What doctors or other people don’t know about sex in fat people (the numbers of whom are increasing everyday) could fill an encyclopedia. From our own experience with obese patients consulting us for bariatric surgery, we can at least offer some thoughts on the subject.
First, let us reiterate what many psychologists probably already know. Fat people love to have sex. Yes they do, contrary to popular notion.
The problems with sex in the obese stems from mechanical problems due to their oversized belly coming in the way of the sexual act, altered anatomy of their external genitalia which are often buried in the fat all around, low self esteem due to negative body image and low self confidence. In addition, hormonal or drug related sexual dysfunction may be present.
The sea of fat drowns the external genitalia in the very obese, making them hardly visible. The men are unable to flaunt the male organ leave aside being able to penetrate. This lack of visibility sometimes occurs during erection too! An obese woman’s vagina may be visible only if one separates the entire fat covering it. Such physical disadvantage can even translate into difficulty in masturbation. At BMI, we have patients who have suffered psychological stress due to their inability to masturbate.
Attaining a normal intercourse in these individuals may require a lot of innovation by the partners – the right position and attitude- something that may not be easy on a regular basis. There is a lot of talk about the modification of various sex positions to facilitate the act in the obese. There is a male dominant position, female dominant position, rear entry position, Sim’s position, upside down position, T square position, X position, etc. The recommendation of various positions during sex in a fat individual is a testimony to the difficulty faced by the severely obese in performing the sexual act. As a rule, the bigger the individual, the bigger the problem. The lack of discussion on this highly sensitive topic- by the obese people and the society alike- is definitely of no help.
“I did not feel like having sex after some months because at 160 kgs I did not know how to do it. I was ashamed and even frustrated by my inability to satisfy my husband’s needs”, said Neha, one of our patients.
Interestingly, the most direct effect in dampening a sexual relationship in an obese couple comes from dieting. Prolonged semi starvation as an effort to reduce weight can itself dampen the libido!
The obese are also often beset with fears and prejudices. They may be more prone to doubt their partner’s sincerity because of their insecurity. Self-hatred manifests itself in a number of anti-erotic behaviors. Some women are reluctant to act seductively for fear of rejection and ridicule. Young women often have the desire to look ‘sexy’ and wear seductive clothes, but fear that men in particular will not appreciate them. It is also known that many obese people attempt to hide their bodies under cover of darkness, or keep their clothes on during sexual intimacy.
Bariatric surgery is one of the ways all this can be effectively addressed in a severely obese. Once these people start losing weight, one of the benefits that is immediately evident to the patient is that their genitalia becomes visible as a result of the fat melting all around it. Most patients after bariatric surgery have a sense of elation and this mood elevation also translates into greater libido. The positive benefit on the sexual life of an obese is one of the underrated but a key advantage after bariatric surgery.
In a nutshell, sexual difficulties among the obese are a more common problem than one would expect, and they deserve treatment, but everyone chooses to ignore the issue. As such it has become an elephant in the room. It can be addressed with the help of sex education, psychological counseling, weight loss either by diet and exercise or by more aggressive methods like bariatric surgery.
