In the city of Ouagadougou, 424 doctors are listed by the Regional Medical Council as general practitioners. Figure 1 shows the flow chart for the inclusion of GPs in the survey.

Of the 121 GPs surveyed, 84 were males and 37 females, giving a sex ratio of 2.27. The average age was 31.99 ± 5.70 years, with a range of 25 to 65 years. Table 1 shows the distribution of GPs by age.

All GPs identify cardiovascular complications as one of the main consequences of obesity, followed by metabolic complications. In addition, they also recognize mechanical, respiratory, sexual, reproductive, digestive and renal complications as conditions that can be associated with obesity. Figure 2 shows the distribution of GPs according to their knowledge of the consequences of obesity.

Of the 121 GPs surveyed, 97.5% said that obesity can have an impact on women’s sexual and reproductive health. Furthermore, 89.3% recognized the possibility of sexual disorders in obese women, while 91.6% believed that obesity may be responsible for a decline in female fertility. In addition, 96.7% of doctors considered that obesity can lead to complications during pregnancy and childbirth. Table 2 shows the number and proportions of doctors aware of the consequences of obesity on women’s sexual and reproductive health.

Discussing the consequences of obesity on sexual health was considered important by 81.1% of the 121 GPs surveyed. However, only 24.8% felt that it was relevant to broach the subject of sexuality with their patients. Furthermore, 57.9% of GPs considered the impact of obesity on sexual and reproductive health to be moderate. Of the 121 GPs participating in the survey, 70, or 57.85%, rated the impact of obesity on sexual health as important, indicating a degree of impact of between 75% and 100%. Figure 3 illustrates the GPs’ assessment of the degree of impact of obesity on sexual health.

As for the reasons why GPs might avoid broaching the subject of sexuality with obese patients, 42.1% feel that the subject should only be raised when the request is made. A further 5% consider the subject to be taboo. Figure 4 shows GPs’ responses according to their attitudes to discussing the consequences of obesity on sexuality with their patients.

Of the 121 GPs surveyed, 100 (82.6%) said that they offer treatment for sexual or fertility problems in obese women. In addition, 34 doctors (28.1%) said they were actively looking for sexual or fertility problems in these women.

In the event of sexual or fertility problems, 117 or 96.6% of GPs referred their patients to a specialist, and 69.4% referred them to a gynecologist ( Table 3 ).

Regarding the question on contraception, of the 121 doctors, 37, or 30.6% of GPs, discussed the choice of contraceptive method with patients. On the other hand, 84 doctors, or 69.4%, did not. Of those doctors who did discuss contraception with their patients, 13.2% did so to avoid unsuitable methods and thus minimize risks, while 7.4% did so to better plan pregnancies.

Our study has some limitations. Firstly, the online nature of the survey carried out via KoboCollect means that the results are based on declarative data, which may not accurately reflect reality. The specialized nature of the subject matter, which targets a specific population, could also influence GP participation, as some GPs see these issues as falling within the expertise of specialists. The question of sexuality may be perceived as a sensitive subject, which could dissuade some doctors from participating. We obtained the email addresses of general practitioners registered with the Ouagadougou’s regional section of the Medical Council. It is important to note that participation in the questionnaire was voluntary and anonymous. Some doctors indicated that they were no longer practicing as general practitioners, which helped to reduce the participation rate.

The main strength of the study lies in its originality. Indeed, we found no previous data concerning the knowledge, attitudes and practices of general practitioners in the city of Ouagadougou with regard to the sexual and reproductive health of obese patients. Previous research on this topic has focused mainly on the general population. Despite limitations, we have obtained results that have been discussed.

According to 97.5% of doctors surveyed, obesity has an impact on women’s sexual and reproductive health, while 89.3% recognized the possibility of sexual disorders in obese women. Interestingly, 91.6% of GPs believe that obesity can lead to reduced fertility in women. Indeed, weight gain can affect sexual and reproductive life, especially when accompanied by physical and psychological discomfort or in the case of associated chronic illnesses [11] . What’s more, 96.7% of doctors believe that obesity can lead to complications during pregnancy and childbirth. This frequency corroborates the data in the literature. Indeed, obesity-related maternal-fetal complications are much more frequent in obese women, which has also prompted numerous studies [13] - [15] .

In our study, 90% of doctors felt that weight loss could have beneficial effects on sexual and reproductive health. This percentage is similar to that of Bocquier et al. in France, which was 90.2% [16] . The literature does indeed support this assertion, asserting that weight loss contributes overall to better health. According to Magkos et al., even modest weight loss can produce significant health benefits for overweight and obese patients [17] . Weight loss in obese people is associated with improved quality of life, thanks to a reduction in the adverse effects of co-morbidities such as cardiovascular disease and diabetes, but also with an improvement in psychological disorders, such as self-esteem and self-confidence [18] .

The majority of GPs surveyed (81.1%) believe it is important to discuss the consequences of obesity on sexual health. However, only 24.8% were willing to actually discuss sexuality with their obese patients. This low percentage is similar to that observed by Baurain, who reported a rate of 32.26% [19] . Furthermore, 57.9% of GPs consider the impact of obesity on sexual and reproductive health to be moderate. This could be explained by an underestimation of the prevalence of sexual disorders in women, particularly those who are obese.

In our study, several attitudes were identified as being unfavorable to the initiation of a dialogue on sexuality. A significant proportion of GPs are only prepared to discuss sexuality when patients explicitly request it. So, as long as the request is not raised by obese patients, doctors avoid talking about it. Studies of GPs in the USA have also shown that the majority of them do not systematically screen for sexual disorders during routine consultations [20] [21] . Although most patients wish to discuss these subjects, embarrassment often prevents them from doing so, so their complaints are often masked; they usually mention a gynaecological symptom first. It is, therefore, incumbent on doctors to know how to direct the discussion towards sexuality during their questioning [11] . The lack of skills needed to deal with these issues was also highlighted by 20.66% of GPs. These results are in line with numerous studies in the literature [11] [19] [22] . Women’s sexual health is rarely addressed in medical studies. An American study of the way in which primary care physicians discuss sexuality with their patients also revealed that a lack of knowledge and available treatments represented an obstacle to this discussion [23] . Thus, targeted training in sexology could considerably improve their practices when it comes to sexuality and the management of sexual dysfunctions.

Lack of time is also a major obstacle to discussing certain subjects in consultation, with 6.61% of doctors reporting this constraint. Indeed, a general medical consultation lasts an average of 15 minutes, and obese patients often present several co-morbidities requiring special attention [24] . In this context, if the question of sexuality is not perceived as a crucial point in management, the doctor is unlikely to discuss it, given the many other aspects to be addressed. Moreover, the increasing number of patients in consultation often limits the length of interaction.

In our study, only 28.1% of GPs were interested in sexual or fertility disorders in obese female patients. Although disorders of female sexuality are common, they are rarely discussed in general medical consultations [25] . This low percentage can be explained by a number of reasons that hinder discussion of sexuality. It is therefore clear that, despite a satisfactory theoretical recognition of the existence of sexual or fertility disorders in obese women, general practitioners struggle to deal with these problems [25] .

In the event of sexual or fertility problems, 96.6% of GPs refer their patients to a specialist. Sexual disorders in obese people can be seen as complications of chronic pathologies or an unfavorable psychological state, which warrants special attention when managing them, as they could conceal other health problems. This calls for a thorough examination and specialist advice. These findings are comparable to those of Lavenat in 2018 [11] . The gynecologist is considered the referral specialist by 69.4% of general practitioners. The latter represents the main referral for any health problem linked to sexuality. These observations are confirmed by Gavignet’s study [25] , which indicates that GPs consider the gynecologist to be the referral professional for sexual disorders, and it is this type of specialist to whom they mainly refer their patients. However, our results could also be explained by a lack of sexologists in our healthcare structures, or by a lack of awareness of the existence of these professionals.

On the question of contraception, only 30.6% of GPs engage in dialogue with their patients on this subject. This low rate can be explained by the fact that contraception is generally offered in family planning centers by midwives. Doctors who discuss contraception do so with the aim of avoiding the use of unsuitable methods, in order to reduce the risk of failure or complications in obese women. The choice of contraceptive method must take into account the specific contraindications of each method. Obese women are at greater risk of developing chronic conditions such as high blood pressure, stroke or diabetes. The presence of these comorbidities, therefore limits the available contraceptive options. In addition, an inappropriate contraceptive method for obese women may lead to risks of failure, such as unwanted pregnancies, or aggravate obesity, which could lead to further complications [26] .