Even minor weight loss can improve men’s sex lives: Study

By Dr. Ananya Mandal, MDAug 8 2011

According to a latest study weight loss improves the sexual health of obese men with type 2 diabetes.

The team of Australian researchers placed 31 obese men with type 2 diabetes on either a meal replacement-based low-calorie diet or a low-fat, high-protein, reduced-carbohydrate diet meant to decrease calorie intake by 600 calories a day. A modest weight loss of 5 percent led to an easing of erectile dysfunction and improved sexual desire within eight weeks, and these improvements continued for 12 months, according to the study published Aug. 5 in The Journal of Sexual Medicine. Problems with urinary tract function also improved, the team added.

Gary Wittert, of the University of Adelaide said, “Our findings are consistent with the evidence that not only erectile function, but also lower urinary tract symptoms are a marker of cardio-metabolic risk.” The findings support previous research showing that lifestyle changes can have a positive effect on sexual function, according to journal editor-in-chief Irwin Goldstein. He said, “At a time when oral drugs are very popular, it can now be shown that weight loss is an important non-pharmacologic therapeutic intervention in restoring erectile and urinary function and cardiovascular health.”

Researchers believe excess weight - especially excess belly fat - can affect sexual function in many ways; it can interfere with the body's ability to supply blood to the penis, for instance, and it can cause testosterone production to plummet. “You talk all the prevention you want,” says Kevin Billups, M.D., an associate professor of urology at the University of Minnesota, in Minneapolis. “When I talk about restoring penile health, I have their attention.” When a patient comes to see him about ED, one of the first things Billups tells him to do is to stand up and look at his belly. “If you can't see your penis…that's a problem,” he says.

“An erection is basically a cardiovascular event,” explained Robert A. Kloner, M.D., a cardiologist and professor of medicine at the University of Southern California's Keck School of Medicine, in Los Angeles. “If blood flow cannot increase because the blood vessels can't dilate normally, then there's a decrease in erectile function.”

Sure enough, in the new study, endothelial function improved in the men who lost weight. Poor heart health can cause ED in another way. The fatty foods and lack of exercise that cause weight gain also contribute to the narrowing and hardening of arteries (atherosclerosis), in which cholesterol and other substances build up in the artery wall. In fact, atherosclerosis may hit those small blood vessels first, which is why ED is increasingly seen as an early warning sign of heart disease, Kloner explained.

Another explanation for this phenomenon is low testosterone, which is also linked to obesity. Adequate levels of this male sex hormone are necessary to maintain sex drive and get erections. “Low testosterone is very much underdiagnosed,” says Ronald Tamler, M.D., co-director of the men's health program at the Mount Sinai Medical Center, in New York. “And as we are all getting fatter, it's becoming an increasing problem.”

Losing even a little weight can improve blood vessel function (as the new study shows), but the effect of weight loss on testosterone levels may not be as rapid or as direct. Men who have persistently low testosterone levels and ED despite losing weight may need to consider testosterone gels, shots or patches, Tamler said.

Being overweight doesn't seem to affect a man's self-esteem as much as it does a woman's, says Joel Block, Ph.D., a psychologist on Long Island who specializes in couples therapy and sex therapy. ED, on the other hand, can trigger a cycle of shame and doubt in even the most confident men. “Once [ED] happens it becomes self-perpetuating,” says Block, an assistant clinical professor at the Albert Einstein College of Medicine, in New York City. “The more he fails, the more difficulty he has.” Eventually, Block says, a man will begin to avoid sex. And his condition may plunge him into depression. “Even if you have clear cut medical reasons - diabetes, obesity - when you're having erectile dysfunction...it is depressing,” Billups says.

“Losing weight can help with the plumbing aspect of ED, but it can also provide an ego boost that carries over into the bedroom”, says Stephen Josephson, Ph.D., a psychologist at New York-Presbyterian Hospital. “People need to feel good about themselves [to] overcome performance anxiety and other things in the sex arena, and sometimes it's as simple as getting into shape.”

“This is the type of study that we need,” says Drogo Montague, MD, director of the Center for Genitourinary Reconstruction at the Cleveland Clinic in Ohio, who was not involved in the research. “It’s definitely an underappreciated problem,” Montague says. “We have an epidemic of obesity in our society and we’re seeing this more and more and more. I’ve seen patients who have had dramatic reversal of loss of libido and poor erections through weight loss.” “This is kind of a way of showing that even smaller amounts of weight loss can be effective, and it’s done it in a more scientific way,” he says.