Sunday, February 16, 2014

Sex and Inflammatory Bowel Disease

Sexual Desire, Satisfaction, and Ability with IBD

For those who have Crohn’s Disease and Ulcerative Colitis, where discussions of bowel movements have become comfortable and commonplace, sex can sometimes be a taboo subject.  There are implications on sexual function, both psychological and physiological, associated with IBD.  These are exacerbated by a fear of talking about them – both with partners and with care providers.  Additionally, physicians are frequently hesitant in asking about sexual function – furthering the taboo.  What are the implications of IBD on sexual health?

First, the psychological concerns have been looked at from a few different perspectives.  In a small survey-based study of 188 patients (with all of the limitations of survey self-reporting), subjects with IBD had no statistical difference when compared to controls in frequency of sexual intercourse, though the study used subgroup analysis that weakened the reliability of the results (188 patients – four subgroups for gender and type of IBD, each subgroup was approximately 44 patients).  The study did should that there were primary concerns in the IBD group about fecal incontinence, urgency, and abdominal pain, however.(1)  Other studies have shown an impact psychologically based on disease severity, with female patients having more concerns about intimacy.(2)  A larger European study of approximately 3,000 patients should a marked impact on sexual function in a quality of life questionnaire.  While having the same self-reporting related issues, the controls in this study appear to have been stronger.  This study showed a significant quality of life difference related to sexual activity in those with IBD, but did not attempt to qualify the reasons behind it.  Of interest in this study, the quality of sexual activity was inversely correlated with frequency of disease symptoms – those with more severe disease had the highest impact on sexual activity.(3)  Studies looking at ileostomy patients have shown an even more marked concern for sexual performance, attractiveness, and related issues.(4)

In the largest physiological study related to IBD and male sexual function, there were strong correlations between disease activity and erectile dysfunction (OR 2.5, CI 1.3-4.9), ability to have an orgasm (OR 4.3, CI 2.0-9.3) and sexual desire (OR 2.5 CI 1.1-5.5).  Interestingly, all of these factors were directly related to the severity of the disease (as expected) but inversely related to the duration of the disease.  This suggests that individuals who have the disease for longer periods are more likely to have found help for their conditions or adapted to them better.(5)

In a counterpart study, the same group from (5) looked at female sexual function.  They found that women reported having lower sexual desire (OR 1.8 CI 1.0-3.2) associated with active disease, and increases vaginal infection rates.  Similar to men, having IBD for more than 10 years correlated with more positive sexual health and activity.(6)

For patients that have anal involvement in their Crohn’s and Ulcerative Colitis, there is a relationship between anal damage and the ability to achieve erection in men.  This was found to be a problem with men having anal fistula surgery, specifically in those with incontinence issues.  The role of anal function in erection is related to the nerves that are present in the area.  Perianal involvement and subsequent damage through fistulotomy can negatively impact those nerves (, resulting in ED issues.(7)

Bottom Line

·         Sexual desire and function are impacted negatively by Crohn’s and Ulcerative Colitis, through physiological and psychological means.
·         The psychological sexual impact tends to be less for those who have had IBD for more than 10 years.  An exact reason for this is not known.
·         Perianal involvement can have high ED association for men due to the location of the nerves involved in penile muscle stimulation.
1.       Moody, G. A., and J. F. Mayberry. "Perceived sexual dysfunction amongst patients with inflammatory bowel disease." Digestion 54, no. 4 (1993): 256-260.
2.       Drossman, Douglas A., Jane Leserman, Z. M. Li, C. Madeline Mitchell, E. A. Zagami, and DONALD L. Patrick. "The rating form of IBD patient concerns: a new measure of health status." Psychosomatic Medicine 53, no. 6 (1991): 701-712.
3.       Haapamäki, J. 2011. Health-related quality of life, symptoms and comorbitity in inflammatory bowel disease. Medical dissertation, University of Helsinki.
4.       Carlsson, E., I. Bosaeus, and S. Nordgren. "What concerns subjects with inflammatory bowel disease and an ileostomy?." (2009).
5.       Timmer, Antje, Alexandra Bauer, Daniela Kemptner, Alois Fürst, and Gerhard Rogler. "Determinants of male sexual function in inflammatory bowel disease: A surveybased crosssectional analysis in 280 men." Inflammatory bowel diseases 13, no. 10 (2007): 1236-1243.
6.       Timmer, Antje, Daniela Kemptner, Alexandra Bauer, Angela Takses, Claudia Ott, and Alois Fürst. "Determinants of female sexual function in inflammatory bowel disease: a survey based cross-sectional analysis." BMC gastroenterology8, no. 1 (2008): 45.
7.       Shafik, A. "Injured external anal sphincter in erectile dysfunction." Andrologia33, no. 1 (2001): 35-41.

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