Sex After Weight Loss Surgery Question For A Doctor

Question Below Submitted By:  

Ashley (a patient from Miami, Florida)

Hi,

I have questions about sex after weight loss surgery, specifically gastric sleeve. I’ve been with the same man for 5 years, we’re both obese, and we’re both getting gastric sleeve. We love each other, but we don’t have sex. I think it would be tremendous for us to begin having sex again.

I’m wondering if this surgery could help us in the sex department? Here are a few questions I have about sex for him and her:

1. Will your sex life improve after gastric sleeve surgery?

2. My boyfriend had blood tests that showed he has low testosterone. Could his testosterone increase after weight loss surgery? Will my libido increase as well?

3. How long should you wait after gastric sleeve surgery to have sex again?

4. Are there any concerns with having sex after bariatric surgery?

Thanks for your time,
Ashley

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Expert Responses to the Question Above

Surgeon Response To: Sex After Weight Loss Surgery Question For A Doctor

by: Dr. John Rabkin, M.D.

Dear Ashley,

Sex Life, Hormones, and Testosterone After Gastric Sleeve Surgery

The likelihood is that your sex life will improve after achieving weight loss following a gastric sleeve procedure (VSG). From the most basic perspective, your (and your partner's) reduced weight will facilitate the physical aspects of your sexual relationship. Your libido will also likely increase and there is some evidence to suggest that (in male patients) testosterone levels increase.

However, as morbidly obese patients lose weight, many patients experience a period of emotional lability thought possibly related to the mobilization/release of hormones stored in the excess fat. This can often lead to irritability and other emotions that would potentially interfere with intimacy.

How Long Should You Wait After Gastric Sleeve Surgery to Have Sex Again?

Generally, after undergoing a weight loss surgical procedure (WLS) like the VSG when performed laparoscopically (ie: through small incisions) you can begin to explore sexual intimacy during your recovery as soon as you're comfortable: you shouldn't fear disrupting your surgery which won't happen. This can often be within the first few weeks after the surgery. If the WLS was done 'open' (ie: through a long incision) the period of discomfort and recovery will be longer and generally you'll want to avoid any strenuous activities for at least six weeks following the surgery.

Concerns About Sex After Bariatric Surgery

As far as any 'medical' concerns regarding sexual activity following WLS, I always point out to my patients that fertility often dramatically improves very quickly after WLS so that some form of birth control should be employed to prevent unwanted and/or premature pregnancy even if no pregnancy had ever previously resulted despite not using birth control before the WLS. For both the health of the developing fetus as well as the mother, intended pregnancy post WLS is best deferred until the weight loss stops and the mother's weight stabilizes, generally at least a year after the WLS. And you should never forget the potential issue of sexually transmitted disease: you need to know the health of any potential new sexual partner(s) before becoming intimate!

There are a variety of other issues that may continue to adversely affect your sex life following WLS however. To help better explain some of these 'non-medical' issues, I asked an expert in the field, William Hartman, PhD, who has extensive experience addressing the psychological issues around obesity and WLS for his opinion and here is what he shared with me which I believe you'll find very helpful:

"Here's what I am aware of, from research and from talking to patients - Sex life is very likely to improve after surgery (quality more so than quantity). There are more data showing bigger improvements in women than in men, but quality improvements have been shown in both. In women, sexual dysfunction resolves to levels consistent with normal weight women. In men, testosterone is likely to increase but has not necessarily been correlated with better sexual function.

"Improvement in sexual quality begins immediately (one month!) and continues improving through at least two years post WLS (which is as far out as the data has looked.) The improvement is also correlated with body image dissatisfaction: people with lower body image satisfaction are less likely to show improvement.

"Finally, and this is from observation as well as some limited data, sometimes it's slow going. Reticence (shyness, insecurity) on the part of one partner or the other can be due to shame, body image dissatisfaction (as above), fear or uncertainty due to lack of experience or 'it's been so long' as well as prior bad experiences. Sometimes one partner is 'rarin' to go' and the other slow/cautious/afraid/holding back, perhaps because of fear of not meeting the eager partner's expectations. This may be especially an issue for couples who are not currently having sexual relations at all. Hopefully couples can openly discuss these issues to address them up front. For these reasons access to a bariatric savvy therapist can be particularly helpful.

"I recommend that the questioner read an excellent book by author/health reporter Sarah Varney exploring the issues of intimacy in obesity (including post WLS) titled '"XL Love."

John M. Rabkin, M.D.
Pacific Laparoscopy

(click here for Dr. Rabkin's full bio & contact info)

DISCLAIMER: This educational advice is based on the depth of your question and the details provided. The above should never replace the advice of your local physicians as they have the ability to evaluate you in person.

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