Sexual and Urinary Health among Women following Bariatric Surgery

Women with obesity are more likely to experience bothersome urinary and sexual symptoms, but the long-term effect of metabolic and bariatric surgery (MBS) on these outcomes is poorly understood. We aimed to describe how MBS longitudinally impacted women's urinary and sexual health.

Patients who underwent MBS at the University of California, San Francisco Medical Center (UCSF) between 2009 and 2021 participated in a survey examining sexual health, pelvic organ prolapse (POP), and urinary health using three validated questionnaires: a modified version of the Female Sexual Function Index (FSFI), the Pelvic Organ Prolapse Distress Inventory 6 (POPDI-6), and the Urinary Distress Inventory 6 (UDI-6). All questions asked referenced two time points: before surgery and at the time of survey. Logistic regression identified predictors of symptom improvement.

Of 162 participants contacted, 118 (73%) had complete survey data. Mean body mass index (BMI) decreased from 52.4 ± 12.6 to 36.3 ± 9.7 kg/m² (p < 0.01) with an average follow-up of 6 years. The mean UDI-6 score amongst women was 24 ± 24 prior to MBS and 24 ± 26 at the time of survey administration (p = 0.458). Mean modified FSFI scores amongst women were 15 ± 5 prior to surgery and 14 ± 7 at the time of survey administration (p = 0.005). The overall mean POPDI-6 score amongst women was 13 ± 15 prior to surgery and 9 ± 14 at the time of survey administration (p = 0.056).

Women who underwent MBS reported a high rate of sexual and urological dysfunction that did not improve longitudinally, despite significant weight loss.