Clinicians Encouraged To Discuss Sexual Function with IBD Patients

While many women (and men) with inflammatory bowel disease (IBD) have experienced some level of sexual dysfunction, according to recent data, only less than one in 10 female patients revealed their physicians speak with them about this issue.

“We’ve been approaching this issue with a ‘don’t ask, don’t tell’ mentality, because both clinicians and patients find it uncomfortable to bring up,” said Sonia Friedman, MD, associate physician in the Division of Gastroenterology at Brigham and Women’s Hospital, Boston, and an expert on sexual dysfunction in patients with inflammatory bowel disease (IBD).

Friedman touted the significance of this research: “Many of our patients are young, and a shocking number have problems with sexual functioning, which is a very important part of quality of life.”

Tauseef Ali, MD, director of Saint Anthony Hospital’s Crohn’s and Colitis Program, in Oklahoma City, and his colleagues recruited 29 patients with Crohn’s disease (CD) and 18 with ulcerative colitis (UC) to complete the Female Sexual Function Index (FSFI) or the International Index of Erectile Function (IIEF) in order to effectively measure clinical disease activity, depression, and fatigue.

The researchers found that 66% of men with IBD reported some kind of sexual dysfunction: 81% said they had decreased sexual desire, 52.4% reported erectile dysfunction, and 23% said they had difficulty achieving orgasm over the preceding four weeks. Additionally, 76.2% reported feeling dissatisfied with intercourse.

A total of 61.5% female IBD patients reported experiencing sexual dysfunction: 96.7% said they had low sexual desire, 54% indicated experiencing difficulties with arousal, and more than 50% reported having inadequate vaginal lubrication, difficulty reaching orgasm, pain during intercourse, and overall dissatisfaction with sexual activity.

Ali and his team learned sexual dysfunction was significantly more common among patients with depression than among non-depressed patients.

However, only 8% of the participants admitted their physicians had initiated conversation regarding these conditions.

“It’s clear that physicians need to start assessing and addressing sexual function in their clinical practice. It can have an adverse effect on quality of life,” Ali said.

Physicians are encouraged to overcome several barriers, such as potentially adding another clinical care element to the typically brief appointments.

“The encouraging thing is that there are very effective treatments,” said Friedman. “Most patients can be managed successfully, with a huge improvement in their quality of life.”

Gastroenterologists should promote an extra level of comfort to IBD patients when discussing delicate topics surrounding their sexual history. “That means thoroughly explaining our recommendations, the limitations of our current medical knowledge when it comes to sexual dysfunction, and ensuring patients are offered a referral if needed. Assuring patients of confidentiality, responding nonjudgmentally and avoiding some of the more sensitive questions during the first interview are other key components of sexual history taking,” concluded Friedman.