A comparison of sexual dysfunction in functional bowel disorders and inflammatory bowel disease: does the diagnosis make a difference to patients?

Abstract

Functional bowel disorders (FBDs) are extremely common and share similar symptoms with inflammatory bowel disease (IBD). Rates of sexual dysfunction are reported to be high in patients with IBD. We therefore sought to examine the prevalence of reported sexual dysfunction in FBDs and directly compare it to that of a local cohort of IBD patients. Relationship status, body image, libido, and frequency and level of sexual activity were assessed in FBD and IBD participants using the same open-ended, self-report questionnaire mailed to patients known to two local Gastroenterology units. Chi-square analysis was used to compare groups. Content analysis was used to identify the most frequently reported problems in free-text responses.252 FBD and 365 IBD patients were mailed questionnaires, with 77 and 217 responses respectively (response rate FBD 31%; IBD 59%; p < 0.001). Level of sexual activity differed significantly, with the IBD group more likely to report decreased levels since disease onset (FBD 36%; IBD 64%), χ2(1, N = 260) = 15.25, p < 0.001. There were no other significant differences. Both groups reported high rates of perceived difficulties in relation-ship status (FBD 57%; IBD 50%), body image (FBD 62%; IBD 67%), libido (FBD 28%; IBD 39%) and frequency of sexual activity (FBD 40%; IBD 40%). Content analysis revealed a range of similarities and differences between groups. Both groups attributed many of their relationship, body image and sexual problems to disease flares, attacks, specific symptoms, or general feelings of tiredness and unwellness (FBD 84%; IBD 60%). FBD participants reported being affected by difficult-to-control symptoms, particularly bloating (FBD 32%; IBD 8%). IBD participants reported that many problems occurred only during disease flares and due to the side effects of medication (FBD <1%; IBD 16%) and surgery (FBD < 1%; IBD 8%). These problems often resolved while in remission (FBD < 1%; IBD 17%) unless the disease was frequently active or a stoma or scarring was present. Whilst our data show IBD participants to have a reduced level of sexual activity, other parameters of sexual dysfunction are equally impaired. In contrast to previous studies, the use of free-text responses has facilitated an improved understanding of specific patient concerns which are not elicited using standard sexual function scoring tools.