; 95% CI = 0.56−2.00; P = .0005) were also significantly improved. However, bariatric surgery did not affect orgasm function (MD = 0.26; 95% CI = -0.15 to 0.68; P = .21). Three studies that reported the IIEF-5 score also showed a significant improvement of erectile function (MD = 5.45; 95% CI = 3.38−7.52; P < .00001).

Conclusions

Bariatric surgery could improve the erectile function, sexual desire, sexual intercourse satisfaction, and total satisfaction in morbidly obese men. Due to limited data on body mass index and hormone levels, our meta-analysis had some limitations. More clinical studies are needed to further explore the relationship between bariatric surgery and male sexual function.

Xu J, Wu Q, Zhang Y, et al. Effect of Bariatric Surgery on Male Sexual Function: A Meta-Analysis and Systematic Review. Sex Med 2019;7:270–281.

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Most cited references 40

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Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013.

Marie Ng, Tom Fleming, Margaret W. Robinson … (2015)

In 2010, overweight and obesity were estimated to cause 3·4 million deaths, 3·9% of years of life lost, and 3·8% of disability-adjusted life-years (DALYs) worldwide. The rise in obesity has led to widespread calls for regular monitoring of changes in overweight and obesity prevalence in all populations. Comparable, up-to-date information about levels and trends is essential to quantify population health effects and to prompt decision makers to prioritise action. We estimate the global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013. We systematically identified surveys, reports, and published studies (n=1769) that included data for height and weight, both through physical measurements and self-reports. We used mixed effects linear regression to correct for bias in self-reports. We obtained data for prevalence of obesity and overweight by age, sex, country, and year (n=19,244) with a spatiotemporal Gaussian process regression model to estimate prevalence with 95% uncertainty intervals (UIs). Worldwide, the proportion of adults with a body-mass index (BMI) of 25 kg/m(2) or greater increased between 1980 and 2013 from 28·8% (95% UI 28·4-29·3) to 36·9% (36·3-37·4) in men, and from 29·8% (29·3-30·2) to 38·0% (37·5-38·5) in women. Prevalence has increased substantially in children and adolescents in developed countries; 23·8% (22·9-24·7) of boys and 22·6% (21·7-23·6) of girls were overweight or obese in 2013. The prevalence of overweight and obesity has also increased in children and adolescents in developing countries, from 8·1% (7·7-8·6) to 12·9% (12·3-13·5) in 2013 for boys and from 8·4% (8·1-8·8) to 13·4% (13·0-13·9) in girls. In adults, estimated prevalence of obesity exceeded 50% in men in Tonga and in women in Kuwait, Kiribati, Federated States of Micronesia, Libya, Qatar, Tonga, and Samoa. Since 2006, the increase in adult obesity in developed countries has slowed down. Because of the established health risks and substantial increases in prevalence, obesity has become a major global health challenge. Not only is obesity increasing, but no national success stories have been reported in the past 33 years. Urgent global action and leadership is needed to help countries to more effectively intervene. Bill & Melinda Gates Foundation. Copyright © 2014 Elsevier Ltd. All rights reserved.

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To develop a brief, reliable, self-administered measure of erectile function that is cross-culturally valid and psychometrically sound, with the sensitivity and specificity for detecting treatment-related changes in patients with erectile dysfunction. Relevant domains of sexual function across various cultures were identified via a literature search of existing questionnaires and interviews of male patients with erectile dysfunction and of their partners. An initial questionnaire was administered to patients with erectile dysfunction, with results reviewed by an international panel of experts. Following linguistic validation in 10 languages, the final 15-item questionnaire, the international index of Erectile Function (IIEF), was examined for sensitivity, specificity, reliability (internal consistency and test-retest repeatability), and construct (concurrent, convergent, and discriminant) validity. A principal components analysis identified five factors (that is, erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction) with eigenvalues greater than 1.0. A high degree of internal consistency was observed for each of the five domains and for the total scale (Cronbach's alpha values of 0.73 and higher and 0.91 and higher, respectively) in the populations studied. Test-retest repeatability correlation coefficients for the five domain scores were highly significant. The IIEF demonstrated adequate construct validity, and all five domains showed a high degree of sensitivity and specificity to the effects of treatment. Significant (P values = 0.0001) changes between baseline and post-treatment scores were observed across all five domains in the treatment responder cohort, but not in the treatment nonresponder cohort. The IIEF addresses the relevant domains of male sexual function (that is, erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction), is psychometrically sound, and has been linguistically validated in 10 languages. This questionnaire is readily self-administered in research or clinical settings. The IIEF demonstrates the sensitivity and specificity for detecting treatment-related changes in patients with erectile dysfunction.

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Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old.

Kenneth F Adams, Arthur Schatzkin, Tamara Harris … (2006)

Obesity, defined by a body-mass index (BMI) (the weight in kilograms divided by the square of the height in meters) of 30.0 or more, is associated with an increased risk of death, but the relation between overweight (a BMI of 25.0 to 29.9) and the risk of death has been questioned. We prospectively examined BMI in relation to the risk of death from any cause in 527,265 U.S. men and women in the National Institutes of Health-AARP cohort who were 50 to 71 years old at enrollment in 1995-1996. BMI was calculated from self-reported weight and height. Relative risks and 95 percent confidence intervals were adjusted for age, race or ethnic group, level of education, smoking status, physical activity, and alcohol intake. We also conducted alternative analyses to address potential biases related to preexisting chronic disease and smoking status. During a maximum follow-up of 10 years through 2005, 61,317 participants (42,173 men and 19,144 women) died. Initial analyses showed an increased risk of death for the highest and lowest categories of BMI among both men and women, in all racial or ethnic groups, and at all ages. When the analysis was restricted to healthy people who had never smoked, the risk of death was associated with both overweight and obesity among men and women. In analyses of BMI during midlife (age of 50 years) among those who had never smoked, the associations became stronger, with the risk of death increasing by 20 to 40 percent among overweight persons and by two to at least three times among obese persons; the risk of death among underweight persons was attenuated. Excess body weight during midlife, including overweight, is associated with an increased risk of death. Copyright 2006 Massachusetts Medical Society.

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Author and article information

Contributors

Changsong Pei

Journal

Journal ID (nlm-ta): Sex Med

Journal ID (iso-abbrev): Sex Med

Title: Sexual Medicine

Publisher: Elsevier

ISSN (Electronic): 2050-1161

Publication date PMC-release: 10 July 2019

Publication date Collection: September 2019

Publication date (Electronic): 10 July 2019

Volume: 7

Issue: 3

Pages: 270-281

Affiliations

[1 ]Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China

[2 ]Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, China

[3 ]Soochow University, Suzhou, China

Author notes

[∗ ] Corresponding Author: Changsong Pei, MD, PhD, Department of Urology, The First Affiliated Hospital, School of Medicine, Soochow University, Suzhou, China, 215000. Tel: +86-512-13506218258; Fax: +86-512-13506218258 changsongpei@ 123456qq.com

Article

Publisher ID: S2050-1161(19)30049-2

DOI: 10.1016/j.esxm.2019.06.003

PMC ID: 6728768

PubMed ID: 31302076

SO-VID: 2f070d48-ec60-4055-acf8-f813b48e36d2

License:

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

History

Date received : 20 March 2019

Date accepted : 9 June 2019

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Effect of Bariatric Surgery on Male Sexual Function: A Meta-Analysis and Systematic Review

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Abstract

Introduction

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Most cited references 40

Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013.

The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction.

Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old.

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Cited by 12

Most referenced authors 3,493