Determinants of Female Sexual Function in Inflammatory Bowel Disease
Determinants of Female Sexual Function in Inflammatory Bowel Disease
Background: Sexual function is impaired in women with inflammatory bowel disease (IBD) as compared to normal controls. We examined disease specific determinants of different aspects of low sexual function.
Methods: Women with IBD aged 18 to 65 presenting to the university departments of internal medicine and surgery were included. In addition, a random sample from the national patients organization was used (separate analyses). Sexual function was assessed by the Brief Index of Sexual Function in Women, comprising seven different domains of sexuality. Function was considered impaired if subscores were < -1 on a z-normalized scale. Results are presented as age adjusted odds ratios with 95% CI based on multiple logistic regression.
Results: 336 questionnaires were included (219 Crohn's disease, 117 ulcerative colitis). Most women reported low sexual activity (63%; 17% none at all, 20% moderate or high activity). Partnership satisfaction was high in spite of low sexual interest in this group. Depressed mood was the strongest predictor of low sexual function scores in all domains. Urban residency and higher socioecomic status had a protective effect. Disease activity was moderately associated with low desire (OR 1.8, 95% CI 1.0 to 3.2). Severity of the disease course impacted most on intercourse frequency (OR 2.3, 95% CI 1.4 to 4.7). Lubrication problems were more common in smokers (OR 2.5, 95% CI 1.3 to 5.1).
Conclusion: Mood disturbances and social environment impacted more on sexual function in women with IBD than disease specific factors. Smoking is associated with lubrication problems.
Ulcerative colitis and Crohn's disease typically affect adolescents or young adults and are characterized by a chronically remitting course. Many symptoms, complications and consequences of these diseases are likely to impact on body image, intimacy and sexual function. Fatigue, pain and diarrhoe are typical features of relapse and may further be aggravated by the embarrassing features of incontinence and bad odours. Perianal disease affects about one third of patients with Crohn's disease. Many will require surgery, possibly including the installation of a permanent or, more often, transient ostomy. Malnutrition or medical therapy with corticosteroids may also be associated with changes in the bodily appearance. Furthermore, mood disorders, in particular depression, are reported to be common in IBD. Mood disorders are, at the same time, known to constitute a major risk factor for decreased sexual function.
It was therefore not surprising, when, almost 15 years ago, Moody and Mayberry described significantly decreased sexual activity in women with Crohn's disease, based on structured interviews in 50 women with friend controls. Twenty-four percent of the cases abstained from sexual activities altogether due to the disease (controls: 4%). Moody and Mayberry complemented this study by another survey including 50 women with ulcerative colitis. Since then, there has been very little research on this issue as recently reviewed. The few studies available mostly focused on postoperative outcomes, as abdominal surgery has the potential for structural changes or pelvic nerve damage. Many other issues concerning sexual health in women with IBD remain unclear.
We have recently conducted a case control survey in members of the German IBD patients organization. These persons form a relatively healthy group of IBD patients. Even so, all aspects of female sexuality covered by a sensitive validated instrument were impaired in the IBD cases, as compared to controls. In contrast to the results in men, impaired function in women did not depend on the activity of the disease but was also manifest in remission. Due to the case-control design and the use of ambulatory patients only, this previous survey offered little information on disease specific risk factors.
To shed more light on the disease related determinants of sexual function in women with IBD, we have now conducted a survey in a well described clinical sample of patients. Here, we present data from both surveys.
Background: Sexual function is impaired in women with inflammatory bowel disease (IBD) as compared to normal controls. We examined disease specific determinants of different aspects of low sexual function.
Methods: Women with IBD aged 18 to 65 presenting to the university departments of internal medicine and surgery were included. In addition, a random sample from the national patients organization was used (separate analyses). Sexual function was assessed by the Brief Index of Sexual Function in Women, comprising seven different domains of sexuality. Function was considered impaired if subscores were < -1 on a z-normalized scale. Results are presented as age adjusted odds ratios with 95% CI based on multiple logistic regression.
Results: 336 questionnaires were included (219 Crohn's disease, 117 ulcerative colitis). Most women reported low sexual activity (63%; 17% none at all, 20% moderate or high activity). Partnership satisfaction was high in spite of low sexual interest in this group. Depressed mood was the strongest predictor of low sexual function scores in all domains. Urban residency and higher socioecomic status had a protective effect. Disease activity was moderately associated with low desire (OR 1.8, 95% CI 1.0 to 3.2). Severity of the disease course impacted most on intercourse frequency (OR 2.3, 95% CI 1.4 to 4.7). Lubrication problems were more common in smokers (OR 2.5, 95% CI 1.3 to 5.1).
Conclusion: Mood disturbances and social environment impacted more on sexual function in women with IBD than disease specific factors. Smoking is associated with lubrication problems.
Ulcerative colitis and Crohn's disease typically affect adolescents or young adults and are characterized by a chronically remitting course. Many symptoms, complications and consequences of these diseases are likely to impact on body image, intimacy and sexual function. Fatigue, pain and diarrhoe are typical features of relapse and may further be aggravated by the embarrassing features of incontinence and bad odours. Perianal disease affects about one third of patients with Crohn's disease. Many will require surgery, possibly including the installation of a permanent or, more often, transient ostomy. Malnutrition or medical therapy with corticosteroids may also be associated with changes in the bodily appearance. Furthermore, mood disorders, in particular depression, are reported to be common in IBD. Mood disorders are, at the same time, known to constitute a major risk factor for decreased sexual function.
It was therefore not surprising, when, almost 15 years ago, Moody and Mayberry described significantly decreased sexual activity in women with Crohn's disease, based on structured interviews in 50 women with friend controls. Twenty-four percent of the cases abstained from sexual activities altogether due to the disease (controls: 4%). Moody and Mayberry complemented this study by another survey including 50 women with ulcerative colitis. Since then, there has been very little research on this issue as recently reviewed. The few studies available mostly focused on postoperative outcomes, as abdominal surgery has the potential for structural changes or pelvic nerve damage. Many other issues concerning sexual health in women with IBD remain unclear.
We have recently conducted a case control survey in members of the German IBD patients organization. These persons form a relatively healthy group of IBD patients. Even so, all aspects of female sexuality covered by a sensitive validated instrument were impaired in the IBD cases, as compared to controls. In contrast to the results in men, impaired function in women did not depend on the activity of the disease but was also manifest in remission. Due to the case-control design and the use of ambulatory patients only, this previous survey offered little information on disease specific risk factors.
To shed more light on the disease related determinants of sexual function in women with IBD, we have now conducted a survey in a well described clinical sample of patients. Here, we present data from both surveys.
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