Female sexual function, urinary incontinence, and sexual position use 5 years after bariatric surgery: a prospective cohort study.

backgroundFemale sexual dysfunction and urinary incontinence are common among women with obesity. Bariatric surgery may improve sexual health, but long-term data are limited, and evidence on the use of sexual positions is lacking. We prospectively assessed female sexual function, urinary incontinence, and selected sexual positions before and 5 years after bariatric surgery.

methodsIn this single-centre prospective cohort study, women who underwent bariatric surgery completed the Female Sexual Function Index (FSFI) and the International Consultation on Incontinence Questionnaire–Urinary Incontinence Short Form (ICIQ-UI SF) preoperatively and at the 5-year follow-up. A study-specific questionnaire was used to assess the frequency and perceived pleasure of eight predefined coital positions. Paired comparisons were performed using the Wilcoxon signed-rank and exact McNemar tests. Predictors of changes in total FSFI (ΔFSFI) were examined using robust linear regression.

resultsSeventy women were enrolled in this study, and a total of 40 patients provided paired baseline and 5-year data. The mean age at the time of surgery was 39.8 years, and the mean body mass index (BMI) decreased from 39.1 to 30.7 kg/m². The proportion of patients who met the study definition of urinary incontinence decreased from 67.5% to 37.5% (p = 0.004). The total FSFI score increased modestly from 25.83 ± 7.96 to 27.16 ± 7.38, but the change was not statistically significant (p = 0.107), and no FSFI domain showed a significant within-subject change. In exploratory regression analyses, a lower baseline FSFI and a lower postoperative body mass index were associated with greater improvement in the FSFI. In the correlation analysis, urinary incontinence severity showed a negative association with the FSFI score, but did not reach statistical significance. Sexual position frequency and pleasure ratings were largely stable over time, with no significant changes in any position.

conclusionsFive years after bariatric surgery, overall FSFI scores showed only modest, nonsignificant improvement. Urinary incontinence improved, but the negative correlation with FSFI scores was not significant. Women with poorer baseline sexual function and lower postoperative body mass index appeared more likely to experience improvement. These findings should be interpreted in light of the modest sample size and the substantial loss to follow-up.