Obez Erkeklerde Bariatrik Cerrahi Sonrası Cinsel Fonksiyonlardaki Değişi-klikler ve Partner Cinsel Fonksiyonları Üzerine Etkileri
Yıl 2025,
Cilt: 22 Sayı: 2, 227 - 232, 27.06.2025
Güçlü Gürlen
,
Mubariz Aydamirov
,
Ediz Vuruşkan
,
Cihan Gökler
,
Buğra Aksay
,
Adem Altunkol
,
Kadir Karkin
Öz
Amaç: Bu çalışmanın amacı, bariatrik cerrahi (BC) geçiren obez erkeklerde ameliyat öncesi ve sonrası cinsel işlevleri değerlendirerek BC’nin etkinliğini incelemektir.
Materyal ve Metod: Bu gözlemsel çalışmaya Ocak 2013 ile Eylül 2021 arasında obezite nedeniyle BC geçiren erkek hastalar dahil edildi. Hastalara standardize laparoskopik Roux-en-Y gastrik bypass veya laparoskopik sleeve gastrektomi uygulandı. Cinsel işlev için, BC'den önce ve bir yıl sonra Uluslararası Ereksiyon Fonksiyonu İndeksi (IIEF) sorgulama formu dolduruldu. Ayrıca, kadın partnerlerin yaşı, Vücut Kitle İndeksi (BMI) ve Kadın Cinsel İşlev İndeksi (FSFI) skorları operasyon öncesi ve sonrası kaydedildi. Hastaların takip kilosu, bel çevresi, serum biyokimyası ve hormon değerleri operasyon-dan sonraki 6-12 aylık dönemde yeniden değerlendirildi.
Bulgular: Çalışmaya toplam 1027 hasta dahil edildi. Erkek hastaların yaş ortalaması 37.33±12.4 yıl, ameliyat öncesi ortalama BMI 38.51±3.98 kg/m2 (35.20-49.80) idi. Ameliyat sonrası takip süresi 9.72±2.98 ay idi. Hastaların IIEF (tüm alanlarda) skorlarında ameliyattan sonra anlamlı artış vardı (her biri için p<0.001). Ameliyat sonrası kadın partnerlerin FSFI skorlarında artış olduğu saptandı (21.67±6.78’e karşı 27.55±5.48; p<0.001). IIEF-EF skorlarındaki değişimin partner BMI ile orta dü-zeyde ters korelasyon gösterdiği, D vitamini düzeyleri ile orta düzeyde korelasyon gösterdiği ve testosteron düzeyleri ile doğrusal korelasyon gösterdiği bulundu (sırasıyla p=0.034, r=-0.434; p=0.012, r=0,537 ve p=0.027, r=0.476).
Sonuç: BC obez erkeklerin cinsel fonksiyonlarında önemli bir artış sağlar. Bu artış partner BMI ve D vitamini seviyeleri ile önemli bir ilişki göstermektedir.
Kaynakça
-
1. Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, et al. Global, regional, and national preva-lence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014; 384:766-81.
-
2. Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults. Lancet. 2017; 390:2627-2642.
-
3. Adams KF, Schatzkin A, Harris TB, Kipnis V, Mouw T, Ballard-Barbash R, et al. Overweight, obesity, and mortal-ity in a large prospective cohort of persons 50 to 71 years old. N Engl J Med. 2006; 355:763-78.
-
4. Pastuszak AW, Badhiwala N, Lipshultz LI. Depression is correlated with the psychological and physical aspects of sexual dysfunction in men. Int J Impot Res. 2013; 25:194-9.
-
5. Álvarez-Castro P, Sangiao-Alvarellos S, Brandón-Sandá I, Cordido F. (2011). Función endocrina en la obesidad [En-docrine function in obesity]. Endocrinol Nutr. 2011;58(8): 422–432.
-
6. Greenberg I, Sogg S, M Perna F. Behavioral and psycholo-gical care in weight loss surgery: best practice upda-te. Obesity, 2009;17(5): 880–884.
-
7. Pull CB. Current psychological assessment practices in obesity surgery programs: what to assess and why. Curr Opin Psychiatry, 2010;23(1): 30–36.
-
8. Wadden TA, Sarwer DB, Fabricatore AN, Jones L, Stack R, Williams NS. Psychosocial and behavioral status of pa-tients undergoing bariatric surgery: what to expect before and after surgery. Med Clin North Am, 2007;91(3): 451–xii.
-
9. Scott KM, McGee MA, Wells JE, Oakley Browne MA. Obe-sity and mental disorders in the adult general popula-tion. J Psychosom Res, 2008;64(1): 97–105.
-
10. Bacon CG, Mittleman MA, Kawachi I, Giovannucci E, Glasser DB, Rimm EB. Sexual function in men older than 50 years of age: results from the health professionals fol-low-up study. Ann Intern Med. 2003; 139:161-8.
-
11. Knoblovits P, Costanzo PR, Valzacchi GJ, Gueglio G, Layus AO, Kozak AE, et al. Erectile dysfunction, obesity, insulin resistance, and their relationship with testosterone levels in eugonadal patients in an andrology clinic setting. J An-drol. 2010; 31:263-70.
-
12. Silva FH, Alexandre EC, Calmasini FB, Calixto MC, Antunes E. Treatment With Metformin Improves Erectile Dysfunc-tion in a Murine Model of Obesity Associated With Insulin Resistance. Urology. 2015; 86:423.e1-6.
-
13. Fernández-Sánchez A, Madrigal-Santillán E, Bautista M, Esquivel-Soto J, Morales-Gonzales A, Esquivel-Chirino C, et al. Inflammation, oxidative stress, and obesity. Int J Mol Sci. 2011; 12:3117-32.
-
14. Aygın D, Aslan FE. The Turkish adaptation of the Female Sexual Function Index. Türkiye Klinikleri J Med Sci. 2005;25: 393-399.
-
15. Vidal J, Ibarzabal A, Nicolau J, Vidov M, Delgado S, Martinez G, et al. Short-term effects of sleeve gastrecto-my on type 2 diabetes mellitus in severely obese subjects. Obes Surg. 2007; 17:1069-74.
-
16. Mechanick JI, Youdim A, Jones DB, Garvey WT, Hurley DL, McMahon MM, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical sup-port of the bariatric surgery patient--2013 update: co-sponsored by American Association of Clinical Endocrinol-ogists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery. Surg Obes Relat Dis. 2013; 9:159-91.
-
17. Glina FPA, de Freitas Barboza JW, Nunes VM, Glina S, Bernardo WM. What Is the Impact of Bariatric Surgery on Erectile Function? A Systematic Review and Meta-Analysis. Sex Med Rev, 2017;5(3): 393–402.
-
18. Maas R, Schwedhelm E, Albsmeier J, Böger RH. The path-ophysiology of erectile dysfunction related to endothelial dysfunction and mediators of vascular function. Vasc Med, 2002;7(3):213–225.
-
19. Nimbi FM, Virginia C, Cinzia DM, Michela DT, Gianfranco S, Emanuela P. The relation between sexuality and obesi-ty: the role of psychological factors in a sample of obese men undergoing bariatric surgery. Int J Impot Res. 2022; 34:203-214.
-
20. Jeong JY, Lee SK, Kang YW, Jang SN, Choi YJ, Kim DH. Relationship between ED and depression among middle-aged and elderly men in Korea: Hallym aging study. Int J Impot Res. 2011; 23:227-34.
-
21. Arterburn DE, Telem DA, Kushner RF, Courcoulas AP. Benefits and Risks of Bariatric Surgery in Adults: A Re-view. JAMA, 2020;324(9):879–887.
-
22. Małczak P, Wysocki M, Pisarska-Adamczyk M, Strojek J, Rodak H, Lastovetskyi I, et al. Influence of Bariatric Sur-gery on Erectile Dysfunction-a Systematic Review and Me-ta-Analysis. Obes Surg, 2023;33(6): 1652–1658.
-
23. Emami MR, Safabakhsh M, Khorshidi M, Moghaddam OM, Mohammed SH, Zarezadeh M, et al. Effect of bariatric surgery on endogenous sex hormones and sex hormone-binding globulin levels: a systematic review and meta-analysis. Surg Obes Relat Dis. 2021; 17:1621-1636.
-
24. Mattack N, Devi R, Kutum T, Patgiri T. The evaluation of serum levels of testosterone in type 2 diabetic men and its relation with lipid profile. J Clin Diagn Res. 2015; 9:04-7.
-
25. Khodamoradi K, Khosravizadeh Z, Seetharam D, Mallepalli S, Farber N, Arora H. The role of leptin and low testos-terone in obesity. Int J Impot Res. 2022; 34:704-713.
-
26. Talib RA, Khalafalla K, Cangüven Ö. The role of vitamin D supplementation on erectile function. Turk J Urol. 2017; 43:105-111.
-
27. Culha MG, Atalay HA, Canat HL, Alkan I, Ozbir S, Can O, et al. The relationship between erectile dysfunction severity, mean platelet volume and vitamin D levels. Aging Male. 2020; 23:173-178.
-
28. Ermec B, Culha MG, Kocak G, Canat L, Otunctemur A, Altunrende F. The effect of vitamin D replacement in pa-tients with lower urinary tract complaint/erectile dysfunc-tion resistant to Tadalafil 5 mg treatment: A pilot clinical study. Andrologia. 2022; 54:e14473.
-
29. Stocco C. Tissue physiology and pathology of aroma-tase. Steroids, 2012;77(1-2): 27–35.
-
30. Kim B, Hwang J, Lee H, Chae GM, Kim S, Kim HS, et al. Associations between ambient air pollution, obesity, and serum vitamin D status in the general population of Ko-rean adults. BMC Public Health. 2022; 22:1766.
-
31. Akan S, Uruc F, Aydin MT, Verit A. The effect of sleeve gastrectomy technique on women's sexual function: A prospective study. Rev Int Androl, 2018;16(4): 167–173.
-
32. Calderón B, Galdón A, Calañas A, Peromingo R, Galindo J, García-Moreno, et al. Effects of bariatric surgery on male obesity-associated secondary hypogonadism: comparison of laparoscopic gastric bypass with restrictive procedu-res. Obes Surg, 2014;24(10): 1686–1692.
-
33. Sarwer DB, Spitzer JC, Wadden TA, Rosen RC, Mitchell JE, Lancaster K, et al. Sexual functioning and sex hormones in persons with extreme obesity and seeking surgical and nonsurgical weight loss. Surg Obes Relat Dis, 2013;9(6): 997–1007.
-
34. Xu J, Wu Q, Zhang Y, Pei C. Effect of Bariatric Surgery on Male Sexual Function: A Meta-Analysis and Systematic Review. Sex Med, 2019;7(3): 270–281.
Changes in Sexual Functions and Effects on Partner Sexual Functions in Obese Men after Bariatric Surgery
Yıl 2025,
Cilt: 22 Sayı: 2, 227 - 232, 27.06.2025
Güçlü Gürlen
,
Mubariz Aydamirov
,
Ediz Vuruşkan
,
Cihan Gökler
,
Buğra Aksay
,
Adem Altunkol
,
Kadir Karkin
Öz
Background: The aim of this study was to evaluate the efficacy of bariatric surgery (BS) by evaluating preoperative and postoperative sexual functions in obese men undergoing BS.
Materials and Methods: Male patients who underwent BS due to obesity between January 2013 and September 2021 were included in this observational study. Patients underwent standardized laparoscopic Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy. For sexual function, the International Index of Erectile Function (IIEF) inquiry form was filled in before, and one year after BS. In addition, the age, Body Mass Index (BMI) and Female Sexual Function Index (FSFI) scores of the female partners were recorded before and after the operation. Follow-up weight, waist circum-ference, serum biochemistry and hormone values of the patients were re-evaluated in the 6-12 month period after the operation.
Results: A total of 1027 patients were included in the study. The mean age of the male patients was 37.33±12.40 years, and the mean preoperative BMI was 38.51±3.98kg/m2 (35.20-49.80). The pos-toperative follow-up period of the patients was 9.72±2.98 months. There was a significant increase in the IIEF (all sub-dimensions) scores of the patients after the operation (p<0.001 for each). An increase in FSFI scores was found in female partners after surgery (21.67±6.78 vs. 27.55±5.48; p<0.001). The change in IIEF-EF scores was moderately inversely correlated with partner BMI, mo-derately correlated with vitamin D levels, and linearly correlated with testosterone levels (p=0.034, r=-0.434; p=0.012, r=0.537 and p=0.027, r=0.476, respectively).
Conclusions: BS provides a significant increase in the sexual functions of obese men. This increase shows a significant relationship with partner BMI and vitamin D levels.
Etik Beyan
In accordance with the 1964 Helsinki Declaration and its layer amendments, our study was approved by the Clinical Research Ethics Committee of the Health Sciences University, Adana City Training and Research Hospital (Ethical Committee approval number: 106/1963 Date: 30.05.2022). Written informed consent was obtained from each patient participating in the study.
Kaynakça
-
1. Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, et al. Global, regional, and national preva-lence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014; 384:766-81.
-
2. Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults. Lancet. 2017; 390:2627-2642.
-
3. Adams KF, Schatzkin A, Harris TB, Kipnis V, Mouw T, Ballard-Barbash R, et al. Overweight, obesity, and mortal-ity in a large prospective cohort of persons 50 to 71 years old. N Engl J Med. 2006; 355:763-78.
-
4. Pastuszak AW, Badhiwala N, Lipshultz LI. Depression is correlated with the psychological and physical aspects of sexual dysfunction in men. Int J Impot Res. 2013; 25:194-9.
-
5. Álvarez-Castro P, Sangiao-Alvarellos S, Brandón-Sandá I, Cordido F. (2011). Función endocrina en la obesidad [En-docrine function in obesity]. Endocrinol Nutr. 2011;58(8): 422–432.
-
6. Greenberg I, Sogg S, M Perna F. Behavioral and psycholo-gical care in weight loss surgery: best practice upda-te. Obesity, 2009;17(5): 880–884.
-
7. Pull CB. Current psychological assessment practices in obesity surgery programs: what to assess and why. Curr Opin Psychiatry, 2010;23(1): 30–36.
-
8. Wadden TA, Sarwer DB, Fabricatore AN, Jones L, Stack R, Williams NS. Psychosocial and behavioral status of pa-tients undergoing bariatric surgery: what to expect before and after surgery. Med Clin North Am, 2007;91(3): 451–xii.
-
9. Scott KM, McGee MA, Wells JE, Oakley Browne MA. Obe-sity and mental disorders in the adult general popula-tion. J Psychosom Res, 2008;64(1): 97–105.
-
10. Bacon CG, Mittleman MA, Kawachi I, Giovannucci E, Glasser DB, Rimm EB. Sexual function in men older than 50 years of age: results from the health professionals fol-low-up study. Ann Intern Med. 2003; 139:161-8.
-
11. Knoblovits P, Costanzo PR, Valzacchi GJ, Gueglio G, Layus AO, Kozak AE, et al. Erectile dysfunction, obesity, insulin resistance, and their relationship with testosterone levels in eugonadal patients in an andrology clinic setting. J An-drol. 2010; 31:263-70.
-
12. Silva FH, Alexandre EC, Calmasini FB, Calixto MC, Antunes E. Treatment With Metformin Improves Erectile Dysfunc-tion in a Murine Model of Obesity Associated With Insulin Resistance. Urology. 2015; 86:423.e1-6.
-
13. Fernández-Sánchez A, Madrigal-Santillán E, Bautista M, Esquivel-Soto J, Morales-Gonzales A, Esquivel-Chirino C, et al. Inflammation, oxidative stress, and obesity. Int J Mol Sci. 2011; 12:3117-32.
-
14. Aygın D, Aslan FE. The Turkish adaptation of the Female Sexual Function Index. Türkiye Klinikleri J Med Sci. 2005;25: 393-399.
-
15. Vidal J, Ibarzabal A, Nicolau J, Vidov M, Delgado S, Martinez G, et al. Short-term effects of sleeve gastrecto-my on type 2 diabetes mellitus in severely obese subjects. Obes Surg. 2007; 17:1069-74.
-
16. Mechanick JI, Youdim A, Jones DB, Garvey WT, Hurley DL, McMahon MM, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical sup-port of the bariatric surgery patient--2013 update: co-sponsored by American Association of Clinical Endocrinol-ogists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery. Surg Obes Relat Dis. 2013; 9:159-91.
-
17. Glina FPA, de Freitas Barboza JW, Nunes VM, Glina S, Bernardo WM. What Is the Impact of Bariatric Surgery on Erectile Function? A Systematic Review and Meta-Analysis. Sex Med Rev, 2017;5(3): 393–402.
-
18. Maas R, Schwedhelm E, Albsmeier J, Böger RH. The path-ophysiology of erectile dysfunction related to endothelial dysfunction and mediators of vascular function. Vasc Med, 2002;7(3):213–225.
-
19. Nimbi FM, Virginia C, Cinzia DM, Michela DT, Gianfranco S, Emanuela P. The relation between sexuality and obesi-ty: the role of psychological factors in a sample of obese men undergoing bariatric surgery. Int J Impot Res. 2022; 34:203-214.
-
20. Jeong JY, Lee SK, Kang YW, Jang SN, Choi YJ, Kim DH. Relationship between ED and depression among middle-aged and elderly men in Korea: Hallym aging study. Int J Impot Res. 2011; 23:227-34.
-
21. Arterburn DE, Telem DA, Kushner RF, Courcoulas AP. Benefits and Risks of Bariatric Surgery in Adults: A Re-view. JAMA, 2020;324(9):879–887.
-
22. Małczak P, Wysocki M, Pisarska-Adamczyk M, Strojek J, Rodak H, Lastovetskyi I, et al. Influence of Bariatric Sur-gery on Erectile Dysfunction-a Systematic Review and Me-ta-Analysis. Obes Surg, 2023;33(6): 1652–1658.
-
23. Emami MR, Safabakhsh M, Khorshidi M, Moghaddam OM, Mohammed SH, Zarezadeh M, et al. Effect of bariatric surgery on endogenous sex hormones and sex hormone-binding globulin levels: a systematic review and meta-analysis. Surg Obes Relat Dis. 2021; 17:1621-1636.
-
24. Mattack N, Devi R, Kutum T, Patgiri T. The evaluation of serum levels of testosterone in type 2 diabetic men and its relation with lipid profile. J Clin Diagn Res. 2015; 9:04-7.
-
25. Khodamoradi K, Khosravizadeh Z, Seetharam D, Mallepalli S, Farber N, Arora H. The role of leptin and low testos-terone in obesity. Int J Impot Res. 2022; 34:704-713.
-
26. Talib RA, Khalafalla K, Cangüven Ö. The role of vitamin D supplementation on erectile function. Turk J Urol. 2017; 43:105-111.
-
27. Culha MG, Atalay HA, Canat HL, Alkan I, Ozbir S, Can O, et al. The relationship between erectile dysfunction severity, mean platelet volume and vitamin D levels. Aging Male. 2020; 23:173-178.
-
28. Ermec B, Culha MG, Kocak G, Canat L, Otunctemur A, Altunrende F. The effect of vitamin D replacement in pa-tients with lower urinary tract complaint/erectile dysfunc-tion resistant to Tadalafil 5 mg treatment: A pilot clinical study. Andrologia. 2022; 54:e14473.
-
29. Stocco C. Tissue physiology and pathology of aroma-tase. Steroids, 2012;77(1-2): 27–35.
-
30. Kim B, Hwang J, Lee H, Chae GM, Kim S, Kim HS, et al. Associations between ambient air pollution, obesity, and serum vitamin D status in the general population of Ko-rean adults. BMC Public Health. 2022; 22:1766.
-
31. Akan S, Uruc F, Aydin MT, Verit A. The effect of sleeve gastrectomy technique on women's sexual function: A prospective study. Rev Int Androl, 2018;16(4): 167–173.
-
32. Calderón B, Galdón A, Calañas A, Peromingo R, Galindo J, García-Moreno, et al. Effects of bariatric surgery on male obesity-associated secondary hypogonadism: comparison of laparoscopic gastric bypass with restrictive procedu-res. Obes Surg, 2014;24(10): 1686–1692.
-
33. Sarwer DB, Spitzer JC, Wadden TA, Rosen RC, Mitchell JE, Lancaster K, et al. Sexual functioning and sex hormones in persons with extreme obesity and seeking surgical and nonsurgical weight loss. Surg Obes Relat Dis, 2013;9(6): 997–1007.
-
34. Xu J, Wu Q, Zhang Y, Pei C. Effect of Bariatric Surgery on Male Sexual Function: A Meta-Analysis and Systematic Review. Sex Med, 2019;7(3): 270–281.