Obesity and sexual health: focus on postmenopausal women

Abstract

Menopause is a cardiometabolic transition with many women experiencing weight gain and redistribution of body fat. Hormonal changes may affect also several dimensions of well-being, including sexual function, with a high rate of female sexual dysfunction (FSD), which displays a multifactorial etiology. The most important biological factors range from chronic low-grade inflammation, associated with hypertrophic adipocytes that may translate into endothelial dysfunction and compromised blood flow through the genitourinary system, to insulin resistance and other neuroendocrine mechanisms targeting the sexual response. Psychosocial factors include poor body image, mood disorders, low self-esteem and life satisfaction, as well as partner’s health and quality of relationship, and social stigma. Even unhealthy lifestyle, chronic conditions and putative weight-promoting medications may play a role. The aim of the present narrative review is to update and summarize the state of the art on the link between obesity and FSD in postmenopausal women, pointing to the paucity of high-quality studies and the need for further research with validated end points to assess both biomarkers of obesity and FSD. In addition, we provide general information on the diagnosis and treatment of FSD at menopause with a focus on dietary interventions, physical activity, anti-obesity drugs and bariatric surgery.

摘要

更年期是心脏代谢的转变, 许多女性经历体重增加和身体脂肪的重新分布。激素变化也可能影响健康的几个方面, 包括性功能, 女性性功能障碍(FSD)的发生率很高, 这表现为多因素病因。最重要的生物学因素从与肥大脂肪细胞相关慢性低度炎症, 可能转化为内皮功能障碍和通过泌尿生殖系统的血流受损、胰岛素抵抗和其他针对性反应的神经内分泌机制。心理社会因素包括身体形象不佳、情绪障碍、自尊和生活满意度低, 以及伴侣的健康和关系质量, 以及社会耻辱。甚至不健康的生活方式、慢性疾病和可能的增重药物也可能起作用。本叙述性综述的目的是更新和总结绝经后女性肥胖和FSD之间联系的最新进展, 指出缺乏高质量的研究, 需要进一步研究验证终点, 以评估肥胖和FSD的生物标志物。此外, 我们还提供了更年期FSD诊断和治疗的一般信息, 重点是饮食干预、体力活动、减肥药物和减肥手术。

Keywords:

• Sexual function
• obesity
• overweight
• menopause
• female sexual dysfunction
• anti-obesity interventions

Acknowledgements

The authors would like to thank Hellas Cena (Professor of Dietetics and Clinical Nutrition, University of Pavia, Italy) and Alberto Beretta (MD, PhD, president and chief scientific officer of SoLongevity, Milan, Italy) for a very inspiring discussion on the determinants of female healthy aging that gave origin to the new term ‘femgevity’. R. E. Nappi and L. Cucinella, as members of the European Campus of City-Universities (EC2U) Alliance, received funding at the University of Pavia, Italy, for the activities of Work Package 4 ‘Life-long wellbeing and healthy aging’.

Potential conflict of interest

R. E. Nappi had past financial relationships (lecturer, member of advisory boards and/or consultant) with Boehringer Ingelheim, Ely Lilly, Endoceutics, Palatin Technologies, Pfizer Inc., Procter & Gamble Co., TEVA Women’s Health Inc. and Zambon SpA; and at present has ongoing relationships with Abbott, Astellas, Bayer HealthCare AG, Besins Helathcare, Exeltis, Fidia, Gedeon Richter, HRA Pharma, Merck & Co., Novo Nordisk, Organon & Co., Shionogi Limited, Theramex and Viatris. None of these are relevant to the present work. All the other authors have nothing to disclose.

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

R. E. Nappi and L. Cucinella received funding from European Campus of City-Universities (EC2U) Alliance [Grant Agreement n. 101004065-EC2U].