Impact of Bariatric Surgery on Sexual Dysfunction in Obese Men

Introduction: Currently bariatric surgery is the most effective treatment for significant and sustained weight loss. Erectile and endothelial dysfunctions may share some metabolic and vascular pathways in common that may be influenced by weight loss. Aim: The aim of the study was to assess the impact of surgically induced weight loss on the erectile function on obese patients undergoing laparoscopic sleeve gastrectomy (LSG). We also aimed to examine the proposed underlying mechanism associated with improvement in erectile function after weight loss by LSG. Methods: Eighty-two consecutive obese men who underwent a LGS were followed up for 12 months. All operations were performed by the same surgeon at a single institution. Main Outcome measure: Patients were examined both before and after 12 months of LSG for biochemical tests; total serum cholesterol, triglyceride, C-reactive protein, interleukin-6, and endothelial nitric oxide synthase, and for erectile function tests. International Index of Erectile Function (IIEF) scores were recorded. Results: Eighty-two men (mean age 39 +/- 14.6 years, range 24e62; mean BMI 41.2 +/- 4.8 kg/m(2)) completed all preoperative and postoperative questionnaires and biochemical tests. At 12 months, the mean weight loss was 34.8 kg and the mean BMI decrease was 8.6 kg/m(2). Preoperative and postoperative IIEF scores of the 65 sexually active patients showed significant improvement in erectile function (21.2 +/- 5.7 vs 26.5 +/- 4.5; P =.02). Seventeen (20.7%) men were not sexually active preoperatively; only 5 became sexually active postoperatively. Men had a significant decrease in serum cholesterol and triglyceride levels. Nitric oxide synthase activity showed a significant increase (P <.02). In addition, our patients showed a statistically significant decrease in interleukin- 6 levels and C-reactive protein compared with preoperative period (P <.03 and P <.01, respectively). Conclusion: A significant improvement of erectile function was documented among obese young men undergoing LGS. This improvement was documented both clinically by improvement in IIEF score postoperatively and biochemically. Copyright (C) 2021, The Authors. Published by Elsevier Inc. on behalf of the International Society for Sexual Medicine. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).