Table I.
Summary of Studies Examining Sexual Functioning and Quality of Life in IBD Patients
| Authors | Year | Total (N) | Diagnosis (N) | Surgery (N) | Sexual Functioning Measure | Sexual Functioning Results | QoL Measure | Quality of Life Results | SF and QoL Associations |
|---|---|---|---|---|---|---|---|---|---|
| Bengtsson et al. | 2011 | 108 | UC | Failed Pouch (36), Functioning Pouch (72) | FSFI, IIEF | No differences on any of the FSFI or IIEF domains were found b/t pts with pouch failure vs those with functioning pouch; Median summary scores for men and women in pouch failure group were below cut-offs for SD | SF-36 | Men/women with pouch failure scored lower on all SF-36 domains, compared to men/women with functioning pouch; only the social function domain for men was statistically significant | |
| Cornish et al. | 2012 | 109 | IBD (54, RPC), UC no stoma or RPC (55) | RPC | FSFI | No differences on all domains b/t patients who had RPC compared to those who did not | SF-36 | Overall physical health and bodily pain were significantly better among UC pts who did not have RPC; No significant differences were found on general health, overall mental health or social role domains | |
| Da Silva et al. | 2008 | 93 | Benign (154), malignant disease (32) | Pelvic (57), abdominal (36) | FSFI | Overall SF had significantly deteriorated 6-mo post-operatively, with partial recovery at 12-mo | SF-36 | For both groups, mental status improved significantly at 12-months, and physical status improved significantly at 6 months; patients undergoing abdominal surgery had faster physical status recovery | MCS scores improved over time, with significant improvement ( p= 0.007) at 12 months. PCS scores demonstrated significant improvement at 6-months (but no significant improvement between 6 and 12 months). Better sexual functioning was also observed among women with higher MCS and PCS scores at 6 months. |
| Davies et al. | 2008 | 59 | UC (54), IC (1), FAP (4) | IPAA | FSFI, IIEF | Male SF scores remained high post-operatively; Post-operatively, female SF improved significantly and female SD decreased significantly | S-IBDQ | Men and women demonstrated statistically significant improvement at 6- and 12-months post-operatively | |
| El-Gazaaz et al. | 2010 | 28 | CD: healed (15), unhealed (14) | Surgery for rectovaginal fistulas | FSFI | No significant differences on all domains between healed and unhealed patients | SF-12, FIQL | No significant differences on both measures between healed and non-healed pts | |
| Hueting et al. | 2004 | 111 | IBD | IPAA | Self-created questions on SF | SD=19.8%; Impotence or retrograde ejaculation=25.7%; Dyspareunia = 30.3% | Self-created questions on QoL, and QoL rating 0–10 | 90% were satisfied with IPAA; 71% felt no general restrictions after IPAA; 78% felt QoL improved after IPAA | |
| Kjaer et al. | 2014 | 50 | UC (44), FAP (4), other (2) | L-IPAA (28), O-IPAA (22) | FSFI, IIEF | No significant differences on any domain between L-IPAA vs O-IPAA groups; Median scores on SF for men in both groups and women in L-IPAA were normal; Median scores for women in O-IPAA demonstrated SD | S-IBDQ | No significant differences were found between pts who had L-IPAA and those who had O-IPAA; Median scores in both groups indicate some impairment in QoL | |
| Larson et al. | 2008 | 125 | UC and FAP | L-IPAA (46), O-IPAA (79) | FSFI, IIEF | No significant differences on any domain between women in L-IPAA vs O-IPAA; Women in both grps demonstrated SD; Men in the L-IPAA group demonstrated significantly lower orgasmic function compared to men in the O-IPAA group | SF-8 | No significant differences were found between pts who had L-IPAA vs those who had O-IPAA; Mean scores on physical and mental health for both groups were within normal range | |
| Muller at al. | 2010 | 217 | UC (85), CD (127), IC (5) | N/A | Self-created questions on SF | 50% felt that IBD negatively affected their relationship status; 58% reported that frequency of sex was decreased by IBD; Female gender had a statistically significant negative impact on libido and frequency of sex | Single Q: “Has IBD ever affected QoL?” | 88.5% reported that QoL had been affected by IBD | |
| Riss et al. | 2012 | 168 | CD (69), healthy controls (69) | Surgery for anal fistulas | FSFI, IIEF | No significant differences on any domains between patients and controls; SD was high among female pts and female controls | SF-12, IBDQ | Median SF-12 physical health score was significantly lower among patients, compared to controls; Pts also demonstrated significnatly poorer IBDQ scores | |
| Slors et al. | 2000 | 76 | UC (65), FAP (10), CC (1) | Mesorectal Excision | Self-created questions on SF | Sexual activity, satisfaction and libido were better among males; incidental ED found in 7.5%; dyspareunia found in 41.7% | QoL rating 0–10 | Significant improvement in QoL for UC pts; No differences in QoL between men and women | No correlation b/t QoL and sexual dysfunction |
| van Balkom et al. | 2012 | 23 | UC (16), FAP (10) | RPC with IPAA | FSFI, IIEF | None of the men demonstrated sexual dysfunction and none reported impotence or retrograde ejaculation; 50% of women reported sexual dysfunction | SF-36; GIQLI | QoL scores were lower among men/women compared to normative data | Male and female sexual function were highly correlated (r=0. 70) with QoL: PCS and MCS and GIQLI total scores although the correlation only trended toward significance (p=0.08). |
| Wang et al. | 2011 | 66 | UC (56), CD (10) | IPAA (48), Permanent End ileostomy (18) | FSFI, IIEF, SFQ | SF-36, IBDQ | Men/women with IPAA demonstrated significant improvement on SF-36 and IBDQ scales; Men/women with permanent end ileostomies did not demonstrate improvement on SF-36; Men demonstrated improvement on emotional health subscale of IBDQ | ||
| Yoshida et al. | 2014 | 61 | UC | IPAA | Sex life question from IBDQ; Self-created questions on SF | 32% reported SD; no significant differences in SF between men and women; | IBDQ-Japanese | Social functions other than Sex life correlated with SF; significant difference in scores for Social functions other than Sex life between pts with poor and good sexual activity; scores for Bowel, Systemic and Emotional subscales were not correlated with SF |
Notes:
IBD=Inflammatory Bowel Disease, SF=Sexual function, SD=Sexual dysfunction, UC=Ulcerative Colitis, CD=Crohn’s Disease, IC=Indeterminate Colitis, FAP=Familial adenomatous polyposis, CC=Chronic Constipation, ED=Erectile dysfunction, Pts=patients, FSFI=Female Sexual Function Index, IIEF=International Index of Erectile Function, SFQ=Sexual Function Questionnaire, FIQL=Fecal Incontinence Quality of Life Scale, L-IPAA=Laparoscopic Ileal Anal Anastomosis, O-IPAA=Open Ileal Anal Anastomosis, GIQLI=Gastrointestinal Quality of Life Index, BISF-W=Brief Index of Sexual Function in women, IBDQ=Inflammatory Bowel Disease Quality of Life Questionnaire, S-IBDQ=Short Form Inflammatory Bowel Disease Questionnaire; PCS=Physical Component Summary of SF-36; MCS =Mental Component Summary of SF-36