Sexual function may be compromised in patients with inflammatory bowel disease (IBD). We aim to describe sexual function at baseline and over time in a prospective incidence cohort of adult women with IBD.Methods:
Women aged 18 years and older enrolled between April 2008 and January 2013 in the Ocean State Crohn's and Colitis Area Registry (OSCCAR) with a minimum of 2 years of follow-up were eligible for study. All subjects were enrolled within 6 months of IBD diagnosis. Female sexual function was assessed using the Female Sexual Function Index (FSFI), a self-administered questionnaire that assesses 6 domains of sexual function over the past 4 weeks. The FSFI total score ranges from 1.2 to 36, with a total score 26.55 or lower indicating sexual dysfunction. Total FSFI and domain scores were calculated for each subject at baseline and then yearly. We described the demographics, IBD subtype (Crohn's disease [CD], ulcerative colitis [UC]), disease-specific symptoms and characteristics, medication use, Personal Health Questionnaire Depression Scale (PHQ-8), anxiety, Harvey-Bradshaw index (HBI), Simple Clinical Colitis Activity Index (SCCAI), Functional Assessment of Chronic Illness Therapy‐Fatigue (FACIT-Fatigue) Scale, the Inflammatory Bowel Disease Questionnaire (IBDQ) and the Short Form Health Survey (SF-36) of the cohort at each time point. To assess changes in FSFI according to these factors, linear mixed effect models and generalized estimating equation (GEE) method were used.Results:
120 of 170 eligible women (70.6%) completed the questionnaire (63 CD, 57 UC). The mean age (SD) of the cohort at diagnosis was 40.1 (15.6) years. Baseline mean FSFI score (SD) was 16.5 (8.4) overall (15.6 [8.7] in Crohn's, 17.5 [8.1] in UC, P = 0.205), corresponding to sexual dysfunction. 97% of women had abnormal sexual function. There was no significant change in the FSFI score or individual domain scores over the entire 2-year study period. Among all patients, older age, marital status, SF-36 bodily pain, SF-36 role limitations due to physical health problems, systemic and rectal corticosteroid use and presence of anal fistula were significantly associated with lower total FSFI scores. Cohabitating and single women had higher FSFI scores than women who were married, divorced/separated or widowed. Disease activity scores were not associated with FSFI scores. In UC, older age, rectal corticosteroid use, SF-36 decreased physical functioning, SF-36 decreased social functioning and lower IBDQ score were significantly associated with lower FSFI scores. In CD, older age, use of systemic steroids, stool incontinence and presence of anal fistula were significantly associated with lower FSFI scores. Domain analyses showed older age was associated with lower scores in all domains, except pain. Lower FACIT-Fatigue scores were associated with lower scores in the desire domain. Higher PHQ8 scores were associated with increased pain and higher anxiety was associated with lower scores in the desire and pain domains.Conclusions:
In an incident cohort of IBD patients, we found that 97% of women experienced sexual dysfunction, which did not improve over time despite improvement in overall disease activity. Greater clinical recognition and methods for addressing female sexual dysfunction among IBD patients is needed.