Effect of Inflammatory Bowel Disease on sexual function in men and women: A controlled study

Inflammatory bowel disease (IBD) includes Crohn*s disease (CD) and ulcerative
colitis (UC). These diseases typically manifest in adolescence or early
adulthood and are characterized by a chronically relapsing course. Abdominal
pain, fatigue, and diarrhea are typical symptoms in active disease. These
symptoms may be aggravated by the embarrassing features of incontinence and bad
odour. Complications may include perianal disease and malnutrition. Surgery,
possibly including the installation of ostomy, and medical therapy with
corticosteroids may be associated with changes in bodily appearance. In
consequence, IBD is likely to have a substantial impact on issues of body
image, intimacy and sexuality. Furthermore, mood disorders, particularly
depression, are reported to be common in IBD (1), and since sexual dysfunction
is known to be related to depression (2), depression may be an important
determinant of sexual functioning in patients affected with IBD.
Despite the relevance of possible sexual problems, knowledge about the extent
of sexual dysfunction in persons affected with IBD is scarce. Timmer et al (3)
studied a male sample from the German national patient organization, and found
that sexual function measured with the International Index of Erectile Function
(IIEF) was not impaired as compared to healthy controls. However, sub-analyses
showed impaired function on all domains of the IIEF in the subgroup of men with
active disease in this sample. In a study in a clinical group of 98 male
patients attending the department of internal medicine of a university
hospital, 44% percent of the patients reported to feel severely comprised
sexually due to their IBD (4). In this group, all IIEF scores were within one
standard deviation of the means of a normal population, except for sexual
desire, which was significantly lower in patients. Disease activity and
depressive mood had a significant influence on sexual function. In addition,
feelings of sexual attractiveness, and masculinity were strongly influenced by
disease activity.
In women, Moody and Mayberry (5) described decreased sexual activity in women
with Crohn*s disease, based on structured interviews with 50 women with friend
controls. Twenty-four percent of the cases abstained from sexual activity
altogether because of their disease (4% in controls), and dyspareunia was also
more common in patients. More recently, Timmer et al (6) reported a study in a
female sample from the national patient organization, and a clinical sample of
female patients attending the department of internal medicine of a university
hospital. Sexual function, assessed by the Brief Index of Sexual Function in
Women (BISF-W), was not significantly impaired in women with IBD as compared to
healthy controls. Depressive mood was strongly associated with sexual function.
In addition, disease activity was related to sexual desire, and use of steroids
was associated with low pleasure and orgasm scores. In the clinical sample, 80
% of the women reported low interest in sexual activity, with 17 % reporting no
sexual activity at all. Feelings of attractiveness, femininity, as well as
satisfaction with bodily appearance were strongly influenced by disease
activity.
Taken together, the very few studies on IBD and sexual function show mixed
results. In general, male and female persons affected with IBD did not report
more sexual problems than healthy controls. However, during active disease,
sexual function and feelings of attractiveness are diminished. In addition, as
can be expected, depression seems to affect sexuality in IBD patients.

The present study aims to extent the sparse knowledge on sexual function in IBD
by 1) examining the prevalence of sexual problems in men and women with IBD
(including Crohn*s disease and ulcerative colitis), 2) comparing this with the
prevalence of sexual problems in age-matched control groups, 3) studying the
influence of IBD related clinical factors on sexuality, and 4) studying the
mediating effect of depression on sexual function.

Matched controlled survey study, comparing sexual dysfunction scores of male
and female patients with IBD with gender and age-matched controles.

Participants will be asked, by written information sent to their home-adress,
twhether they are willing to complete a web-based questionnaire about
Inflammatory Bowel Disease and sexuality. The questionnaire will consist of:

-7 questions about socio demographic variables, for women extended with 5
questions about contraceptives, pregnancy, menopause etc.,
-the 15-item International Index of Erectile Function (IIEF(7) or the 19-item
Female Sexual Function Index (FSFI)(8),
-3 questions about distress about sexual problems,
-the 14-item Hospital Anxiety and Depression Scale (HADS(9),
-For IBD patients: the 10-item Short version of the Inflammatory Bowel Disease
Quality-of-Life Questionnaire (IBDQ, (10), 3 body image related and 7 stoma
related items from the EORTC module for colorectal cancer patients (11), 11
questions about disease activity(12;13), and 1 question about willingness to be
informed about future research on IBD and sexuality.

There will be no risk for the participants. The burden may be to complete a
questionnaire about an intimate subject, which will take about 30 minutes.
There will be no direct benefit for the participants, although completing the
questionnaire may break down possible barriers to ask for help for sexual
problems.