Previous research has shown that people with an IBD like Crohn’s disease or ulcerative colitis have reduced sexual function and that certain drugs can play a role in that. But there’s hope: New research shows that biologic, or small molecule, therapy may reduce disease burden and improve sexual dysfunction in all genders. In an abstract presented on October 26, 2021, at the American College of Gastroenterology Annual Scientific Meeting and Postgraduate Course, Gabriel Castillo, MD, a gastroenterology and hepatology fellow at New York University Langone Medical Center in New York City, outlined the preliminary results of the first study to include both men and women, but only those who were treating IBD with biologics. According to Dr. Castillo, sexual dysfunction is tied to disease activity, including flares, and patients who have more severe disease have more sexual dysfunction. “It’s the closest therapy we have for disease modifying therapy,” says Castillo, referring to the ability of biologic therapy to reduce inflammation, the root cause of IBD, rather than treat the symptoms of a flare. “Theoretically, if we control inflammation, we control side effects of IBD like sexual dysfunction.” The study included 123 people, roughly half men and half women, all who were managing their IBD with biologics. They found that those who responded to the treatment reported significantly less sexual dysfunction after being on the therapy for six months. “We still need more studies that put therapies head-to-head, but in the current context, [improved sexual dysfunction] does seem to be specific to biologic therapy,” says Castillo. However, the results are best taken in context with what other recent studies have concluded, which is that, compared with other therapies, biologics may actually make people with IBD more likely to experience sexual dysfunction. RELATED: Your Everyday Guide to Living Well With Crohn’s Disease A previous study on 130 women with IBD, published in February 2019 in the journal Inflammatory Bowel Diseases, found that 97 percent of women experienced sexual dysfunction. The participants were all enrolled within one year of their IBD diagnosis. Researchers followed the women, who were managing their disease with therapeutics, for two years. They found that despite improvement in overall disease activity, the women did not report significant changes in sexual dysfunction. And using biologics appeared to be an independent risk factor that made participants more likely to experience sexual dysfunction. On the other hand, corticosteroids and budesonide didn’t appear to have an effect on sexual dysfunction, good or bad. Castillo points out that patients with worse disease activity — and in this case, presumably higher sexual dysfunction — are typically selected to start biologics, so the therapies themselves may not actually be causing worse outcomes. “Hopefully further studies will shed some light on the new finding,” says Castillo. The main takeaway is that specific therapies don’t work for everyone, and managing the physical impact of IBD whatever way is best for your body can help alleviate other factors that contribute to sexual dysfunction.
There Are Many Ways an IBD Can Impact a Person’s Libido
According to Jessica Philpott, MD, PhD, a gastroenterologist at Cleveland Clinic, there are mainly two different ways that IBD can impact sexual function. If a person is having active inflammation, abdominal cramping, or recently underwent surgery, they may not be in the mood for sex. “When people are not well, it can affect their ability to enjoy sexual activity and their desire to have sex. Men can experience erectile dysfunction and women may experience a higher rate of painful sexual intercourse,” says Dr. Philpott. Getting used to a J-pouch may also interfere with the desire to have sex. Living with chronic illness can also have a huge impact on mental health. A study published in January 2021 in the journal Science Reports found that people with Crohn’s disease have much higher rates of anxiety and depression than the general public, and rates are even higher in people with ulcerative colitis. “We know patients with IBD are at a higher risk of anxiety and depression, which alone has an impact on sexual function. When the disease is active, it can impact a person’s ability to function, which can be depressing, so it’s like a vicious cycle,” says Philott. Castillo hopes that the new research will shed light on the broader topic of sexual dysfunction, which he says can be very detrimental to a patient’s quality of life but is infrequently addressed in office visits. For some, the results offer hope. “The improvement in sexual function may be multifactorial, but it is most likely related to control of disease,” says Philpott. “The research provides hope because it shows that with good disease control, there is an improvement, and thankfully we have more tools to do so.”
