Sexual Health

Obesity can impact a person's sexual health as early as puberty. There have been strong correlations between the timing of sexual maturation and a person's body weight, body mass index (BMI), and skin fold thickness. The most common sexual health complaint among obese women is polycystic ovary syndrome (PCOS). The severity of the syndrome and the severity of obesity are often directly correlated. Obesity also impacts pregnancy and infertility. Obesity also has an impact of sexual function and dysfunction with obese men reporting more cases of erectile dysfunction (ED) than nonobese men. A major comorbidity that is listed along with obesity is cancer, especially cancers of the sexual organs.

Girls who experience early sexual maturation are twice as likely to be overweight and obese than girls who experience sexual maturation at the average age. However, the opposite was found in boys. Boys who reach sexual maturation early are less likely to be obese. The evidence that links fatness and maturation in girls does not confirm that obesity causes early sexual maturation. There are several theories that propose [Page 687]a mechanism of interaction. One of the earlier theories looks at the idea of allocation of energy. In women especially, reproduction is very energy expensive. As such, a woman will not reach sexual maturation until her body stores enough energy to maintain a pregnancy. Because overweight and obese females have more stored energy, they reach menarche sooner.

Hormones that affect a woman's ovulation cycle, such as estrogen, tend to be higher in obese females.

Another theory examines the close relationship between adipose tissue and hormones. Hormones that affect a woman's ovulation cycle, such as estrogen, tend to be higher in obese females. As such, these females experience premature menarche. The relationship may also be bidirectional. Women often experience weight gain once they have reached sexual maturation. As such, an individual may not be obese until after reaching sexual maturation; however, the timing of events may not be well known. There are few theories regarding males and sexual maturation.

Obesity is also strongly correlated to PCOS. The most common complaints associated with PCOS are hyperandrogenism and menstrual irregularities. It is also a leading cause of infertility and will affect 4 to 7 percent of women. The severity of PCOS is proportionate to the severity of obesity. Increased abdominal adiposity is more strongly related to PCOS. The relation between PCOS and obesity is thought to be a result of poor regulation of hormones. An increase in adipose tissue causes changes in insulin, estrogen, iodothyrins, and growth hormone, which all regulate sex hormone-binding protein (SHBG). Significantly lower SHBG plasma levels and worse hyperandrogemia are a main characteristic of obese women with PCOS.

Women with PCOS are characterized by a high prevalence of several metabolic abnormalities that are strongly influenced by the presence of obesity. Weight loss has been reported to be increasingly difficult among women with PCOS. However, weight loss induces significant benefits on hyperandrogenism and the severity of PCOS. Weight loss is a simple, cost-effective, and safe way of treating the symptoms and is highly recommended for women with PCOS.

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