Bariatric surgery patients need sex counseling

By Selina L. Mangassarian, M.A.
March 14, 2014

Bariatric surgery patients need sex counselingObesity is associated with life-threatening co-morbid conditions including type-2 diabetes, heart disease, hypertension, and certain cancers. Given the severe consequences of obesity and the short-term results with traditional diet programs, many American adults undergo bariatric surgery for weight loss.

Pre-operative psychosocial assessments are often required to determine appropriateness for surgery, as well as post-operative risk factors for weight loss and mental stability. However, the assessment of sexual functioning is lacking. Levels of impairment in sexual quality of life are high among individuals seeking bariatric surgery. Healthy sexual functioning refers to the biological sequencing of desire, arousal and orgasm, whereas sexual dysfunction is the impairment in one of these stages. Pre-operatively, many individuals faced lack of sexual desire, poor sexual performance and avoidance of sexual intimacy. The impact of weight loss on sexual functioning significantly improves pre-operative dysfunction due to increase in self-esteem, improved body image, mood, mobility, endurance and energy.

Although sex lives are more satisfying post-operatively, the lack of identifying pre-operative sexual dysfunction leads to sexual health concerns once weight is lost. For example, obesity can cause irregular menstrual cycles, increased risk of miscarriage, difficulty conceiving and decreased sperm count. However, weight loss re-establishes and/or improves ovulation and increases sperm count.

If these changes in reproductive health are not discussed following weight loss, especially for those who may still believe they have difficulty conceiving, patients may face unplanned pregnancies. Additionally, the increase in self-esteem may encourage patients to divorce, separate or break-up with an unsupportive, abusive or undesirable partner. Those who separate from long-term partners or those who rarely dated report feeling clueless in dating, including discriminating between casual and serious dating, paying for the date and how quickly sexual activity should be introduced.

The scarcity of literature on sexuality proceeding bariatric surgery is shocking since such a drastic lifestyle change would have a significant impact on one’s sex life. Post-operative psychoeducation regarding sexual health is necessary for bariatric surgery patient populations.

Some issues that should be discussed are the changes in one’s reproductive system due to the weight loss; decreasing risks of contracting sexually transmitted diseases, including HIV/AIDS; options for contraceptive methods and protecting the emotional health of individuals who may still face rejection or those who enter casual sexual relationships.

It is imperative that psychologists are prepared to meet the needs of adult bariatric surgical populations with sexual health issues.

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