Background <p>Severe obesity is associated with lower health-related quality of life, including sexual health. Metabolic and bariatric surgery (MBS) is well-known for its benefits in weight loss and the resolution of obesity-related comorbidities, but its impact on sexual satisfaction remains less documented. Obesity can negatively affect sexual health through hormonal imbalances, lowered self-esteem, and physical limitations.&#xa0;This study aims to evaluate differences in sexual satisfaction following MBS using validated sexual health assessment tools.</p> Methods <p>This case-matched study involved patients awaiting MBS (preoperative group) and those at 1-year follow-up (postoperative group). Participants were matched by age and preoperative BMI. Sexual satisfaction was measured using the New Sexual Satisfaction Scale (NSSS), along with gender-specific tools: the Female Sexual Function Index (FSFI) and the International Index of Erectile Function (IIEF). Statistical analysis was performed using <i>t</i>-tests, Mann–Whitney tests, and <i>χ</i>² tests.</p> Results <p>After matching, 190 pairs were analyzed based on gender. Postoperative patients reported a 24% higher NSSS score compared to preoperative patients (<i>p</i> &lt; 0.001). Male participants showed significant improvements in all IIEF domains except orgasmic function, with the greatest improvement in erectile function. Female participants demonstrated a 20% higher FSFI score, with notable improvements in arousal and desire but not pain.</p> Conclusions <p>There are significant differences in sexual satisfaction before and after MBS in both men and women. Future studies should focus on the long-term sustainability of these effects and the role of psychological support in enhancing sexual well-being post-surgery.</p>