Meeting News CoveragePerspective

Sexual dysfunction more prevalent in men with IBD

WASHINGTON — Men with inflammatory bowel disease are more likely to have impaired sexual dysfunction according to findings from a study presented during Digestive Disease Week.

“The symptoms of IBD, disease complications and treatments impair body image, sexual function and intimacy,” Aoibhlinn M. O’Toole, MD, a clinical fellow in the IBD Center at Beth Israel Deaconess Medical Center and the Brigham and Women’s Hospital  in Boston, said during her presentation. “Despite the clear significance of these issues, the knowledge and extent of the impact is scarce.”

O’Toole and colleagues, conducted the study to assess the prevalence of sexual dysfunction in men with IBD and to try to identify the causal or associative factors that could be treatable or preventable.

With no available questionnaire specific to IBD, the researchers developed a novel IBD-specific questionnaire. The end result was a 43-question survey called the IBD sexual dysfunction scale (IBD-SDS). The investigators also included a validated sexual function tool (the international index of erectile function, or IIEF) and a validated depression screening tool (patient health questionnaire-9, or PHQ-9).

A total of 156 adult men who attended IBD clinics at either Beth Israel Deaconess Medical Center or Brigham and Women’s Hospital in Boston. From that cohort, 57.7% of the patients had Crohn’s Disease and 42.3% had ulcerative colitis. The mean age of the population was 42 years (range, 20-84). A total of 87% of the men reported being in a relationship that could involve sexual activity and 70% reported being married or in a long-term relationship. Additionally, 2% of the patients reported not being sexually active in the past year.

The data showed that 20% of the patients reported they were hesitant to start a new relationship because of their IBD and 7.8% reported that IBD was responsible in some way for the breakup of an existing relationship.

Additionally, 38% reported that IBD affected their desire to engage in sexual activity, 26% said that IBD specifically prevented them from having sex, 18% reported IBD caused problems during sex and 20% reported IBD made them feel guilty about sex.

Using the PHQ-9 as a measure, the patients deemed to have moderate to severe depression had lower sexual satisfaction scores (P < .0001) and that they had a harder time keeping their erections (P = .0047).

Patients who had ostomies did have higher scores on PHQ-9 than those patients who had no prior surgery (P = .0095), greater difficulty getting (P < .0001) or keeping an erection (P = .0001) and poorer quality of erections (P = .0002). Additionally, patients with peri-anal disease reported higher rates of premature ejaculation (P = .0440).

Patient’s with Crohn’s disease who had a Harvey-Bradshaw Index score of greater than 5 were significantly less-satisfied with their sex life scores (P = .0152), had more difficult getting an erection (P = 0.0245) and had a poorer quality of erections (P = .0049).

Patients with ulcerative colitis and a simple clinical colitis activity index scores greater than 4 had higher PHQ-9 scores (P = .0025) but there was no difference in their sexual function scores.

Those patients aged 50 years or older had lower sexual satisfaction scores (P = .0214) reported greater difficulty getting erections (P = .0042) and keeping them (P = .0007) and poorer quality of their erections (P < .0001).

Using the IIEF alone to analyze the data, all of the results reported were considered statistically significant. – by Anthony SanFilippo 

For more information: O’Toole, AM, et al. Presentation #151. Presented at: Digestive Disease Week; May 15-19, 2015; Washington, D.C.

Disclosure: O’Toole reports no relevant financial disclosures. See the faculty disclosure index on the DDW website for a full list of disclosures.

WASHINGTON — Men with inflammatory bowel disease are more likely to have impaired sexual dysfunction according to findings from a study presented during Digestive Disease Week.

“The symptoms of IBD, disease complications and treatments impair body image, sexual function and intimacy,” Aoibhlinn M. O’Toole, MD, a clinical fellow in the IBD Center at Beth Israel Deaconess Medical Center and the Brigham and Women’s Hospital  in Boston, said during her presentation. “Despite the clear significance of these issues, the knowledge and extent of the impact is scarce.”

O’Toole and colleagues, conducted the study to assess the prevalence of sexual dysfunction in men with IBD and to try to identify the causal or associative factors that could be treatable or preventable.

With no available questionnaire specific to IBD, the researchers developed a novel IBD-specific questionnaire. The end result was a 43-question survey called the IBD sexual dysfunction scale (IBD-SDS). The investigators also included a validated sexual function tool (the international index of erectile function, or IIEF) and a validated depression screening tool (patient health questionnaire-9, or PHQ-9).

A total of 156 adult men who attended IBD clinics at either Beth Israel Deaconess Medical Center or Brigham and Women’s Hospital in Boston. From that cohort, 57.7% of the patients had Crohn’s Disease and 42.3% had ulcerative colitis. The mean age of the population was 42 years (range, 20-84). A total of 87% of the men reported being in a relationship that could involve sexual activity and 70% reported being married or in a long-term relationship. Additionally, 2% of the patients reported not being sexually active in the past year.

The data showed that 20% of the patients reported they were hesitant to start a new relationship because of their IBD and 7.8% reported that IBD was responsible in some way for the breakup of an existing relationship.

Additionally, 38% reported that IBD affected their desire to engage in sexual activity, 26% said that IBD specifically prevented them from having sex, 18% reported IBD caused problems during sex and 20% reported IBD made them feel guilty about sex.

Using the PHQ-9 as a measure, the patients deemed to have moderate to severe depression had lower sexual satisfaction scores (P < .0001) and that they had a harder time keeping their erections (P = .0047).

Patients who had ostomies did have higher scores on PHQ-9 than those patients who had no prior surgery (P = .0095), greater difficulty getting (P < .0001) or keeping an erection (P = .0001) and poorer quality of erections (P = .0002). Additionally, patients with peri-anal disease reported higher rates of premature ejaculation (P = .0440).

Patient’s with Crohn’s disease who had a Harvey-Bradshaw Index score of greater than 5 were significantly less-satisfied with their sex life scores (P = .0152), had more difficult getting an erection (P = 0.0245) and had a poorer quality of erections (P = .0049).

Patients with ulcerative colitis and a simple clinical colitis activity index scores greater than 4 had higher PHQ-9 scores (P = .0025) but there was no difference in their sexual function scores.

Those patients aged 50 years or older had lower sexual satisfaction scores (P = .0214) reported greater difficulty getting erections (P = .0042) and keeping them (P = .0007) and poorer quality of their erections (P < .0001).

Using the IIEF alone to analyze the data, all of the results reported were considered statistically significant. – by Anthony SanFilippo 

For more information: O’Toole, AM, et al. Presentation #151. Presented at: Digestive Disease Week; May 15-19, 2015; Washington, D.C.

Disclosure: O’Toole reports no relevant financial disclosures. See the faculty disclosure index on the DDW website for a full list of disclosures.

    Perspective

    Sexual dysfunction is understudied. For years, we have not been asking questions about intimacy. There’s been a lot of focus on women regarding intimacy, fertility and pregnancy but there has been very little interest in men’s sexual health. We need to become very comfortable asking questions about intimacy and figuring out what to do with the answers.  As medical homes evolve for treatment of chronic conditions — and IBD will be one of them — we’re going to have to start thinking outside of GI and do more. Truly, what are the joys of life? Eating and having sex. If you are not having sex, that’s a negative. As a physician if you can get patients well, treat their depression, treat their disease and help improve their sex life even by making an appropriate referral, it’s going to help improve quality of life and make them like you more as a physician. It is awkward sometimes because providers want to stay within their area of expertise. You want to talk about what you know and what you know well and most of us in GI haven’t treated erectile dysfunction since we were internal medicine residents, so that’s part of the reticence among providers to ask questions about intimacy. The other thing is we are pinched for time. Patients with Crohn’s and colitis are very complicated patients. You have a 20 or 30 minute slot to evaluate each patient. In the last 3 minutes you ask about their sexual health and the tears start coming, which is  hard to handle. You need time and we don’t have a lot of time as providers. Medical homes that integrate other care providers into them may help us address more aspects of patients’ lives then what we as providers can do in a 20 or 30 minute session.

    • Raymond K. Cross, MD, MS
    • University of Maryland, Baltimore

    Disclosures: Cross reports financial relationships with Abbvie, Janssen and Takeda.

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