Obesity is a growing problem worldwide. The rise in overweight and obese individuals presents not only a global health challenge but also raises questions about the multifaceted impact of weight on various aspects of well-being, including sexual function. Weight has been hypothesized to have a negative impact on sexual function via hormonal, metabolic, and psychological parameters. Available data on the effect of excess weight on sexual function are less abundant. Experts give us the lowdown on ways to keep up your libido while losing weight.
Defining Overweight and Obesity
The proportion of individuals who are overweight or obese, which is defined as a body mass index (BMI) 25-29.9 kg/m2 and ≥30 kg/m2 respectively, is increasing. Within the United States, the rate of obesity reached nearly 40% in adults in 2015-2016. Overweight has been identified as a risk factor for a number of diseases including heart disease, stroke, type 2 diabetes mellitus, sleep apnea, infertility, and some forms of cancer. Losing weight can be a great benefit not only in preventing many of the diseases mentioned, but also in helping you get your sex life back. Weight loss can transform your life in many ways. From increased energy to better erections, the benefits are clear. Improved self-esteem and reduced health risks make the journey even more worthwhile.
Assessing Sexual Function
In order to quantify sexual dysfunction in men, the International Index of Erectile Function (IIEF), a survey validated across cultures, is considered the gold standard. It contains five domains: erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction. Currently, the best tool for evaluating female sexual dysfunction (FSD) is considered to be the Female Sexual Function Index (FSFI), a self-report survey validated across several languages. It contains 6 subcategories: desire, arousal, lubrication, orgasm, satisfaction, and pain.
The Interplay of Weight and Libido: Unpacking the Complex Relationship
The ways that living with obesity can affect your libido (sex drive) can be a sensitive topic. If you’ve noticed weight has impacted your libido, you’re not alone. People of all genders and sexualities who are living with obesity may experience changes in their sexual desire due to physical, emotional, and hormonal factors.
Hormonal Imbalance
Hormones are chemical messengers that regulate many aspects of your health, including libido. For people living with obesity, hormone imbalances can be a significant factor affecting sexual desire.
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In people with testes, testosterone is the most important hormone driving libido. Obesity has been linked to lower levels of testosterone in the body, a condition also called “hypogonadism.” That’s because fat cells, especially fat cells in the abdomen, convert testosterone into another hormone called estrogen. As a result, obesity may be associated not only with lower testosterone levels but also with higher estrogen levels. This combination has been shown to reduce sexual desire and cause erectile dysfunction. Low testosterone may also lead to fatigue, lowered muscle mass, increased abdominal fat, and mood changes.
On the flip side, weight loss can help replenish testosterone levels. One study found that after bariatric surgery - a type of weight loss surgery - participants saw a significant improvement in erectile function.
In people with ovaries, estrogen and progesterone nor only regulate the menstrual cycle but also impact sexual desire. Fat cells can increase estrogen levels, disrupting the hormonal balance. In fact, one study published in the journal Medicina de Familia stated that up to 70 percent of women with obesity deal with sexual dysfunction.
This often leads to irregular menstrual cycles, polycystic ovary syndrome (PCOS), and lowered libido. Some people with obesity also report vaginal dryness or discomfort during penetration. This can make intimacy physically uncomfortable and frustrating for you and your partner.
Psychological and Emotional Factors
Sex drive isn’t all about biology - it’s also impacted by your mental state.
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In a society that often values thinness and stigmatizes obesity, some people with obesity face low self-esteem and poor body image. If you’re not feeling confident in your own skin, you may be inclined to avoid intimacy with new or existing partners. No matter how supportive and loving your partner is, these negative feelings can create emotional distance. Over time, these feelings can make sexual experiences feel more stressful than enjoyable. It can impact even the healthiest of relationships.
People with obesity have been found to have higher rates of depression and anxiety than people without obesity. These mental health disorders have a direct effect on libido. Although antidepressants can be essential in regulating your mood, they may also have sexual side effects like reduced desire or difficulty achieving orgasm. When emotional health suffers, so can interest in intimacy. Some antidepressants can also cause weight gain.
Physical Limitations and Discomfort
People with obesity are at higher risk for other medical conditions that may impact their sex life. These conditions include joint pain and sleep apnea. Sex is a physical experience and for some people with obesity, pain and fatigue may interfere with it.
Carrying extra weight can cause strain on the joints and muscles, leading to chronic pain or discomfort. This can make certain sexual positions difficult or unenjoyable. It can also make the idea of sex feel exhausting and uncomfortable rather than exciting and fun.
Obesity is a risk factor for obstructive sleep apnea (OSA), a condition where breathing stops and starts over and over again while you’re sleeping. This leads to fatigue during the daytime, which can impact your mood and sexual interest.
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Cholesterol and Heart Disease
One well-known risk factor for erectile dysfunction is cardiovascular disease, or damage to the heart and blood vessels due to high blood pressure and high cholesterol. Not all people with obesity have cardiovascular disease, but the two diseases often co-occur. While this disease increases the risk for heart attack and stroke, it also directly impacts blood’s ability to flow to the genitals. This decreases a person’s ability to achieve and maintain an erection.
Relationship Dynamics
Sexual desire in relationships is deeply connected to the mood and feelings of your partner. When one or both partners are struggling with the physical and mental effects of obesity on sex drive, relationship stress may arise. Changes in libido, body image concerns, or sexual function challenges can create feelings of distance, frustration, or misunderstanding between partners. That’s why open communication is essential in any partnership. It’s easier said than done, but discussing needs, preferences, and feelings with a partner can relieve tension. Together, you can brainstorm new ways to connect emotionally and physically.
Weight Loss Strategies and Their Impact on Sexual Function
Another avenue researchers have used to determine the effects of weight on sexual function is studies comparing sexual function in patients before and after weight loss. Experts say that losing as few as 10 pounds can often free up testosterone and almost immediately give a boost to your love life.
Lifestyle Interventions
Making the same diet changes -- such as following a low-fat diet and eating lots of fruit and vegetables -- that help get blood sugar and cholesterol under control can also help turn your sex drive around -- even if you don't lose weight. Participation in a healthy lifestyle really helps, even if you don't lose the extra pounds.
Also, exercises designed not for weight loss but to increase circulation to the genitals can make a big difference, particularly for women. Any activity that increases blood flow to the large muscle groups in the thighs, buttocks, and pelvis -- such as yoga, brisk walking, or cycling for 20 minutes three times a week -- is also going to bathe the genitals with better circulation. The result, she says, is more lubrication, better arousal, and better orgasmic function. And ultimately a return of sexual desire.
Pharmaceutical Interventions
A multicenter randomized controlled trial compared naltrexone/bupropion, an FDA approved weight loss drug, plus a lifestyle program to a control group with minimal lifestyle intervention. Over the 26-week study period, the experimental group lost significantly more weight than the control group (p<0.0001). Sexual function was determined by Arizona Sexual Experiences Scale (ASEX) score, with dysfunction defined as a total score ≥19, any individual score ≥5, or 3 individual scores ≥4. Of those participants with sexual dysfunction at baseline, 19% of the control group versus 58% of experimental group no longer met criteria.
GLP-1 (glucagon-like peptide-1) agonists and related medications, originally developed for the treatment of type 2 diabetes, have gained significant attention for their efficacy in promoting weight loss. Medications such as semaglutide (Ozempic, Wegovy), tirzepatide (Mounjaro, Zepbound), and liraglutide (Victoza, Saxenda) are some of the most widely used GLP-1 agonists. We, at IntimMedicine Specialist, began work on these agents for weight loss about 12 years ago leading to the original FDA approval of Saxenda for weight control.
GLP-1 agonists function primarily by enhancing the secretion of insulin in response to elevated blood glucose levels, slowing gastric emptying, and acting on the central nervous system to suppress appetite. The hypothalamus, which plays a critical role in regulating hunger and satiety, is a primary site of action for GLP-1 agonists. This brain region also influences sexual desire and function, suggesting that GLP-1 agonists might impact these aspects of behavior and physiology as well.
By decreasing the desire for food and other substances like alcohol, cannabis, opioids, and cigarettes, these medications might also alter sexual desire. The reward pathways that are stimulated by food and these substances overlap significantly with those involved in sexual arousal and satisfaction, potentially leading to changes in libido. Weight loss achieved through GLP-1 agonists can lead to hormonal changes that affect sexual function. For example, weight reduction is associated with improved testosterone levels in men, which can enhance libido and erectile function. Similarly, weight loss in women can lead to hormonal adjustments that improve sexual satisfaction and desire.
Obesity and metabolic syndrome often contribute to psychological issues such as depression and anxiety, which can adversely affect sexual function. By promoting weight loss and improving overall metabolic health, GLP-1 agonists may enhance mood and self-esteem, leading to improvements in sexual desire and function.
Some studies suggest that GLP-1 receptors are present in reproductive tissues, indicating that these agonists might have direct effects on sexual organs. For example, improved endothelial function resulting from weight loss could enhance blood flow to sexual organs, potentially improving erectile function in men and lubrication in women.
Surgical Interventions
Several studies use bariatric surgery patients-most commonly comparing pre-operative to post-operative survey results of the same patients-as a method to investigate the relationship between sexual function and weight. Four similarly-sized studies investigated the effect of bariatric surgery and the subsequent resulting weight loss on sexual function in men, but reported slightly different outcomes. All of these studies compared IIEF scores at baseline and postoperatively. As expected, participants lost a significant amount of weight (p<0.001). When comparing the cohort on a whole, significant increases in scores of erectile function (p=0.02), intercourse satisfaction (p=0.01), and overall satisfaction (p=0.02) domains were observed.
Practical Strategies to Enhance Libido During Weight Loss
Here are a few steps to take if you’ve found that your body weight is affecting your sex drive.
Steps that you take to improve your overall health - such as through movement, nourishing foods, and restorative sleep - will make a huge impact on your sex drive. Exercise can both boost mood and body confidence, which can contribute to a healthier sex life. In addition, weight loss - both from lifestyle changes and from surgery - has been found to restore the balance of hormones in your body, increase energy levels, and reduce physical limitations such as erectile dysfunction. If you have sleep issues, especially sleep apnea, a diagnostic test and treatment may be required to get the quality of sleep you need.
If physical limitations like joint pain are a barrier to your sex life, you and your partner should try experimenting with different sexual positions or activities that feel comfortable and pleasurable. Sexual health isn’t only about intercourse - it’s about closeness, touch, and communication.Couples may also benefit from seeing a sex therapist or counselor, especially if intimacy has put a damper on their relationship outside of the bedroom.
Mental health is closely tied to sexual health. If depression, anxiety, or body image struggles are affecting your libido, it can be empowering to seek help. Some mental health treatment options that can make a big difference include therapy, support groups, and medication.
You should feel open to talk with your healthcare provider about your libido just as you would any other physical or mental health symptoms. Your doctor can evaluate your hormone levels, screen for related health conditions, and discuss treatment options with you. If your low sex drive is found to be more related to your mental health than physical health, they can help set you up with a therapist who focuses on sexual desire or body image concerns. Having your physician be keyed into challenges in your sex life can have big impacts on your sexual quality of life and overall wellness.
Lifestyle Recommendations to Boost Libido
- Avoid Alcohol: Consumption of alcohol can lower inhibitions, which can help alleviate body image concerns and increase your nerve to actually get intimate, says Taub-Dix. The catch? It's also a central nervous system depressant, which means it can also be harder for you to achieve orgasm, she says. Alcohol in any amount is considered bad for your health, according to Mayo Clinic; plus, it’s loaded with empty calories. It’s best to skip it.
- Don’t Overly Restrict Calories: The “Dietary Guidelines for Americans” lay out caloric intake recommendations based on age, activity level, and sex. Men generally need to eat more calories than women, and the amount of calories you're consuming can dramatically impact both your weight loss and libido. You need to be consuming enough that you can still exercise every day and have the energy to do activities you enjoy, which includes sex,” says Taub-Dix. If you're feeling fatigued, dizzy, or just like there's no gas in your tank, consult with a physician or registered dietitian to ensure you're consuming the right amount based on your goals.
- Steer Clear of Processed Foods: Processed foods - or anything that doesn't come straight from the ground or isn't grown on a tree - can sap your energy, says Kirkpatrick. Plus, they're not exactly great for your body - period. Research shows the consumption of processed foods may be associated with an increased risk of high blood pressure, metabolic syndrome, and obesity, as well as increases in LDL (“bad”) and total cholesterol.
- Fuel Up on Fish and Nuts: Fatty fish like salmon, mackerel, tuna, herring, and sardines, as well as nuts, seeds, and plant oils including flaxseed, soybean, and canola oil, are all rich in omega-3 fatty acids. These can help boost blood circulation, says Taub-Dix. More blood circulation means that there is a greater amount of blood flowing everywhere in your body - including your genitals - which makes it easier to get aroused, she adds, saying that the omega-3s in these foods also boost dopamine levels in the brain, a hormone linked to sexual response. An animal study published in 2023 showed that omega-3s improve sexual and erectile function in males.
- Spice Up Your Meals: One easy way to add zest to your foods without adding high-calorie sauces or dressings is to reach for red pepper flakes, says Kirkpatrick. They contain capsaicin, a compound that is good for your heart and circulation. Just resist the impulse to flavor with salt instead - it's linked to high blood pressure, a real libido killer.
- Get Your Sleep: Sleep is super important. A critical component of everything we do throughout our waking hours - from digestion to recovery - our time tucked in can impact our weight as well. Research shows sleep disorders are strongly linked to sexual dysfunction in women. Bonus: If you're safely in bed, you won't be raiding the kitchen at midnight.
- Don’t Smoke: A slew of negatives go hand in hand with cigarette smoking, including a diminished sex drive and worse sexual health compared with non-smokers.
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