Some survey-based studies show rates of sexual dysfunction as high as 90% for IBD patients across all stages of the disease. Due to the complexities involved, patients and providers may miss the opportunity to discuss and resolve this important issue.
“Many factors play a role in sexual dysfunction, from the physical, like perianal disease, to symptoms like abdominal pain, urgency, and diarrhea. There’s physical aspects, as well as the related fears and concerns,” explains Sushila Dalal, MD, Assistant Professor of Medicine at the University of Chicago Medicine Digestive Diseases Center. Dalal specializes in treating patients with IBD, and seeks to address issues of sexual dysfunction, infertility, and related issues.
Other patient concerns like body image issues (which can stem from surgery, or medication side effects), the feeling of being ill, pelvic floor dysfunction, and psychosocial factors like anxiety and depression, can all affect sexual function.
Explains Dr. Dalal, “If someone has been having frequent bowel movements, those muscles might be tight, and might lead to pain during sexual activity. It’s our job to reassure patients that it’s not ‘all in their head’ and provide resources to address this important problem.”
How can a gastroenterologist address sexual dysfunction? A gastroenterologist who specializes in IBD in can help patients achieve lasting remission, which may relieve some of the physical symptoms that impact sexual function (e.g., pain, urgency, fatigue). A gastroenterologist can also refer patients for pelvic floor physical therapy to relax or strengthen core and pelvic muscles. For psychosocial concerns, a gastroenterologist may help a patient connect to a mental health provider, such as a psychologist or clinical social worker.
Alyse Bedell, PhD, is a health psychologist at the University of Chicago Medicine Digestive Diseases Center, who specializes in both gastrointestinal conditions and sexual health.
“When many people think of sexual functioning, they think of a very physical process, but the reality is that every part of a human’s sexual response cycle is impacted by psychosocial factors. This might include a person’s mood, anxiety or stress level, body image, as well as social and environmental factors like privacy and time for sex, the availability of a partner, and the quality of relationship with their partner,” explains Dr. Bedell. “It can be particularly helpful to meet with a mental health provider with experience working with patients with IBD and sexual health concerns to help identify which psychosocial factors may be impacting sexual functioning and develop a treatment plan.”
“The problem is multifactorial, depending on the specific problems the patient is encountering, so the solution is multidisciplinary. We need an individualized approach,” says Dr. Dalal. “Feeling well is totally different than feeling sick, and these obstacles are mostly surmountable. We want to do all we can to help our patients lead full lives.”