This is from the Summer 2013 edition of the OAC magazine.
Answer provided by Walter Medlin, MD, FACS
Dear Doctor, I am affected by
obesity and not interested in
intimacy. Why is this?
Dr. Walter Medlin
Putting the Frisky back in Our Business!
The dilemma for most of us: Wanting intimacy but
Sexuality is still probably the toughest issue to
discuss, or even to think clearly about in our
society. It’s very ironic that we are deluged with
sexual images and humor to sell stuff and to get
our attention, but Americans are fairly repressed
and conservative in terms of actual intimacy and
Media and society will show explicit violence over
sexuality for some reason, to the point of laughable
avoidance of male nudity. You can watch TV and see
murder, mayhem and meanness on network shows
even in the “family hour,” but there will be no actual
depiction of sexual pleasure on TV (unless it is
betrayal). We are far more comfortable as a country
with sexual tension than sexual activity.
Please let me remind you that you’re talking with
a surgeon about something that is usually more
in the realm of a counselor. As a member of your
healthcare team, I am very happy, though, to get
you started on this process and help if I am the
provider you’re most comfortable sharing these
Let’s clarify some specifics. In what way (or ways) does
this loss of interest in intimacy bother you? Is it more of
an issue for you or your partner? Or maybe something
you have mutually decided is an area of desired change?
Misconception of Female Sexual Response
I highly recommend a book that I read for this article,
titled The Sex Starved Marriage, by Michele Weiner-
Davis, PhD. The book is very clearly written and reflects
an extensive clinical experience. One key concept is that
women often expect to be interested in sexual intimacy
prior to actually engaging in contact. This is often the
reverse of what actually occurs! Many women just don’t
get desire until actually involved in arousing activity. Dr.
Weiner-Davis also highlights many important areas in
her book that are listed on the following page.
One key concept is that women often expect
to be interested in sexual intimacy prior to
actually engaging in contact. This is often
the reverse of what actually occurs!
There are several factors that can lead
to loss of sexual desire or enjoyment.
Antidepressant medications in the
SSRI class can alter libido. These
include Celexa, Lexapro, Paxil,
Prozac, Zoloft and others.
Menopausal or premenopausal
changes can alter feelings of desire
and are often unrecognized in early
stages. The body can also have
adjustments after childbirth or
The term “chronic disease” covers a
lot of ground, but many conditions,
including diabetes, can contribute to
change in desire. Vascular disease is
more highlighted in males because of
the role in maintaining erection, but
likely has some role in female sexual
response as well. Smoking cessation
is always a good idea!
Polycystic ovary syndrome can give
women higher testosterone values,
which can lead to acne and hair
issues, as well as irregular periods.
Fatigue is probably most important,
medically, for desire. Low Vitamin D
is almost the rule in our patients, and
it takes weeks to months to correct.
Hypothyroidism is less common, but
treatable. Lack of regular exercise
directly affects sexual desire and
arousal and ability to orgasm. It also
indirectly affects fatigue, which is
part of the body’s counter-regulatory
efforts to dieting.
By the time many women reach our
clinic, they have been through dozens
of diet attempts throughout the years.
Their bodies have become welladapted
to this self-imposed “famine”
by going into a near hibernation
state, which is best characterized by
overwhelming chronic fatigue.
Medical, Hormonal and Physical issues
When you feel burnout in life, it is understandable to be
sexually disempowered. Clinical depression, medications
and body image problems can certainly have a role.
Understanding all of this is the first step to adjusting to it
all. Please note that I did not use the word “fixing” here!
An attitude of “fix” can block our ability to “treat.”
Behavioral and Relationship Issues
Another of Dr. Weiner-Davis’ ideas that I really appreciate
is that of “emotional nutrition,” which is an inborn need
to bond. How can we have a true sexual bond with our
partner if there is no friendship? Anger, cynicism and
even selfishness may all be reasonable responses to the
harsh reality of the world for many of us, but they also
isolate us. Balancing the need for self-care with the need
to be cared for requires a leap of faith!
Here are some questions for you and your partner that
may help you both identify intimacy issues:
• Are you in a relationship now? If so, how has
intimacy worked in this relationship in the past?
What previous relationships do you bring into the
• Are you a post-op metabolic/bariatric surgery
patient? Has your partner responded positively to
changes? Is your partner “oversexed” (exhibiting
an excessive sexual drive or interest)?
• Does your body image or previous sexual trauma
create fear or reluctance toward intimacy?
• Are you sexually active but feeling a lack of
desire/pleasure or not having intercourse? Do
you have a sexual relationship with yourself?
(Yes, we are now talking about masturbating, an
even more taboo subject than sex!) Do you have
thoughts but not act on them?
• How is your underlying friendship with your
partner? What other conflicts may be unresolved?
Some relationships undergo radical “power”
changes after bariatric surgery, and the partner
who has been taking the other for granted often
• How do you handle stress now? Food can be a
crutch even for normal weight people – they don’t
call it comfort food for nothing! You may need to
replace old coping behaviors with new ones.
• Do you have “safe” space in your relationship to
talk about issues without causing hurt feelings?
Are you waiting for your partner to agree with
you before taking action? When we offload the
obligation for our happiness onto our partner, it
can lead to a compounding of problems.
• Remember, change can be stressful, even if it is
winning the lottery. A new life can be disruptive,
and adjustment disorder is common.
Recognizing Other Important Issues
Most relationships hit roadblocks at some point, and
counseling can give tremendous benefit even if it is
only for a few sessions or a few months. Even when
the underlying sexual problem is completely related
to medication or physical problems, our feelings and
communications are easily disrupted. As the saying goes,
“Sex is only 10 percent of the relationship – unless you’re
not having sex, then it’s 90 percent!”
Here is a list of other concepts to explore:
• Distracted society (Internet, TV, busy lives)
• Anxious society (continual messages of crisis
• Neurotic society (continual messages of
• Pornified society (inability to live up to fictional
• Hyper-society (inability to just chill out for a
day on the couch with partner or self)
• Habit of avoiding, delayed gratification
• Does only intercourse “count” anymore? Are we
keeping score too closely?
• Romantic fiction (Is it okay just to “hook up”
with your partner occasionally? Does all sex
need to have deep personal connection, or can
it just be fun?)
• Spontaneous ideal (Sometimes planning, even
scheduling, can be helpful.)
• Sensitive feelings (Innocent comments can
cause real harm. Your body language may
be misunderstood as rejecting, even if it has
nothing to do with your partner.)
• Discounting positive attention (Negative selftalk
• Honest and CLEAR communication of needs
• Do you talk with friends, but your partner is in
• Be VERY careful of the word “should.” It is the
root of a lot of toxic behavior and unrealistic
• Is impatience for a complete solution keeping
you from making small steps?
• Would regular exercise help?
• Do we feel overly responsible for our partner’s
As you can see, there are a wide variety of concepts that
may impact sexual behavior and desire. It is important to
discuss these issues with your partner to encourage clear
and honest communication.
Communicate with your partner, take that leap of faith!
If you have major anger, or major vulnerability, it is a
good idea to have a counselor. Just get started! Don’t let
intercourse or orgasm problems block the enjoyment
you can have with other components of an intimate
relationship (even if it starts alone). Most important –
don’t ever count yourself out! This important part of life
has not passed you by, even if you are far out of practice.
Expect to have some dead ends in your search for
solutions. No single source or practitioner has every
answer, and many of us practitioners have only limited
experience with certain components of sexuality. Be
wary of the easy answers, this is complicated stuff!
As you progress through examining and making changes
in your sexual life, expect that the questions may change.
I am a strong advocate of Mindfulness-based Stress
Reduction techniques for keeping our problems in
perspective. Remember, your most important sex organ
is your brain! Self-care is fundamental to happiness.
Most of us have ongoing negative internal dialogue
about weight and self-worth. Don’t beat yourself up just
for having a challenge in desire. It is not a “fault,” but
another opportunity for learning about this amazing
journey of life.
Here’s hoping you all have the frisky, romantic summer
that you surely deserve!
Be positive, but be persistent!
Answer provided by:
Walter Medlin, MD, FACS, is director of the Metabolic
Surgery program at Billings Clinic in Montana and an
OAC Advisory Board Member. He struggled with his
weight since first grade. After performing hundreds of
bariatric surgeries, he underwent sleeve gastrectomy
in 2008, with outstanding results. Dr. Medlin is also a
participating practice in the OAC Sponsored Membership
Program where he gives each of his patients a one-year
membership in the OAC and he is honored to be a
longtime member of OAC. Dr. Medlin is also an avid user
of Twitter; his handle is “@bonuslife.”