Sexuality is a central aspect of being human as it encompasses not only sex, but also gender identities and roles, eroticism, pleasure, intimacy, reproduction and sexual orientation.

Inflammatory Bowel Disease (IBD) often impairs the sexual function of patients suffering from IBD. This means their sexual health. Sexual health is understood as a state of physical, mental and social well-being in relation to sexuality. All chronic diseases can cause disturbances in sexual health; it is not a problem unique to IBD.

Some studies indicate that IBD affects sexuality in the following ways.

– In 50% of patients there is a decrease in libido.

– In 45% it prevents them from continuing intimate relationships.

– 50% of women and 33% of men report a worsening of sexual activity.

– 75% of women and 51% of men see changes in their body image. This is also more prevalent in patients who have had surgery (81%) versus non-surgical patients (51%).

– 67% of patients in active IBD and 19% in remission choose abstinence.

Despite these data, only 20% of physicians (according to patients) address body image and sexuality issues in consultation with their IBD patients, with patients themselves proactively raising the issue.

Both health professionals and patients do not feel comfortable talking about sexuality, as it is a taboo subject because it belongs to the ‘intimate life’ of the patient. However, it is very important to do a communication exercise, rejecting stereotypes related to sexuality, broadening knowledge about the impact of IBD on the sexual life of IBD patients and training communication strategies and skills.

Factors that may affect the sex life of patients with IBD

PHYSICAL FACTORS

The active presence of the disease, i.e. flares, is one of the key factors affecting sex life. Fatigue, abdominal pain or diarrhoea are common factors affecting general health and the desire and enjoyment of sexual activity.

In diseases such as Crohn’s disease or perianal conditions (such as fistulas or fissures), they can cause pain.

Body image also plays an important role, as IBD patients may experience alterations in body perception due to scarring, weight changes or the side effects of treatments. All this creates anxiety, embarrassment and lowers the patient’s self-esteem.

A possible solution would be to surround oneself with a good support network, practice self-care and focus on one’s positive qualities.

PSYCHOLOGICAL FACTORS

In patients with IBD, depression, anxiety and low self-esteem are the most common factors that have a major impact on sexual function.

Between 60-80% of patients experience episodes of anxiety and/or depression during flares, and 29-35% in periods of remission.

The solution is to identify negative thoughts and replace them with positive thoughts to help combat these moods. If the symptoms are severe and prolonged, it is advisable to seek professional help from a psychologist.

 Can medication affect my sex life?

25% of erectile dysfunction cases are associated with medecine use.


Yes, drugs used to treat IBD can have adverse effects that affect sexual function.

Corticosteroids are a good example, causing mood swings, weight gain and cosmetic changes that affect body image and thus sexuality.

Sulphasalazine (salicylates or 5-ASA) can affect male fertility, but this effect is reversible when the drug is stopped.

Decreased libido induced by antidepressants, beta-blockers, opiate analgesics, depressive syndrome and/or anxiety.

Despite this, the improvement in IBD symptoms due to treatment often has a positive impact on sexual function by counteracting the above

Surgery and ostomies and their effects on sex life


Although surgery improves a patient’s health, due to remission of flare-ups and elimination of complications such as abscesses and fistulas, it can alter the patient’s body image and, consequently, self-esteem.  

Removal of the rectum can very rarely affect the pelvic nerves, which may cause erectile dysfunction in men or lubrication problems and dyspareunia (painful intercourse) in women.

In the case of an ostomy, patients may face difficulties with self-esteem and, above all, concerns about leakage of faecal material during intercourse. To minimize these concerns, it is advisable to empty the ostomy pouch before sexual intercourse.

The key in both cases, surgery and ostomy, is communication with the doctor and with the partner, considering, for example, the use of special underwear or girdles to hide the stoma if that is what the patient needs.

You might find it helpful to connect with other patients who have undergone similar procedures and their experiences with sexual activity after recovery.

IBD sexuality and adolescence

        

 Adolescence is a phase in the evolutionary cycle of our lives in which self-concept and personal identity develop. It is often a time of fragility and emotional disturbances which, if accompanied by a diagnosis of IBD, can have a significant impact on self-esteem.

Some of the difficulties that adolescents may encounter are:

  • problems in initiating new friendships, more aware of the problems and consequences of IBD,
  • fear of rejection or compromising situations,
  • changes in body image…

Talking to people you trust (friends), carrying a change of clothes and learning to manage your activities according to the level of energy you have each day can help improve your self-confidence and well-being.

Ultimately, although sexual disturbances associated with IBD are common, sex and sexual relationships are an important part of health, and it is possible to maintain a satisfying sex life with IBD with appropriate treatment and attention to the psychological effects. Open communication, both with partners and medical professionals, is a key factor in resolving and addressing IBD-related sexual problems as early as possible.

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