Body image/sexuality

Many of the symptoms, morbidities, and quality-of-life issues in patients with IBD affect women’s body image and sexuality. Sexual dysfunction in this population was first highlighted by Moody and colleagues in 1992, when they described decreased sexual activity in women with CD. They interviewed 50 women with IBD and age-matched controls. Twenty-four percent of the women with CD versus 4% of controls reported abstinence from sexual activity. The most common reason for decreased frequency of sexual activity was dyspareunia, which was reported by as many as 60% of patients with CD. Abdominal pain, diarrhea, and fear of fecal incontinence were other reasons for decreased frequency of sexual intercourse in this group of patients.

A year later, Moody and Mayberry looked at the perceived sexual dysfunction among patients with IBD. Although differences in the frequency of sexual intercourse between the patients with IBD and controls did not reach statistical significance, patients with IBD cited numerous reasons why they limited their sexual activity, including fear of fecal incontinence, fatigue, abdominal pain, and urgency.

More recent studies have shown that women with IBD indicate that sexual function is significantly affected by their disease. In a survey of 336 women with IBD ages 18 to 65, 63% reported low sexual activity. In this study, there was no specific feature of IBD that explained the high prevalence of sexual dysfunction. Psychosocial factors did, however, play a large role. The greatest risk factor was depressed mood, which affected all aspects of sexuality.

Discussion of sexual health in the context of disease activity is essential to facilitate psychosocial adjustment to living with IBD. Unfortunately, physicians do not adequately address sexuality in women with these diseases. Borum and colleagues surveyed women with IBD addressing the frequency at which physicians (gastroenterologists, primary care physicians, and obstetricians/gynecologists) discuss issues related to IBD, sexuality, and sexual function. Of the 64 women surveyed, 12 (18.8%) reported that their gastroenterologist more frequently addressed issues of sexuality than their primary care physician (0%) or obstetrician/gynecologist (0%). The discussion of sexuality was reportedly initiated in all cases by the patient rather than the gastroenterologist.

It is important that physicians are aware of the impact IBD can have on women’s body image and sexuality. Physicians need to do a better job at addressing issues of self-image and sexuality with their patients with IBD and provide support and disease-specific information to help with these issues. Although as gastroenterologists most of us remain focused on management of IBD disease activity, it is important to remember that issues of body image and sexuality are equally important to patients and it is our duty as physicians to make every attempt to initiate and discuss these issues with them.