Weighed down by erectile dysfunction

Dear Dr G,

I understand from your previous article that you are dealing with New Year resolutions to improve sexual performance.

I am somewhat surprised you have not mentioned the motivation to lose weight for a better sex life.

I am a 45-year-old married man who has been having trouble with my weight since my youth.

During the pandemic, due to lack of exercise and excessive eating, my BMI (body mass index) has gone from overweight to obese.

This has taken a toll on my overall health, especially my sexual health.

Apart from noticing not getting any “morning wood”, I am unable to obtain or maintain erection during intercourse.

Besides, I am also losing my libido and getting breathless during sex.

My wife also hates having sex with me as I am getting too heavy to be on top.

I went to the doctors for some blue pills, but was somewhat disappointed when he reckoned I should lose weight instead for better overall health.

In fact, he reckons I should consider bariatric surgery for weight loss.

Before I begin my weight loss New Year resolution, I would like to put Dr G on the spot for my opinion on weight and sexual health management.

Firstly, am I really having erectile dysfunction at the young age of 45?

Is the evidence robust associating obesity and erectile dysfunction?

Can weight loss really improve the erection and libido?

I am really weighed down by my poor erection and looking forward to your opinion.

Yours truly,

Overweight Oliver

Erectile dysfunction (ED), also known as impotence, is defined as the persistent inability to attain and maintain a penile erection sufficient for satisfactory sexual intercourse.

A previous study by the Massachusetts Male Aging Study (MMAS) reported that ED is the most common sexual health issue that affected over 150 million men worldwide in 1995 and will reach over 300 million in 2025.

The Health and Morbidity Survey 2019 in Malaysia also revealed ED affected nearly one-third of young men aged 18 to 29.

At the same time, ED is also associated with substantial adverse effects on physical and psychological health in men facing a high incidence of non-communicable diseases such as diabetes, hypertension, dyslipidemia and obesity.

Being overweight or obese, defined as having abnormal or excessive fat accumulation, causes impaired quality of life.

With its rapidly increasing prevalence, obesity has become a global public health concern.

Sexual dysfunction, especially ED, is also common among obese males.

One study revealed the risk of ED in overweight and obese males and reported that obesity increases the risk of ED by approximately 1.3 times.

This risk is compounded by other additional risk factors such as diabetes, smoking, high cholesterol and blood pressure.

Other studies also demonstrated that the incidence rate of ED was directly attributed to the growing prevalence of obesity.

A regional study found that the prevalence of ED was as high as 42.1% in higher BMI and larger waist circumference in young non-diabetic men.

The association of obesity with erectile dysfunction is not completely clear.

However, there is an association with metabolic syndrome, inducing high risk of pathophysiologic processes, including oxidative stress, inflammation and insulin resistance.

This might partly explain the elevated prevalence of chronic diseases (hypertension, hyperlipidemia and diabetes) in men facing ED.

Moreover, the efficacy of medications such as the blue pill on erectile function is reduced in obese men as their weight problems worsen.

Many randomised controlled trials have been performed to evaluate weight reduction on ED in obese men.

The results showed that lifestyle changes are associated with improvements in erectile function.

In addition, weight loss by bariatric surgery has been reported to improve erectile function in obese men.

Any form of weight loss intervention seems to be reversible; weight loss from exercise, diet, or surgery could reverse ED and provide a view of the cost-effectiveness for the treatment of ED.

A 15% weight loss in obese men can significantly improve the erectile function measured by the International Index of Erectile Function (IIEF) score.

In addition to weight loss by lifestyle changes, bariatric surgery has been reported to improve overall health in affected men.

The association of obesity with the increasing risk of sexual dysfunction is well documented in medical literature.

Although medications such as PDE5-Is are effective in the treatment of ED, given its increasing prevalence of ED in obese men, clinicians are paying more attention to getting them to maintain a healthy body weight instead of the quick solution of the little blue pill.

The late US comedian and actor Ralphie May (1972-2017) once declared: “I’m obese, but I’m not obtuse.”

When young(ish) obese men put Dr G on the spot, his view is: Do not be obtuse, but understand how obesity can damage your sexual and overall health, and how weight loss can reverse being weighed down by erectile dysfunction.