Overweight? Sexual Issues and How to Handle Them

First, let’s get the lay of the land, even though it’s probably all review to you. To identify whether you’re overweight, the best (although not perfect) determinate is your Body Mass Index (BMI). It’s a simple calculation of your weight-to-height ratio, and it’s a more accurate assessment than weight alone.

(Here’s a tool to determine your BMI.)

Generally, a BMI score between 25 and 29.9 is considered overweight and over 30 is obese. If you fall within that range, you’ve probably heard all the risk factors associated with obesity, so I won’t reiterate.

But there are a few facts about obesity and sexual function—and aging in general—that might be helpful to know. While there’s some hemming and hawing about whether menopause and aging cause weight gain, there’s general agreement that fat deposits tend to redistribute themselves around the belly during menopause. Also that we tend to lose both muscle mass and metabolic efficiency as we age, making it easier to gain weight and harder to lose it.

So, if you’re heading into your menopausal years packing too many pounds, this might be a good time to tackle the problem. You’re on the cusp of a cascade of hormonal, metabolic, and physical change that will only exacerbate it.

Beyond the risk factors you’ve already heard, probably many times, obesity carries some very specific issues regarding sexual health. The most obvious? Sexual health tracks overall physical health. If you’re in good health, you’ll probably have more sex and enjoy it more. (Consider more and better sex one tempting carrot for losing weight.) Plus, studies repeatedly show that sex, in and of itself, is good for your health and sense of wellbeing.

You probably know that obesity is linked to higher risk for cardiovascular problems. For men, this often compromises blood flow to the penis, resulting in difficulty with erection and, consequently, with libido. A similar problem occurs in women.

“We are beginning to see that the width of the blood vessels leading to the clitoris in women is affected by the same kind of blockages that impact blood flow to the penis,” says Susan Kellogg, PhD, in this article about sex and weight.

Blood flow—and thus sensitivity—to the genitals often decrease during menopause, so coupled with excess avoirdupois, sexual sensitivity receives a double whammy.

The solution?

We need to learn to love ourselves first, in all our glory and our imperfections.A little targeted exercise to improve genital blood flow (as well as muscle mass in general) is a good place to begin. You don’t have to work out like Jane Fonda—a little of the right stuff goes a long way. “Any activity that increases blood flow to the large muscle groups in the thighs, buttocks, and pelvis—such as yoga, brisk walking, or cycling for 20 minutes three times a week is also going to bathe the genitals with better circulation,” Kellogg says.

Additionally, don’t neglect your pelvic floor. Excess weight puts extra stress on those overlooked muscles that hold a bunch of your abdominal organs in place. With menopause women tend to lose muscle tone as well, further affecting the pelvic floor. Lots of Kegel exercises will help increase circulation and tone that critical area.

To target blood flow to the genital area, you could also try a clitoral pump, of which I like the Fiera for ease of use. These devices use vibration or suction to improve circulation, and the Fiera in particular is easy to incorporate before foreplay.

Aging and the menopausal transition pose challenges to any woman’s self-image. As we’ve mentioned before, it’s hard to feel sexy when you’re focused on sags, bags, wrinkles, and cellulite. For obese women, body image can become a serious hurdle to pleasurable sex—or to having sex at all.

There are two ways to skin this cat, and they’re not mutually exclusive. You can begin to address with your overall health issues—and you don’t have to be the Biggest Loser to see significant improvement. Baby steps count, too. Small weight loss and a steady, gradual approach to improving your health can yield significant improvement in quality of life and improved self-image.

“I've noted that very often when patients start to take better care of themselves, they also report a substantial increase in their interest in sex. I think participation in a healthy lifestyle really helps, even if you don't lose the extra pounds,” says Martin Binks, PhD, director of behavioral health at Duke University's Diet and Fitness Center in Durham, North Carolina.

And you can also work on your self-image from within. If you feel sexy, you are sexy. “Don't buy into society's idea of the perfect sexual body, and do allow your own sexuality and sensuality to thrive inside the body you have,” says Abbie Aronowitz, PhD.

To that end, all the tips and tricks here on MiddlesexMD to jump-start libido and help you feel sexy are a click away.

A lot more research is needed to tease out the connections between obesity, aging, sexual desire, and performance. The hormonal dance in women is delicate and not well understood, and that may be compounded for those who go into menopause with extra weight. The good news is that small gains reap big rewards, both for sex and life in general.


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