Associations Between Weight and Sexual Behavior and Function in Chinese Men and Women: Role of Body Image and Physical Factors

Obesity is associated with increased risk of a number of physical and psychological problems, including heart disease, depression, and sexual dysfunction. We investigated the relationship between Body Mass Index categories, body image, and sexual function using more detailed assessment of potential weight related sexual problems than previous research. We recruited 251 Chinese participants (124 men) aged 18-57 to fill out an online questionnaire regarding sexual function, general body image, body image related to sexuality, and weight-related physical problems during sexual activity. The created body weight category groups with equal age controlling for its potential confounding effect on the association between obesity and sexual function. Participants' and their partners' height and weight as well as the International Index of Erectile Function-5 (IIEF-5), Checklist for Early Ejaculation Symptoms (CHEES), Female Sexual Function Index (FSFI), Body Image States Scales (BISS), sexual body image questions, and a series of questions regarding weight-related physical problems during sex were used. Obese and overweight men had worse erectile and ejaculatory function than normal weight men whereas in women no association with sexual dysfunction was found. Obese and overweight men and women had worse general and sexual body image than normal weight individuals of their gender. For men, Body Mass Index was associated with erectile and ejaculatory function through sexual body acceptance and sexual body shame. In addition, Body Mass Index was associated with ejaculatory function via body image and physical problems related to exhaustion and fat tissue during the sex. For women, Body Mass Index was associated with female sexual function through body image and sexual body acceptance. Finally, we also found that participants' own Body Mass Index was positively associated with their partners' Body Mass Index. The resulted indicate that obesity and overweight have complex relationships with sexual function that clinicians should be aware of. This study is first to investigate the potential mediation psychological and physical factors on the relationship between obesity and sexual function both for men and women. However, the sample size is limited and the cross-sectional design does not allow causal conclusions. Body Mass Index is associated with individuals' sexual functioning via satisfaction with their own body, body satisfaction specifically related to sexual activity as well as physical problems during sexual activity.