Inflammatory bowel disease (IBD) is a disease that commonly affects adults in the reproductive years (1). The majority of newly-diagnosed cases are between 15 and 35 years of age (2), a time when people typically develop their interpersonal and sexual identities (3). It is common for both male and female patients to have concerns about the effects of IBD on their relationships and sexual function (1). While struggling to cope with the physical manifestations of Crohn's disease and ulcerative colitis, patients are likely to experience a range of social and psychological problems, including isolation (3), and concerns about body image and sexual attractiveness (4). Since psychosocial issues can affect so many aspects of a patient's life, physicians should be aware of these concerns and the consequences for their patients (3), and consider them in both diagnostic and treatment protocols (3).
Impact on Sexual Relationships
Dating and forming new relationships can be a challenge for IBD patients. Both men and women may fear rejection and may experience insecurity when approaching someone new (3, 4). They may struggle with questions of when and how to reveal their illness without derailing the new romance.
Additionally, the fear of unexpected symptoms, coping with constant or unpredictable bouts of cramping, diarrhea and or flatulence, and the worry of having a "toilet accident" in adulthood can chip away at a person's self-image and sexual self-confidence (4).
In addition to the psychosocial aspects of IBD that can affect normal sexual functioning, there are a number of physical challenges to consider as well. These physical barriers can be related to the disease itself, associated complications and/or medical or surgical treatments. Additionally, the fatigue associated with the disease can also interfere with normal sexual functioning (4, 5).
Assessing the Psychosocial Impact of IBD
Physicians should encourage patients to explore the psychosocial aspects of IBD that relate to personal relationships and sexuality (4). Unfortunately, most patients do not readily discuss issues of sexuality or relationships with their treating physician (4). The best opportunity for physicians to create an open dialogue with patients about relationships and sexual health may be at the time of initial diagnosis. Not only will this facilitate a comprehensive patient assessment but also sets the stage for future discussions regarding these topics (4). Effective communication between patient and physician is essential in this area (4). Integrating such psychosocial issues into treatment plans may help patients in terms of their ability to cope with their disease and ultimately may improve their quality of life (3).
Sexual partners play key roles in helping the patient adjust to his or her illness, through emotional or sexual validation. Therefore, whenever possible, partners should be included when addressing sexual issues that might be caused by disease activity (4).
This information is intended for healthcare professionals only.
- Alstead, E., Fertility and pregnancy in inflammatory bowel disease, World Journal of Gastroenterology, 2001; 7(4) 455-459. Available at: http://www.wjgnet.com/1007-9327/7/455.asp. Accessed September 14, 2006.
- Husain, A., and Triadafilopoulos, G., Communicating with Patients with Inflammatory Bowel Disease, Inflammable Bowel Diseases, 2004; 10:444-450.
- Casati, J., Toner, B., De Rooy, E., Drossman, D., and Maunder, R., Concerns of Patients with Inflammatory Bowel disease: A Review of Emerging Themes, Digestive Diseases and Sciences, Volume 45 (1), January 2000, 26 - 31.
- Trachter, A., Rogers, A., and Leiblum, S., Inflammatory Bowel Disease in Women: Impact on Relationship and Sexual Health, Inflammatory Bowel Diseases, 2002; 8(6) 413-421.
- Silberman, S., (n.d.). The Intimate Relationship of Sex and IBD, published by the Crohn's and Colitis Foundation of America. Available at: http://www.ccfa.org/frameviewer/?url=/media/pdf/ibdsexuality.pdf. Accessed July 6, 2006.