Why You Should Speak Up Why People With Ulcerative Colitis Should Speak Up About Sex Keefer and Friedman acknowledge how hard it is for people with UC to start a conversation about sex with their doctor, especially since doctors should also be responsible for broaching the subject, they say. Lanier, for instance, spoke up to his doctor only after his six-year relationship fell apart. A diminished libido, which was due to his UC treatments, was one factor in the breakup. Even then, Lanier couldn’t bring himself to talk about sex face-to-face with his doctor. “I had to do it through email,” he says. Still, Lanier advises people with IBD to start a conversation about sex with their doctor as soon as possible. “I know talking about sex is not something people are always comfortable with,” he says, “but we have to get comfortable because being silent serves no one.”
How UC Affects Sexual Health How Ulcerative Colitis Can Affect Your Sexual Health An estimated 65 percent of people with UC experience some type of sexual dysfunction, according to one research review. Some of these problems are physical: Disease flare-ups, for example, can leave people exhausted and in pain , which can make sex almost unthinkable. But Sonia Friedman, MD , a gastroenterologist and IBD specialist at Tufts Medicine in Boston, says that psychological factors play a role in sexual dysfunction, too.e60dc2a1-f33c-4a05-9b50-8e3e8e5976291639d726-c258-4551-af95-653926804899 That same research review found that 14 to 47 percent of people with IBD experienced depression and anxiety that had a major impact on their sexuality. And other studies have found that a depressed mood is the most common and significant risk factor for developing sexual dysfunction.e60dc2a1-f33c-4a05-9b50-8e3e8e597629f892d6cf-0a31-4499-a512-96e19c6b2798e60dc2a1-f33c-4a05-9b50-8e3e8e597629b4d62a00-a0bf-47ea-82da-c16abc697789 A survey-based study looked at sexual dysfunction in 120 people with IBD and 60 people without IBD. It found that sexual dysfunction was more common in women with IBD than men with the condition (56.8 percent versus 14.6 percent) and in people with IBD ages 18 to 30 and 51 to 60; and that it had a negative effect on overall quality of life. Older age was linked to greater sexual dysfunction in men with IBD, while anxiety, depression, and fatigue helped predict sexual dysfunction in women with IBD.e60dc2a1-f33c-4a05-9b50-8e3e8e59762951b6ece2-8164-47d6-ad78-572745842d47 A study of nearly 42,000 men with IBD who had J-pouch surgery (removal of the colon and rectum, with a pouch created using the end of the small intestine to hold waste) found that they were twice as likely to experience sexual dysfunction, compared with men who didn’t have the surgery. Of those who had the procedure, 4.6 percent experienced sexual dysfunction, compared with 1.79 percent who didn’t have the surgery. A history of hypertension or taking antitumor necrosis factor alpha biologic drugs was connected to higher chances of sexual problems, and the researchers suggest that more severe illness may be related to the higher risk.e60dc2a1-f33c-4a05-9b50-8e3e8e59762923b04cc0-0a4c-4fd9-b104-d3873ca16657e60dc2a1-f33c-4a05-9b50-8e3e8e597629e0876aee-56e6-4290-ae80-2620fd837ee6 Another research review found that in people under 45 years old, IBD was linked to an 88 percent higher chance of sexual dysfunction, while there was no significant increase in people older than 45. Women with IBD were more likely to report problems with nearly every aspect of sex included in the analysis: desire and arousal, lubrication, orgasm, and overall sexual satisfaction and quality. Men with IBD were more likely to report erectile dysfunction and lower overall sexual satisfaction.e60dc2a1-f33c-4a05-9b50-8e3e8e59762964520340-3447-4995-9d6e-8a336fad5133
Resources We Trust Mayo Clinic: Ulcerative Colitis: Symptoms and CausesCleveland Clinic: Ulcerative ColitisCrohn’s & Colitis UK: Sex and Sexual HealthGastrointestinal Society and the Canadian Society of Intestinal Research: Sexuality and IBD (Crohn’s and Colitis) VideoCrohn’s & Colitis Ireland: Impact of Diagnosis on Your Sexual Self
The Takeaway Sexual dysfunction is common in people with ulcerative colitis, especially women. The reasons for sexual issues may be physical or psychological, and both causes can be treated. Speaking about the subject with your gastroenterologist can be awkward, but it’s an important conversation that can lead to solutions that improve your quality of life.
It’s not always easy for doctors to talk about sex with their patients, or vice versa. But after Will Lanier was diagnosed with ulcerative colitis (UC) in 2005 and then colon cancer — one of UC’s potential complications — in 2015, he wished his doctor had brought up the subject. Throughout Lanier’s treatment, his doctor asked him a range of questions about his diet, stress levels , and sleep habits. But there was one topic that never came up: Lanier’s sexual health. “Sex is a huge emotional and physical need,” says Lanier, a lawyer and the founder of the Out Foundation , a nonprofit in New York City that advocates on health and wellness issues for the LGBTQ+ population. “My doctor knew that I had a boyfriend, but he never once asked me, ‘Are you sexually active?’” Despite the negative effects that inflammatory bowel disease (IBD) like UC can have on a person’s sexual health, experts agree that doctors and patients don’t discuss these complications nearly enough. “IBD patients want to talk about sex with their doctors but feel they never get the chance,” says Laurie Keefer, PhD , a gastrointestinal psychologist at Mount Sinai in New York City. Doctors need to be more frank in discussing sexual health with people with IBD, says Lanier, “but at the same time, patients need to get more comfortable discussing it, too.”
Barriers to Discussion Barriers to Discussing Sexual Health and Ulcerative Colitis Talking about sex is often hard, but talking about sex and mood disorders can be especially tough. “Sexual dysfunction can be a consequence of the psychological problems” that come with IBD, says Dr. Keefer. “And both sex and mental health are taboo topics in this country.” Lanier has experienced this hesitancy to discuss sexual dysfunction firsthand. “It’s a tough topic of conversation,” he says, “and I used to be very reserved about it. Shame and embarrassment were big parts of that.” While it can be difficult for many people with UC to discuss how the condition is affecting their sexual health, Dr. Friedman says that doctors can also be reluctant to bring up the subject. When “you ask patients what’s important to them,” Friedman says, the answer is often “lifestyle factors like sex, fertility , and reproduction.” Sometimes, she says, “it’s doctors who are really uncomfortable talking about these things. Patients will gush about it if you prompt them.” Keefer says that while physical challenges and debilitating thoughts can frustrate people’s sex lives, these problems are not inevitable. “Your sex life doesn’t have to be defined by this diagnosis,” she says. Many of the UC symptoms that make satisfying sex difficult are treatable, and if side effects from your medication are causing a problem, your doctor may be able to adjust your medication. If you feel burdened by depression or anxiety, your doctor can refer you to therapy if you’re not already going regularly, and a psychiatrist may be able to adjust any medication you’re taking for a mental health condition. But none of that is possible if doctors and patients don’t talk about sex. “If patients initiate this conversation, they can have a much more normal life than they might have ever thought was possible,” Friedman says. Here are two ways to start a dialogue with your doctor. Talk about the symptoms that interfere with your sex life. “Gastroenterologists don’t always think of sex as in their wheelhouse,” Keefer says. But doctors want to hear about any UC symptoms that are interfering with your life, including your sex life. Talk about sex as it relates to fertility. Most people with IBD receive a diagnosis before age 30 — a time when many of them are thinking about having children. Even if you have no immediate desire to have kids, bringing up the topic can lead to a conversation about sexual desire, frequency, and satisfaction. Plus, Friedman says, “There are a lot of misconceptions about IBD and reproduction. It’s an opportunity for clinicians to correct them.”e60dc2a1-f33c-4a05-9b50-8e3e8e59762951ce9540-acc4-4bae-b7bf-3e55e1c28c8d