1. IBD: Issues With Body Image and Sexuality

2. IBD and Sexuality: Physical Impact Impact of disease Impact of disease –Perianal complications –Draining cutaneous fistulae –Skin lesions –Arthritic deformities –Pain –Fatigue Impact of treatment Impact of treatment –Surgical scars –Stoma –Medication side effects

3. IBD and Sexuality: Psychological Impact Affected aspects Affected aspects –Behavior patterns –Communication –Sexual drive –Sensations connected with sexual activity Negative effects Negative effects –Feeling dirty, unsexy, unattractive –Reduced self-esteem –Loss of former identity –Anxiety over disclosure

4. Sexual Function and IBD No difference in rates of sexual activity No difference in rates of sexual activity Depression a bigger determinant of lower sexual activity Depression a bigger determinant of lower sexual activity Women with IBD more likely to have vaginal dryness, dyspareunia, vaginal infections than healthy controls Women with IBD more likely to have vaginal dryness, dyspareunia, vaginal infections than healthy controls Only 25% of patients wanted to discuss sexuality with their physician Only 25% of patients wanted to discuss sexuality with their physician Timmer A et al. Clin Gastro Hepatol 2007;5:87-94.

5. Maintaining Femininity Following IBD Surgery Body image Body image Sexuality Sexuality Communication Communication Fertility Fertility Pregnancy Pregnancy

6. Sexual Function Following IPAA Usually improved because of improved general well-being Usually improved because of improved general well-being Some problems may continue Some problems may continue –Dyspareunia –Vaginal drying Sexual function improved 16%-25% 1,2 Sexual function improved 16%-25% 1,2 Frequency of intercourse increased 35% 2 Frequency of intercourse increased 35% 2 IPAA = ileal pouch-anal anastomosis. 1 Farouk R, et al. Ann Surg. 2000;231:919-926. 2 Damgaard B, et al. Dis Colon Rectum. 1995;38:286-289.

7. Women With Restorative Proctocolectomies: Satisfaction With Sexual Relationships 22% improved 22% improved 51% unchanged 51% unchanged 26% less satisfactory 26% less satisfactory Overall 86% moderately to extremely satisfied Overall 86% moderately to extremely satisfied Bambrick M, et al. Dis Colon Rectum. 1996;39:610-614.

8. BeforeAfter Dyspareunia * 5%15% Fecal incontinence during intercourse 3%7% Menstrual problems 23%31% Gynecologic Function Before and After IPAA Results of Questionnaire (n=110) 1 *Rates range from 0% to 26%. 2-5 1 Counihan TC, et al. Dis Colon Rectum. 1994;37:1126-1129. 2 Tiainen J, et al. Scand J Gastroenterol. 1999;34:185- 188. 3 Sjogren B, Peppen B. Acta Obstet Gynecol Scand. 1995;74:51-55. 4 Damgaard B, et al. Dis Colon Rectum. 1995;38:286-289. 5 Bambrick M, et al. Dis Colon Rectum. 1996;39:610-614.

9. Women With Ileostomies: Sexual Function % Patients No change47% No change47% Adversely affected47% Adversely affected47% –Mild (22%) –Severe (14%) –Moderate (11%) Improved7% Improved7% Awad RW, et al. Br J Surg. 1993;80:252-253.

10. Women With Ileostomies: Sexual Concerns Sexual attractiveness decreased 52% Sexual attractiveness decreased 52% –Appliance72% –Stoma16% –Odor4% More women (60%) than men (52%) felt less desirable More women (60%) than men (52%) felt less desirable Sexual intercourse is more difficult Sexual intercourse is more difficult –Psychologically46% –Physically32% Rolstad BS, et al. Dis Colon Rectum. 1983;26:170-171. (n=50)