Obesity is a chronic illness that affects over 40% of adults in the United States, and it’s linked to numerous other physical and emotional health issues. One aspect of well-being that’s often overlooked in discussions of obesity is its impact on sex drive.
Excess weight leads to bodily changes that can influence sexual desire, performance and pleasure. The complex relationship between obesity and sex drive differs somewhat for men and women, but hormonal imbalances often contribute to sexual-health problems regardless of gender. And, while weight and sex drive have been linked in many studies, there’s a lot about the interplay between them that experts still need to figure out.
Courtesy of research, here are four things to know about obesity and sexual health.
Obesity can contribute to an imbalance in sex hormones.
Various chemicals in the body, including the sex hormones estrogen and testosterone, influence libido for both men and women. Sexual desire can decline when these hormones are thrown off balance, and studies show that higher amounts of body fat can have this impact.
For women, estrogen is the driving force behind a healthy sex drive. It helps maintain vaginal health, a key factor in sexual arousal, pleasure and comfort. For men, androgens (a group of hormones that includes testosterone) are most important for sexual performance and arousal.
Women typically have higher levels of estrogen than androgens, but weight gain can disrupt this balance and make androgens more dominant. Excess androgens may lead to polycystic ovary syndrome (PCOS), a condition that causes irregular periods and weight gain. PCOS and obesity each independently increase your risk for Type 2 diabetes and heart disease, among other health conditions — all of which can further reduce sexual desire.
The opposite is true for men: Normal-weight men have more testosterone than estrogen. But men who have obesity tend to have excess estrogen, which suppresses testosterone production and results in low testosterone levels (called hypogonadism). Men with low testosterone might have trouble achieving an erection.
Obesity can impair erectile function.
Up to 20% of men who have obesity also have erectile dysfunction, defined as difficulty achieving and maintaining an erection.
Achieving an erection requires sufficient levels of testosterone. Testosterone naturally decreases with age, which is why erectile dysfunction is often associated with older men. However, a recent study found that erectile dysfunction is becoming more common in men under 40, especially among those with low testosterone levels. The same research group found that men with higher waist circumferences and body weight are more likely than normal-weight men to experience erectile dysfunction, which suggests obesity might be a contributing factor.
Adequate blood flow to the penis is also important for erectile function. Those with obesity have an increased risk of developing an accumulation of plaque in their arteries, a condition called atherosclerosis. Accumulated plaque restricts blood flow to areas throughout the body, including the penis.
Additionally, erectile dysfunction can be caused or exacerbated by medications used to manage chronic conditions that are common in those with obesity, such as high blood pressure (hypertension), heart disease and diabetes. This doesn’t mean you should stop taking these medications. But you can ask your healthcare provider whether your medications might be contributing and if so, if there are alternative treatment options.
Sexual dysfunction affects men and women in similar numbers but slightly different ways.
Research suggests that 7% to 22% of women with obesity in the US have sexual dysfunction. The most commonly reported reasons include pain during sex, arousal problems and sexual dissatisfaction. This statistic indicates a similar overall incidence of sexual issues reported by men and women with obesity.
But, while men with obesity are more likely to experience problems with sexual performance, some studies suggest that women with obesity are more likely than men to report a lack of desire, low sexual satisfaction and poor sexual quality of life. Researchers have proposed that psychosocial factors, such as body image and self-esteem, play a bigger role in the obesity-libido link for women than men.
But in terms of comparing sexual health issues in men and women with obesity, there are a lot of inconsistencies across study findings. For example, one 2019 study found that BMI affects sexual function more in women more than men, while a different study found that BMI was linked to sexual dysfunction in men but not women. There are other contradictory study findings too — so there’s still a lot to learn.
Weight loss might reignite a sluggish sex drive, especially for women.
Weight loss might reverse some of the negative effects of obesity on sexual health. Losing 10% of your body weight has been linked to increased testosterone levels and improved erectile function in men, while women have reported an increase in sexual desire and arousal, and more frequent orgasms.
Studies support the Mediterranean diet, which is more of a lifestyle than a traditional diet, as effective for long-term weight loss. (But it’s not the only one; research suggests low-fat and low-carb diets can be just as effective.) This approach to eating — lots of fruits and vegetables, grains, beans and olive oil; light on red meat, dairy and eggs — might have benefits for sexual health too. Researchers found that eating a Mediterranean diet can reduce the risk of erectile dysfunction in men with obesity. And, in one study, women with Type 2 diabetes who followed a Mediterranean diet reported more frequent sex and decreased sexual dysfunction. While not all women in the study had obesity, Type 2 diabetes and obesity are commonly linked.
Exercise appears to support sexual health as well. In those with diabetes or obesity, research shows that regular exercise is protective against sexual dysfunction, especially for women. For men, research suggests that exercise can help improve erectile dysfunction.
Going beyond lifestyle changes, weight-loss interventions such as anti-obesity medications and bariatric surgery might also have positive effects on sex drive.
One 2018 study found that people taking Contrave, an FDA-approved weight loss medication, in conjunction with lifestyle interventions, saw greater improvements in their sex lives than those who only received weight-loss counseling (but did not take medication). It’s worth noting that Contrave contains bupropion, an antidepressant known to boost libido. So we can’t assume the findings apply to newer weight-loss drugs in the GLP-1 family, such as Wegovy and Saxenda, which don’t have any psychoactive properties. At this point, there aren’t any published studies on the sex-life impact of GLP-1s.
And a 2019 study found improvements in sex drive following bariatric surgery, but the effects were more pronounced in women. In the study, women who lost at least one-third of their body weight experienced significant increases in sexual desire, arousal and orgasm frequency during their first four postoperative years. These sexual-health changes diminished somewhat over time, and researchers suspected that weight regain was a contributing factor. Men also reported postoperative improvements in sexual functioning, but they weren’t statistically significant.
Across the board, more research is needed to understand the complex dynamic between obesity and sexual health. But if you think weight loss might help improve issues with sexual desire or functioning, talk to your healthcare provider. Depending on your health history and specific issues, certain weight-loss methods might be better-suited to your needs than others.