Research on the interaction between obesity and sexuality is limited, but some studies suggest that obesity can significantly impair sexual quality of life, particularly in women. Effective management of obesity using lifestyle changes, diet, drugs, behavioural therapies and, occasionally, weight loss surgery, may lead to improvements in self esteem, sexuality and quality of life.
What is sexuality?
Sexuality refers to an individual’s sexual attitudes, behaviours and practices. It is considered an integral part of our personality. The concept varies widely between individuals, and encompasses the physical (including sexual intercourse and sexual practices), the psychological and the cultural. For a long time, it has been recognised that medical conditions such as obesity can alter a peson’s sexuality. This may manifest as reduced sexual desire and lack of self-esteem in sexual relationships. Although it is a sensitive and difficult topic to discuss, with a high potential for embarrassment, proper consideration of any issues you have may lead to improvements in your overall quality of life. Most doctors will be receptive and non-judgmental when discussing these issues with you during your consultation.
Overview of obesity
Obesity and sexuality . Obesity is broadly defined as an excess in body fat or, more specifically, as a body mass index (BMI) greater than 30. Obesity is increasing at an alarming rate in Australia, and has now reached epidemic proportions. It remains a serious health issue due to the various medical complications, including type 2 diabetes, high blood pressure, high cholesterol, bone problems and obstructive sleep apnea. In addition, it may have a negative impact on your quality of life, physical functioning, self esteem, emotional well-being and social functioning. Considerable research has gone into obesity in recent years and efforts have been made to control this growing health problem. A variety of different treatments to combat obesity are available, including lifestyle changes, weight loss drugs, meal replacement programs and surgical procedures.
Relationship between obesity and sexuality
There has been considerable research on obesity and on sexuality as separate issues, but not that much on the relationship between the two. This may reflect general societal misconceptions that obesity and sexuality cannot coexist – that only thin people are attractive, and that there are no sexual opportunities for obese people. However, with over 60% of the Indian population classified as overweight or obese, it is clear that sexuality is, in fact, an important issue.
Obese individuals commonly experience some sexual dissatisfaction or sexual difficulties related to their weight. In males, for example, it has been proven that obesity can lower sexual satisfaction and cause erectile dysfunction. The relationship between obesity and female sexual dysfunction is less clear, though obesity may lead to reduced sexual desires in women. Obese people may experience social stigmatization, discrimination and prejudice because of their weight. Poor self-esteem and body image affect overall sexuality. Overweight people may feel like sexual misfits, unattractive and undesirable, causing them to avoid potential or actual sexual relationships. Generally, those people who consider their weight to be a real problem and who seek treatment are those who have the highest rates of sexual problems.
Obesity can also be related to sexuality in the reverse fashion. If you have had problems with your sexuality or have been the victim of sexual abuse, you may turn to binge or comfort eating to help deal with your experiences. Psychological issues may cause you to use your weight as a means of avoiding relationships or intimacy. A doctor or psychologist can help you to explore the underlying basis for your problems.
General results from recent studies show that:
Obese individuals report higher incidences of sexual difficulties due to their weight (lack of sexual enjoyment, lack of sexual desire, difficulty with sexual performance, and avoidance of sexual encounters)
A higher BMI is associated with a greater impairment in sexual quality of life
Sexual quality of life is impaired in obese women more than in obese men, possibly because women place a greater importance on body image. Men, on the other hand, are more likely to have problems with sexual performance.
Management of sexual dysfunction
Management of sexual dysfunction in obese individuals can be challenging. First, ensure that the problem is adequately assessed. Doctors can help you by screening for sexual problems and discussing this sensitive topic with you. Remember that problems with sexual identity and function are common in both obese and non-obese people. Try not to let embarrassment stop you from receiving the proper care. Good communication, understanding and a strong doctor-patient relationship are important for your treatment.
Part of the management of sexuality issues may involve learning to accept your body, overcoming shame associated with your eating behavior , and learning how to feel good about yourself. Your doctor can use cognitive and behavioral therapy to help you replace bad habits and ways of thinking with new, more productive habits. Improving your self-esteem and promoting your self-acceptance will help you overcome some of your sexuality problems.
There are numerous different sex therapies for non-overweight individuals that can be applied to obese couples. Programs may involve enhancing sexual communication and sexual assertiveness. Therapists may use group or couple therapy. It is also important to address how your partner feels about your weight, as this may cause strain in your relationship.
Weight loss strategies
Adequate weight loss using the various weight loss treatments may be an effective way to improve your sexual quality of life. Not only does it lead to health benefits, but it can improve your self-esteem, general well-being and quality of life.
Effects of obesity treatments on sexuality
Research into the effects of obesity treatments on sexuality is currently limited. It is thought that weight loss can improve sexual function and overall quality of life. Greater levels of weight loss can improve self-esteem, physical activity, social relationships, sexuality, and eating patterns. The effects of surgical weight loss methods on sexuality are unclear. Some studies have shown that the majority of women who underwent gastric banding enjoyed sex more after surgery than before, and that some found their relationships improved. However, sexual function can worsen after surgery, due to identity issues, new relationship demands, distorted body image, excess flabby skin and abdominal skin overhang. Research has confirmed that non-surgical weight loss techniques improve erectile dysfunction (in approximately one third of men) and improve arousal, orgasm, lubrication, and sexual satisfaction in women.
Suction device therapy in the management of Sexual impotence
The effectiveness of a Vacuum device designed to overcome erectile impotence was assessed in 21 patients: 5 patients with vasculogenic impotence due to venous leakage, 6 with diabetes mellitus with or without atherosclerotic cardiovascular disease, 2 paraplegic patients after spinal cord injury, 3 severely obese patients and 5 patients with psychogenic impotence. They were instructed how to use the device, which uses suction to induce penile engorgement and maintains erection with a constriction band. A total of 17 patients (81%) achieved an erection or an erection-like state that was satisfactory for intercourse. No serious ill effect from the use of the device has been reported. In selected patients the device is an alternative to either surgical placement of penile prosthesis, intracavernous injection of vasoactive drugs or sexual abstinence.
The Vacurect device system
is based on the simple concept of entrapment of blood in the penis following vacuum-assisted penile engorgement by proximally placed silicon constriction bands. It can be used safely by any man who feels that he has an impotence problem, and the outcome is fairly predictable. This device seem to be especially effective in men with partial impotence, and they offer the impotent man an alternative to surgical placement of penile prosthesis, a surgical revascularization procedure, intra caver nosal injection of vasoactive drugs, or sexual abstinence. This device appear to be safe and relatively inexpensive ways for the impotent man to make his penis rigid enough to engage in sexual intercourse. An impotent man who selects suction-device therapy may still be able to use other forms of treatment should he need or choose it.