Sexual Concerns After Bariatric Surgery

Adjusting to life after bariatric surgery can be filled with ups and downs. Many people hope that one of the impacts of the surgery is that they will feel better and look better. And of course some people believe this will translate to more and better sex! Unfortunately it’s usually not that simple. Below are some common sexual concerns I here from clients post-bariatric surgery:

  • “I haven’t thought about that in years…” Sometimes old traumas can get stirred up after bariatric surgery. For people that endured trauma as a child (whether it was bullying by peers, sexual abuse by a family member, the loss of a parent, etc.) food may have been a source of comfort and coping. Also being overweight for some children serves as a way to protect themselves from abuse. So suddenly when you’re are loosing weight after bariatric surgery you may find yourself thinking about old traumas and feeling very triggered. If the trauma is too overwhelming, especially if the trauma impacted your body image or the way you viewed yourself sexually, you may find yourself not wanting to have sex. Sex may become a triggering and you might find yourself feeling unsafe in your body despite being physically healthier due to the weight loss! Seeking counseling to process these old traumas can be especially helpful.
  • “My sex drive is much higher! But my partner doesn’t seem to want to have sex…” Bariatric surgery often helps men’s testosterone reach a normal level, usually increasing libido. Women who have bariatric surgery often notice increased desire and generally better sexual functioning. Keep in mind however, just because you are feeling increased desire does not mean your partner is. If the pattern in your relationship before surgery was to have little sexual contact, this is not going to change overnight. Don’t make the mistake of assuming your partner’s lack of drive is about you! Your partner may have their own sexual dysfunction or low desire that was easily hidden and worked in a relationship that had little sexual contact. Now that you want to have more sex, it could be highlighting your partner’s own sexual issues. Couples often have to renegotiate and rediscover their sexual relationship. Couples therapy and sex therapy can be helpful in this process.
  • “I want to get naked in front of my partner again but…” One part of you might want to jump right back into sex, even flaunt your body for your partner. Another part of you might feel hesitant, self-conscious or even afraid. Both are normal reactions after surgery. Give yourself time to adjust to your new body—and for your partner to adjust to your new body too. Many people become more self-conscious about their bodies if they experience sagging skin, a common side effect of bariatric surgery. Counseling can be helpful in adjusting to your new body, regaining self-confidence and developing a positive body image.
  • “I haven’t really wanted to have sex because I’m feeling more down…” While some people experience increased psychological health after surgery, others notice decreases in psychological health after surgery. Sometimes this is related to unmet expectations about how the surgery would change your life or you may be struggling with keeping up with the lifestyle changes needed to maintain the weight loss. In fact, many studies have shown that those who have undergone bariatric surgery are at higher risk for substance abuse, depression and suicide. If you are not feeling well emotionally, you are generally not going to want to have sex. Depression, anxiety and trauma related disorders can all decrease desire. Seeking counseling to deal with emotional distress you may be experiencing after surgery is recommended.

Frequently Asked Questions about EMDR Therapy

What Does “EMDR” Stand For?
EMDR stands for “Eye Movement Desensitization and Reprocessing.”

What is EMDR?
EMDR is a type of therapy used to treat trauma related disorders and emotional distress caused by upsetting life experiences. EMDR uses standardized protocols with bilateral stimulation to facilitate the adaptive processing of traumatic experiences, allowing psychological healing to naturally occur.

What Kinds of Problems Does EMDR Treat?
EMDR can be used to treat trauma related disorders (like Post-Traumatic Stress Disorder) caused by childhood abuse and neglect, rape, sexual assault, combat-related trauma, critical incident stress (in first responders), natural disasters, motor vehicle accidents, etc. EMDR has also been effective in treating specific phobias, social anxiety, performance anxiety, chronic pain, generalized anxiety disorder and distress from infertility. EMDR can be applied to many life experiences that cause emotional distress that don’t meet the criteria for PTSD. For instance, EMDR could be useful in processing the discovery of an affair, overcoming the fear of public speaking or dealing with the impact of bullying in childhood.

How is EMDR Different Than “Talk Therapy?”
One thing that is different about EMDR therapy is that the therapist acts more as a guide and does not give much feedback. Instead, EMDR enables clients to quickly come to their own insights without much feedback from the therapist. Clients also do not have to discuss in detail the trauma in order to overcome the event. In general EMDR works much more quickly than other therapies. Also, other than self-care there are not homework assignments in-between sessions.

Does EMDR work?
While there are never any guarantees of treatment outcomes, EMDR is a highly evidenced-based therapy and many studies have demonstrated its effectiveness. As the EMDR Institute website summarizes, “More than thirty positive controlled outcome studies have been conducted on EMDR therapy.  Some of the studies show that 84%-90% of single-trauma victims no longer have post-traumatic stress disorder after only three 90-minute sessions.  Another study, funded by the HMO Kaiser Permanente, found that 100% of the single-trauma victims and 77% of multiple trauma victims no longer were diagnosed with PTSD after only six 50-minute sessions. In another study, 77% of combat veterans were free of PTSD in 12 sessions. There has been so much research on EMDR therapy that it is now recognized as an effective form of treatment for trauma and other disturbing experiences by organizations such as the American Psychiatric Association, the World Health Organization and the Department of Defense. Given the worldwide recognition as an effective treatment of trauma, you can easily see how EMDR therapy would be effective in treating the “everyday” memories that are the reason people have low self-esteem, feelings of powerlessness, and all the myriad problems that bring them in for therapy. Over 100,000 clinicians throughout the world use the therapy.  Millions of people have been treated successfully over the past 25 years.”

Where Can I Learn More About The Effectiveness of EMDR Therapy?
The following websites provide more information about the research demonstrating EMDR Therapy’s applications and effectiveness:
http://www.emdr.com/research-overview/
http://www.emdria.org/?page=EMDRResearch

How Do I Know If EMDR Therapy Is A Good Treatment Option For Me?
The best way to know if EMDR could be a treatment option for you is to meet with an EMDR certified therapist.

Where Can I Learn More About EMDR?
Websites that offer more information about EMDR include:
http://www.emdr.com/
http://www.emdria.org/
You can also read an interview with the developer of EMDR, Dr Francine Shapiro:
http://consults.blogs.nytimes.com/2012/03/16/expert-answers-on-e-m-d-r/?_r=0

7 Simple Techniques for Coping with Anxiety

  1. Acknowledge the Anxiety. Ignoring your anxiety might actually make you more anxious, especially if your physical symptoms increase. When you notice your anxiety, simply note the experience. Say something like “I am having some anxiety,” or “I’m feeling worried & am experiencing some dizziness.” These types of statements will help you tune into your physical & emotional experience of the anxiety and will prevent distorted thinking from making the anxiety worse (like saying “If I don’t get out of here I’m going to have a heart attack!”).
  2. Tell Yourself “This Will Pass.” Because anxiety can feel distressing, people sometimes panic about the physical experience of anxiety. This panic can make anxiety symptoms worse. Learn to tell yourself that your anxiety will pass, and its intensity often changes. All emotional experiences have a beginning and an end. Remind yourself of a time when you had anxiety before and that the anxiety stopped.
  3. Stay Away From Sugar & Caffeine. The effects of foods high in sugar and those with caffeine can mimic anxiety symptoms. If you’re already anxious, reaching for a cup or coffee or sugar snack will only magnify your symptoms! In a moment when experiencing anxiety never consume a sugary or caffeine laden food or beverage. If anxiety is a chronic problem for you, consider reducing your sugar and caffeine intake overall.
  4. Bring Yourself Back to the Moment. Anxiety can often cause you to wander down the scary “what-if” road. For instance, “What if I mess up my presentation & loose my job…What if I have a heart attack…What if he/she leaves me because she thinks I’m crazy!” Reign in these exaggerated frightening hypothetical thoughts about the future by staying present. Staying in the moment will also help you to tune into what is happening in your body when experiencing anxiety.
  5. Imagine a Calm, Safe Place. The calm safe place can be imaginary or somewhere real. If you happen to be outside when you’re experiencing anxiety tune into calming stimuli around you. For instance pay attention to the trees, their color, their smell, the animals in the trees, sound of birds chirping, etc. Carry a photo of a calming place with you in your wallet or phone for reference. Imaging a calm safe place will redirect your attention from your anxiety to a relaxing stimuli. Download relaxing music or sounds to your phone (there are many apps for phones are designed to play relaxing sounds).
  6. Focus on Your Breath. You may notice that when you’re anxious your breath changes. Breath rate usually becomes quicker and more shallow, sometimes causing hyperventilation. When anxious try taking slow, deep belly breaths to tap into your body’s natural ability soothe an activated nervous system.
  7. Get Moving. Exercising when feeling anxious can help to discharge extra adrenaline and nervous energy. If you’re in a situation where you are unable to exercise (like at work for instance) even taking a five-minute walk or stretching could be helpful. Exercising on a regular basis is also an excellent way to manage and prevent anxiety. Many people with chronic anxiety notice a significant decrease in their symptoms when they are able to exercise on a regular basis.