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 men with IBD.Methods:
Men 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. Male sexual function was assessed using the International Index of Erectile Function (IIEF), a self-administered questionnaire that assesses 5 dimensions of sexual function over the past 4 weeks. The IIEF total score ranges from 0 to 75, with higher scores corresponding to better sexual function. Total IIEF and dimension 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, IBD activity as assessed by the Harvey-Bradshaw index (HBI) and the Simple Clinical Colitis Activity Index (SCCAI), Functional Assessment of Chronic Illness Therapy‐Fatigue (FACIT-Fatigue) Scale, and quality of life as measured by 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 IIEF according to these factors, linear mixed effect models and generalized estimating equation (GEE) method were used.Results:
72 of 110 eligible men (65.5%) completed the questionnaire (44 CD, 28 UC). The mean age (SD) of the cohort at diagnosis was 41.2 (16.2) years. Baseline mean IIEF score (SD) was 44 (18.5) overall (43 [18.5] in CD, 46.1 [18.6] in UC, P = 0.462). The mean score in the erectile function dimension corresponded to mild-moderate erectile dysfunction. There was no significant change in the IIEF score or individual dimension scores over the entire 2-year study period. Among eligible patients, decreased sexual function was significantly associated with lower scores in 4 SF-36 domains (bodily pain, social functioning, physical functioning, role limitations due to physical health problems), higher PHQ8 score and lower IBDQ score (P < 0.05, all). In CD, lower FACIT-Fatigue score, higher PHQ8 score, and low scores on 5 SF-36 domains (physical functioning, role limitations due to physical health problems, bodily pain, social functioning, general health) were significantly associated with lower IIEF scores (P < 0.05, all). In UC, no specific factors were associated with sexual function. Dimension analyses showed an association between decreased erectile function and lower scores in all 8 of the SF-36 domains, increased age, decreased IBDQ score and lower FACIT-Fatigue score (P < 0.05, all).Conclusions:
In an incident cohort of IBD patients, males have mild to moderate erectile dysfunction, without significant change over time. Unlike UC, sexual function in CD is associated with numerous general health and disease-specific characteristics.