Study design

The study was conducted among patients diagnosed with IBD at the Department of Gastroenterology, University Hospital in Kraków, and individuals with IBD who were members of social groups on the Facebook platform. The control group consisted of healthy volunteers matched for sex and age recruited through social groups on Facebook. Consent to participate in the study was obtained as an integral part of the questionnaire completed by the respondents. The survey was conducted electronically between July 2021 and July 2022, using the Microsoft Forms application on a separate website that did not require registration or provision of personal data. The participants were informed upfront that they could withdraw from completing the survey at any time.

The research instrument was a survey consisting of a general section on sociodemographic data, selected questions on the course of IBD and comorbidities, the Female Sexual Function Index (FSFI) or the International Index of Erectile Function (IIEF‑5), as well as the Beck Depression Inventory (BDI‑II).

The FSFI is a 19‑question self‑reported survey on female sexual function.⁹ It comprises 6 domains of desire, arousal, lubrication, orgasm, satisfaction, and pain. The maximum score is 36 points, and scores below 26.55 indicate clinically relevant sexual dysfunction.

The IIEF‑5 is a 5‑item questionnaire designed to diagnose the presence and severity of erectile dysfunction.¹⁰ It includes items relating to erectile function and sexual satisfaction. The established cutoff score is 21 (range, 5–25), and was discriminated best by the presence or absence of erectile dysfunction (sensitivity, 0.98; specificity, 0.88), which was classified into 5 severity levels, from none (22–25) to severe (5–7).

The BDI‑II is a widely used, self‑reported inventory of 21 items scored from 0 to 3, based on the feelings over the past 2 weeks, developed to measure the severity of depression in adolescents and adults.¹¹ BDI‑II is a comprehensive indicator of the severity of depression, and it is proven to be reliable and valid among different populations and cultural groups. The authors of the original instrument proposed that the cutoff between minimal or no depression and mild depression is 14 points.

Inclusion and exclusion criteria

The inclusion criteria were a diagnosis of IBD and age between 18 and 65 years. The exclusion criteria were partial or incorrect completion of the questionnaire, pregnancy and breastfeeding, diagnosis of diabetes, respiratory failure, circulatory failure, alcohol or drug abuse, or poststroke condition reported in the sociodemographic section of the survey. The participants in the control group had to fulfill the same criteria, and could not have a diagnosis of IBD.

Statistical analysis

Numerical variables were expressed as median and interquartile range (IQR) and compared using the Mann–Whitney test. The χ² test was used for nominal variables. The Spearman rank correlation coefficient was calculated to determine the presence of correlations between the data sets. Two‑tailed P values below 0.05 were considered significant. Statistical analysis was conducted using online statistical software Statistics Kingdom.¹²

Ethics

The study received an approval of the Jagiellonian University Bioethics Committee (1072.6120.118.2021).

General characteristics of the participants

The study group included 73 women (70.2%) and 31 men, and in the control group there were 44 women (80%) and 11 men (P = 0.18). Median (IQR) age was 30 (25–36) years in the IBD group and 28 (25–37) years in the control group (P = 0.78). As many as 81 patients (77.9%) and 44 controls (80%) were in a relationship (P = 0.76).

Characteristics of patients with inflammatory bowel disease

Supplementary material, Table S1 contains detailed data on the studied populations, such as the presence of a stoma, fistulas, remission of the disease, and a history of previous surgery, as well as data on topics related to sex and reproduction that were discussed during medical visits.

We found that 4 patients (4%) talked to their doctors about their sexual problems after IBD diagnosis, and 3 individuals (3%) talked about possible sexual dysfunction related to IBD.

Sexual dysfunctions in women

The women with IBD were more likely to experience discomfort or pain during and after vaginal penetration. The differences between the IBD group and healthy controls in sexual desire or interest were minor (P = 0.06). According to the questionnaire, 57.5% of the women with IBD (n = 42) suffered from sexual dysfunction. Detailed data can be found in Supplementary material, Table S2.

Sexual dysfunction in men

In the male sexual dysfunction part of the questionnaire, the patients with IBD scored lower in a number of the studied parameters, indicating greater severity of sexual dysfunction and poorer quality of sexual life than in the healthy controls. Significant differences between the groups were achieved for problems with maintaining an erection after penetration, as well as maintaining an erection until the end of sexual intercourse. As many as 13 patients with IBD (41.9%) scored 21 points or less, indicating sexual dysfunction. Detailed data can be found in Supplementary material, Table S3.

Psychological condition

When comparing the mental health parameters between the patients with IBD and the control group using the BDI‑II scale, we found a higher score in the individuals with IBD, indicating their poorer mental functioning in each domain assessed by the test. Moreover, all reported differences were significant except for “sadness, suicidal thoughts or wishes” and “loss of interest in sex.” In as many as 66 patients with IBD (63.5%) the questionnaire showed mild, moderate, or severe depression (cutoff of 14 points). Detailed data on mental health can be found in Supplementary material, Table S4.

Comparison of outcomes in the patients with ulcerative colitis and Crohn disease

In women with UC, the median (IQR) levels of sexual interest (4 [2–5] vs 4 [4–5]; P = 0.02), overall satisfaction with sexual life (3 [2–4] vs 4 [3–5]; P = 0.02), and sexual arousal (4 [3–4] vs 4 [4–5]; P = 0.03) were lower than in the controls. We did not perform these analyses in men due to the small group sizes. Detailed data are available in Supplementary material, Tables S5 and S6.

Relationships between the psychological condition and sexual disorders

The relationship between the psychological condition of the patients and the intensity of their sexual dysfunction was investigated separately for women (n = 73) and men (n = 31). In both groups, the occurrence of more severe sexual dysfunction positively correlated with a worse psychological condition (R = –0.334; P = 0.004 for women and R = –0.593; P <⁠0.001 for men). The data are shown in Figure 1A and 1B.

We also investigated the correlation between the psychological condition and sexual disorders depending on the primary diagnosis (CD vs UC). In women suffering from CD (n = 45), the correlation coefficient R was –0.431 (P = 0.003), and in those diagnosed with UC (n = 28) it was –0.226 (P = 0.25). The data are shown in Figure 1C and 1D.

Due to small group sizes, we did not conduct these analyses in men.

Correlation between sexual disorders and age

The severity of sexual disorders did not correlate with age of the patients, as the correlation coefficients were –0.097 (P = 0.41) for women and –0.022 (P = 0.9) for men. These data are shown in Figure 1E and 1F.

Conclusions

IBD can adversely impact sexual function in both women and men. Women may experience discomfort or pain during vaginal intercourse, while men might struggle with maintaining an erection. The severity of sexual dysfunction is often linked to depression that affects many IBD patients. Holistic care for IBD patients should address all aspects of their QoL, including sexual health. However, sexual issues remain a challenging and sensitive topic, leading many patients to hesitate about seeking medical assistance. Meeting the needs of patients with IBD requires more open conversations about sexual dysfunctions.