Assessment Of Sexual Function Among Inflammatory Bowel Disease Patients

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To the Editor: Sexual health is important for a person’s physical, mental, and emotional well-being (1). Inflammatory bowel disease (IBD) is a common group of systemic inflammatory conditions affecting more than 1.5 million people in the United States (2). It is well known that IBD adversely affects the quality of life (3). However, its impact on the sexual functions of patients is not well defined. We conducted a single-center prospective cross-sectional survey of IBD patients seen at the IBD Center at Oklahoma University between June 2013 and June 2014. The primary aim of our study was to assess the sexual function of IBD patients using validated assessment tools and assess the impact of various comorbidities and disease activity on sexual function of IBD patients.Patients completed self-reported questionnaires on basic demographics, the female sexual function index for female sexual function (4), the international index of erectile function for male sexual function (5), patient health questionnaire (6) to measure depression, and the fatigue severity scale (7) to measure fatigue. Disease activity was measured using the modified Mayo score and the Harvey–Bradshaw index for Ulcerative colitis and Crohn’s disease, respectively. SAS software (SAS Institute, Cary, NC) was used for performance of data analyses. Continuous variables were reported as mean±s.d. and categorical variables as percentages. A two-sided t-test was used to compare the means of continuous variables, and a χ2 test was used to compare the categorical variables. A P value<0.05 was considered statistically significant.A total of 47 patients completed the survey. The mean age was 31.3±9 years, and 21 (44.7%) of the respondents were males. There were 29 (61.7%) patients with Crohn’s disease and 18 (38.2%) with ulcerative colitis. Erectile function, orgasmic function, and sexual desire was impaired in 52.4%, 23%, and 81% male patients, respectively. Only 23.8% male patients reported intercourse satisfaction, and 26.3% male patients reported overall satisfaction. In male patients, there was a higher prevalence of sexual dysfunction for patients with active vs. inactive disease (60 vs. 33.3%), but these were not significant (P=0.25). For females, sexual dysfunction was present in 61.5% of patients with desire impaired in 96.7% and arousal impaired in 57.7%. Lubrication, orgasm, satisfaction, and pain were impaired in 50, 53, 50, and 54% patients, respectively (Figure 1). There was a trend toward worse sexual function in active disease patients compared with inactive disease patients (73.3% vs. 45.5%; P=0.1). Only 8% of the patients had been inquired about their sexual function in the past. We also found a high prevalence of depression (61.7%) and fatigue (45%) among IBD patients. Patients with depression had more sexual dysfunction compared with patients who were not depressed (71.4 vs. 36.8%; P=0.01). However, the presence of fatigue did not appear to have a significant impact on the prevalence of sexual dysfunction (P=0.13; Figure 2).Limitations of our study include a small sample size and the absence of a control group for comparison. It is important to note the high prevalence of sexual dysfunction (˜60%) among IBD patients compared with similar aged general population cohort (10–20%) discovered in our study (8). The worst affected component of sexual function for both male and female patients was 81 and 96.7%, respectively. Sexual dysfunction appeared to be worse in patients with active disease, female gender, and depression. Only a few (8%) patients had been inquired about her sexual function in the past.

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