Changes in Erectile Function, Genital Self-Image, and Psychological Distress in Men After Bariatric Surgery: A Single-Centre Prospective Cohort Study

Background: Severe obesity is a chronic condition that adversely affects physical health and quality of life, including sexual function. However, its impact on multidimensional psychosexual outcomes remains unexplored. This study aimed to assess changes in erectile function, genital self-image, and psychological distress in men who underwent bariatric surgery. Methods: This prospective cohort study involved 50 male participants undergoing primary bariatric surgery who were evaluated within 30 days prior to the surgical procedure and at a minimum of 12 months postoperatively. Standardised questionnaires were used, including the International Index of Erectile Function-5 (IIEF-5), Male Genital Self-Image Scale (MGSIS-7), and Hospital Anxiety and Depression Scale–Modified (HADS-M). Secondary outcomes encompassed parameters of weight loss, sexual activity, and selected aspects of sexual behaviour, such as the utilisation of various sexual positions, their associated pleasure, and frequency. Results: Significant postoperative improvements were observed in BMI reduction from 42.8 kg/m2 to 31.7 kg/m2 (p < 0.001), erectile function (IIEF-5 improved from 16.3 to 19.6; p < 0.001), genital self-image (MGSIS-7 improved from 19.1 to 21.9; p < 0.001), and psychological distress (HADS-M reduction from 13.3 to 8.7; p < 0.001). Glycated haemoglobin decreased significantly (5.89% to 5.31%; p < 0.001), obstructive sleep apnoea severity improved (p < 0.001), and remission or clinically meaningful improvement of at least one major metabolic comorbidity was documented in 24 of 37 participants (64.9%). Sexual activity increased from 37/50 (74.0%) to 43/50 (86.0%), although this change was not statistically significant (p = 0.114). After FDR correction, frequency increased for 3 of the assessed positions, whereas pleasure increased only for one of them. Weight loss magnitude was not significantly correlated with changes in the IIEF-5 or MGSIS-7 scores. A greater reduction in the HADS-M score correlated with a greater improvement in the IIEF-5 score (ρ = −0.307, p = 0.030). Conclusions: Bariatric surgery was associated with improvements in erectile function, genital self-image, and psychological distress, alongside marked glycaemic and sleep-related recovery. Because the psychosexual changes were not statistically associated with the magnitude of weight loss and of metabolic and respiratory improvement, and because the design was uncontrolled, these exploratory findings indicate association rather than causation and support the incorporation of psychosexual and mental health assessment into postoperative bariatric care.