High Prevalence of Male Sexual Dysfunction in a Prospective Multicenter VA Inflammatory Bowel Disease Population

Abstract

Background

Aims of this study were to assess the prevalence of and risk factors for sexual dysfunction (SD) in male veterans with inflammatory bowel disease (IBD).

Methods

We collected IBD history, quality of life (QOL), and sexual function surveys.

Results

One hundred seventy-one men enrolled, mean age 50 years, 85% had SD, 92% had erectile dysfunction (ED). More severe ED (P = 0.0001), decreased sexual desire (P = 0.004), and decreased satisfaction (P = 0.001) were associated with poorer QOL. Biologic use was associated with increased SD; hypertension with a decrease in sexual desire.

Conclusions

SD and ED are highly prevalent and associated with poorer QOL.

INTRODUCTION

Inflammatory bowel disease (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), are chronic relapsing inflammatory disorders of the gastrointestinal tract. Inflammatory bowel disease currently affects 1.6 million people in the United States with over 13,000 new cases per year.¹ It is well known that IBD adversely affects the quality of life (QOL).² In addition, we know that sexual health is important for physical, mental, and emotional well-being³; however, sexual health is not addressed in most IBD QOL questionnaires. Furthermore, the impact of IBD on sexual health has not been well defined, particularly in the male population with IBD.

Many previous studies on sexual health in IBD have assessed changes related to surgery. Studies in men with IBD without surgery have varied in the reported prevalence of sexual dysfunction without consistent risk factors identified. One study including 280 men with IBD found a 14% prevalence of sexual dysfunction which was not different from healthy controls (9%, P = 0.14).⁴ A higher percentage of men with IBD had erectile dysfunction (ED) which was worsened by disease activity and depression.⁴ A case–control survey study out of Spain, including 153 men with IBD, also reported a 14% prevalence of sexual dysfunction which correlated with depression, treatment with biologics, and diabetes.⁵ Lastly, a recent prospective survey study from 2 tertiary care centers in France including 166 men with IBD showed that 17% of men with IBD had sexual dysfunction compared to 7.4% in healthy controls (P = 0.64) and 43% had any degree of ED compared to 13% in healthy controls (P < 0.01) with depression identified as a predictor for ED.⁶ Few of these studies included common risk factors for sexual dysfunction, such as hypertension or peripheral vascular disease, and none reported on a prior diagnosis or current treatment for ED.

The International Index of Erectile Function (IIEF) score is a commonly used validated questionnaire to assess sexual function in males.⁷ More recently, the National Institutes of Health has established the Patient-Reported Outcomes Measurement Information System (PROMIS) Network to develop a comprehensive, standardized, and efficient means of measuring patient-reported outcomes in persons with chronic diseases. The PROMIS sexual function and satisfaction measures brief profile that was initially tested in patients with cancer⁸ was recently used in an Internet cohort of patients with IBD and found a decrease in sexual satisfaction among the male subjects compared to the general population.⁹ This survey has not been used in a prospective, office-based cohort of patients with IBD.

The primary aims of this multicenter study are to assess the sexual health of a prospective, large cohort of men with IBD using validated assessment tools and to determine the prevalence of and risk factors for sexual dysfunction in this population taking into consideration typical risk factors for sexual dysfunction. The secondary aim was to assess patient-reported outcomes by incorporating the PROMIS Sexual Function and Satisfaction Measures Brief Profile. We hypothesize that the prevalence of sexual dysfunction in our population with IBD is likely higher than in the general population and that sexual dysfunction correlates with poorer QOL.

MATERIALS AND METHODS

Study Design

This prospective study was conducted across 4 Veteran’s Affairs (VA) medical centers. Subjects with IBD were identified and enrolled from September 2016 through April 2018 using the same methods from the VA Medical Centers in Richmond, Virginia; Houston, Texas; Dallas, Texas; and Washington, DC. Patients were enrolled, interviewed, and their chart reviewed locally by each site’s study team. All male subjects 18 years of age and older with a confirmed diagnosis of IBD (based on endoscopy, pathology, and/or radiology) who presented to an outpatient gastroenterology clinic at any of the participating VA study sites were invited to participate.

The data collected at each site included demographic data, IBD characteristics (such as IBD type, age of diagnosis, disease distribution, disease activity, history of IBD-related surgery, medication history), and other comorbidities and medications that can affect sexual function, including hypertension, peripheral vascular disease, and psychiatric diagnosis such as anxiety or depression. In addition, all study subjects were asked to complete a Short Inflammatory Bowel Disease Questionnaire (SIBDQ),¹⁰ a disease activity questionnaire [Simple Clinical Colitis Activity Index (SCCAI)¹¹ for UC or Harvey-Bradshaw Activity Index (HBAI)¹² for Crohn’s], an IIEF survey, and a PROMIS Sexual Function and Satisfaction Measures Brief Profile v1.0 questionnaire. On the SIBDQ, each question is scored on a 7-point scale with scores ranging from 1 to 7, with 1 indicating poor QOL score and 7 indicating optimal QOL score.¹⁰ Scores for the SCCAI range from 0 to 18. A score of not greater than 2 was used to indicate remission and scores greater than 2 were used to indicate active disease.¹³ Scores for the HBAI have no upper limit due to the open-ended question of a number of liquid bowel movements per day. For this study, scores of less than 5 were used to indicate remission and scores of at least 5 indicated active disease.¹³

Sexual Function Surveys

The IIEF survey is a validated questionnaire for sexual function and satisfaction consisting of 15 questions within 5 clinical parameters with overall scores ranging from 5 to 75 with higher scores indicating better sexual function.¹⁴ Consistent with other studies, an overall IIEF score of less than 43 is consistent with sexual dysfunction.⁶ In addition, the questions are divided into 5 subcategories including Erectile Function (EF), Orgasmic Function (OF), Sexual Desire (SD), Intercourse Satisfaction (IS), and Overall Satisfaction (OS). Based on the score, each subcategory is divided into no dysfunction, mild dysfunction, mild to moderate dysfunction, moderate dysfunction, or severe dysfunction as previously described.⁷ For the EF subcategory, a score of less than 26 is consistent with ED.⁵

The PROMIS Sexual Function and Satisfaction Measures Brief Profile v1.0 questionnaire is a validated survey including questions for men and women related to sexual function and satisfaction.⁸ All study subjects were asked to complete a customized version of the PROMIS Sexual Function and Satisfaction Measures Brief Profile v1.0 questionnaire, which included only the sections pertaining to male subjects. The included subsections were EF, global satisfaction with sex life, interest in sexual activity, and orgasm. The individual responses for each subcategory for each subject were collected as a total score. Using the HealthMeasures Scoring Service web site,¹⁵ scores were calculated as a raw score, t-score, and standard error. The t-scores are based on comparison to a cohort of patients with cancer or to a healthy cohort based on what is selected as the comparison group. We submitted each subsection for comparison with all available comparison cohorts.

Statistical Analysis

Aggregate de-identified data were compiled from each participating site. Descriptive statistics were calculated to examine the baseline characteristics of all subjects. Spearman correlations were computed to assess for associations between QOL and IIEF subscores. Multiple logistic regression analyses were performed to assess for risk factors for moderate or severe dysfunction in each IIEF subcategory. Analyses were performed using SAS 9.4 for Linux. In this study alpha was set to 0.05, with a P-value of <0.05 considered significant.

Ethical Considerations

IRB approval was obtained at each individual site. All subjects signed informed consent prior to enrollment.

RESULTS

Demographics

From September 2016 through April 2018, 171 male subjects (67.3% white, 29.2% black) were enrolled (90 CD, 80 UC, 1 indeterminate colitis) from 4 VA Medical Centers (Table 1). The mean age at diagnosis was 36.5 years (range of 15–70), mean duration of disease 13 years (range of <1 year to 50 years), and 65% were diagnosed between the ages of 17 and 40 years. Twenty-four percent of the study subjects had a history of an IBD-related surgery with approximately 40% of those having had an ileocolectomy. Fifty percent of the study subjects were on mesalamine, 26.9% on thiopurines, 17% on steroids, and 54.4% on biologics. Of those on biologic agents, 42% were on adalimumab and 40% were on infliximab.

TABLE 1.

Subject Baseline Characteristics

	Sexual Dysfunction (IIEF Score <43) n = 144	No Sexual Dysfunction (IIEF Score ≥43) n = 26	P
Age at diagnosis	36.4 ± 15.0	36.0 ± 13.8	0.71
Race
White	103 (71.5%)	11 (42.3%)	0.0058
Black	36 (25%)	14 (53.8%)	0.0048
Asian or pacific islander	1 (0.7%)	1 (3.8%)	0.28
Other	4	0	1.0
Ethnicity
Hispanic/Latino	12 (8.3%)	1 (3.8%)	0.69
IBD disease duration	15.3 ± 12.5	12.8 ± 10.3	0.34
IBD disease classification
Crohn’s	78 (54.9%)	11 (42.3%)	0.29
Location
Ileal	22 (28.2%)	1 (9.1%)	0.28
Colonic	19 (24.4%)	4 (36.4%)	0.47
Ileocolonic	36 (46.2%)	5 (45.5%)	1.0
Upper GI	0 (0%)	1 (9.1%)	0.12
Unknown	1 (1.3%)	0 (0%)	1.0
Behavior
Inflammatory	30 (38.5%)	3 (27.3%)	0.74
Stricturing	20 (25.6%)	3 (27.3%)	1.0
Penetrating	26 (33.3%)	4 (36.4%)	1.0
Unknown	2 (2.6%)	1 (9.1%)	0.33
Perianal involvement	17 (21.8%)	2 (18.2%)	1.0
Ulcerative colitis	65 (45.1%)	15 (57.7%)	0.29
Extent
Proctitis	5 (7.7%)	2 (13.3%)	0.61
Left-sided	22 (33.8%)	4 (26.7%)	0.76
Extensive	36 (55.4%)	8 (53.3%)	1.0
Unknown	3 (4.6%)	1 (6.7%)	0.57
Indeterminate colitis	1 (0.7%)	0 (0%)	1.0
Prior IBD-related surgery	31 (21.5%)	9 (34.6%)	0.21
Current IBD medication use
5-aminosalicylate	70 (48.6%)	15 (57.7%)	0.52
Thiopurine	37 (25.7%)	9 (34.6%)	0.35
Methotrexate	8 (5.6%)	0 (0%)	0.61
Corticosteroids	25 (17.4%)	4 (15.4%)	1.0
Biologics	83 (57.6%)	9 (34.6%)	0.0342
Comorbid disease
Erectile dysfunction diagnosis	28 (19.4%)	4 (15.4%)	0.79
Coronary artery disease	5 (3.5%)	0 (0%)	1.0
Hypertension	55 (38.2%)	11 (42.3%)	0.83
Diabetes mellitus	26 (18.1%)	6 (23.1%)	0.59
Peripheral vascular disease	2 (1.4%)	1 (3.8%)	0.39
Depression	35 (24.3%)	6 (23.1%)	1.0
Anxiety	38 (26.4%)	5 (19.2%)	0.62
Current tobacco use	28 (19.4%)	6 (23.1%)	0.79
Current daily EtOH use	29 (20.1%)	5 (19.2%)	1.0
Age at enrolment	49.2 ± 14.7	50.9 ± 12.5	0.60
Disease activity
SCCAI score (for UC)	5.72 ± 3.5	2.44 ± 3.4	0.0003
HBAI score (for CD)	4.79 ± 4.5	3.3 ± 2.2	0.50
Active IBD based on scores	81 (56.3%)	7 (26.9%)	0.0095
Endoscopic activity (%yes)	48 (33.3%)	4 (15.4%)	0.10
SIBDQ score	4.3 ± 1.3	5.0 ± 1.3	0.0096
Abnormal laboratories
C-reactive protein	23	1
ESR	38	3
Hemoglobin	28	7
Marital status
Married/partner	117 (81.3%)	21 (80.8%)	1.0
No partner	26 (18.1%)	5 (19.2%)	1.0
No data	1	0
Sexually active	98 (68.1%)	23 (88.5%)	0.0358

The bold values are the p-values that are statistically significant. These are bolded to facilitate review of the significant findings.

Sexual Health Questionnaire Results

The mean age at study enrollment was 49.5 years (range 23–82) with 81.8% married or with a partner and 71.3% were sexually active within the past 6 months. A subgroup of subjects (33/171, 19.3%) provided the reason(s) for not being sexually active at the time of enrollment with 27% (9/33) reporting having no partner, 24% (8/33) due to functional limitations, and 21% (7/33) due to medication side effects (complete results not shown). At enrollment, 19.3% had a diagnosis of ED, of which 13.4% were on medications for ED; 3.3% had a diagnosis of coronary artery disease; 38.6% had hypertension, of which 33.3% were on treatment; 18.7% had diabetes mellitus, of which 5.9% were on insulin; 2.3% had peripheral vascular disease; 25.2% had depression; and 25.7% had anxiety with 22.2% on psychiatric medications.

The mean SIBDQ score was 4.4 (1.1–6.6). The mean SCCAI score was 5.1 (range 0–15) and the mean HBAI score was 4.7 (range 0–23) with 52.4% of all study subjects having scores indicative of clinically active disease. C-reactive protein levels were available in 142 (83.5%) and were elevated in 16.9%. Erythrocyte Sedimentation Rate was available in 107 (62.9%) and was elevated in 38.3%. Twenty percent of study subjects were current smokers and 32.9% were former smokers. Twenty percent of subjects were daily alcohol drinkers and 49.7% reported rare alcohol use.

IIEF Survey Results

A total of 169 subjects (98.8%) completed the IIEF EF, SD, and OS subsections, whereas 170 subjects (99.4%) completed the OF and IS subsections (Table 2). The mean IIEF score was 29.9 (range 6–65) with 84.9% having overall sexual dysfunction (defined as an IIEF score of <43). Looking at the IIEF subcategories, 92.7% had any decrease in EF with 22% severely decreased; 92.8% had any decrease in OF with 54% severely decreased; 75.7% had any decrease in SD with 7.1% severely decreased; 96.5% had any decrease in IS with 35% severely decreased; and 67.5% with any decrease in OS with 22% severely decreased.

TABLE 2.

Prevalence of Sexual Dysfunction Based on IIEF Subcategories [n (%) for All]

IIEF Domain	No Decrease in Function	Mild Decrease in Function	Mild to Moderate Decrease in Function	Moderate Decrease in Function	Severe Decrease in Function
Erectile function	14 (8.3)	14 (8.3)	51 (30.2)	53 (31.4)	37 (21.9)
Orgasmic function	14 (8.2)	19 (11.2)	27 (15.9)	19 (11.2)	91 (53.5)
Sexual desire	41 (24.3)	46 (27.2)	46 (27.2)	24 (14.2)	12 (7.1)
Intercourse satisfaction	6 (3.5)	15 (8.8)	42 (24.7)	47 (27.6)	60 (35.3)
Overall satisfaction	55 (32.5)	24 (14.2)	29 (17.2)	24 (14.2)	37 (21.9)

Looking at the correlation between sexual function and QOL based on the SIBDQ score, we found that more severe sexual dysfunction in the subcategories of EF (P = 0.0001), SD (P = 0.004), and OS (P = 0.001) was associated with lower QOL scores (Table 3).

TABLE 3.

Correlation Between Sexual Dysfunction and Quality of Life

	EF	OF	SD	IS	OS
Correlation coefficient	−0.322	−0.085	−0.222	−0.139	−0.422
P-value	0.0001	0.27	0.004	0.71	0.001

Risk Factors for Sexual Dysfunction

On univariate analysis, subjects with overall sexual dysfunction were more likely to be white (71% with sexual dysfunction vs 42% without sexual dysfunction, P = 0.0058), less likely to be black (25% with sexual dysfunction vs 54% without sexual dysfunction, P = 0.0048), are more likely to be treated with biologic agents (57.6% with sexual dysfunction vs 35% without sexual dysfunction, P = 0.0342). Subjects with UC were more likely to have higher SCCAI scores consistent with active disease (5.72 ± 3.5 with sexual dysfunction vs 2.44 ± 3.4 without sexual dysfunction, P = 0.0003) and subjects with active disease based on disease activity scores were more likely to have sexual dysfunction (56% with sexual dysfunction vs 27% without sexual dysfunction, P = 0.0095). Subjects with sexual dysfunction were more likely to have lower SIBDQ scores consistent with poorer QOL (4.3 ± 1.3 with sexual dysfunction vs 5.0 ± 1.3, P = 0.0096). Subjects with overall sexual dysfunction were less likely to be sexually active (68% with sexual dysfunction vs 89% without sexual dysfunction, P = 0.0358). Multiple logistic regression analyses revealed 4 significant predictors of overall sexual dysfunction (Table 4). Biologic use was associated with a higher risk of sexual dysfunction [adjusted OR (aOR) = 2.79, 95% confidence interval (CI) 1.10–7.03; P = 0.03]. Higher SIDBQ scores were associated with a lower risk of sexual dysfunction (aOR = 0.56, 95% CI 0.38–0.83; P = 0.004). Surgery (aOR = 0.23, 95% CI 0.07–0.77; P = 0.017) and having CD (aOR = 0.33, 95% CI 0.11–0.99; P = 0.048) were also associated with a lower risk of sexual dysfunction.

TABLE 4.

Risk Factors for Overall Sexual Dysfunction

	Adjusted OR	95% CI	P
Biologic use	2.79	1.10–7.03	0.030
SIBDQ	0.56	0.38–0.83	0.004
Surgery	0.23	0.07–0.77	0.017
Crohn’s disease	0.33	0.11–0.99	0.048

Looking at predictors for sexual dysfunction based on the subcategories of the IIEF (Table 5), subjects with a lower SIBDQ score were more likely to have moderate or severe ED (aOR = 0.73, 95% CI 0.57–0.94, P = 0.010). Those with hypertension (HTN) were 2.9 times as likely to have a moderate or severe decrease in SD (aOR = 2.93, 95% CI 1.31–6.56; P = 0.009). Erectile dysfunction (aOR = 2.68, 95% CI 1.14–6.32; P = 0.024) increased the likelihood for moderate or severe decrease in IS while a higher SIBDQ score was associated with a lower likelihood of having a decrease in OS (aOR = 0.57, 95% CI 0.43–0.76, P > 0.001).

TABLE 5.

Risk Factors for Sexual Dysfunction Based on IIEF Subcategories

EF Domain	Variable	Adjusted OR	95% CI	P
Erectile function	SIBDQ	0.73	0.57–0.94	0.01
Orgasmic function	Thiopurine use	0.55	0.273–1.092	0.09
Sexual desire	HTN	2.93	1.31–6.56	0.009
Overall satisfaction	ED SIBDQ	2.68 0.57	1.14–6.32 0.43–0.76	0.02 <0.001

PROMIS Results

For the PROMIS survey, 139 (81.3%) subjects completed the EF subsection, 135 (78.9%) completed the global satisfaction subsection, and 169 (98.8%) completed the interest in sex subsection. The EF T-score, global satisfaction T-score, and the interest in sex t-score did not differ significantly when compared to a cohort of healthy controls (results not shown).

DISCUSSION

In this prospective, multicenter survey study of patients with IBD from 4 VA medical centers, we found a very high prevalence of sexual dysfunction. In our cohort, 85% had sexual dysfunction. This is in stark contrast to previous studies of Iraq/Afghanistan veterans without IBD who reported a sexual dysfunction rate of 5.5%–18%.^16,17 Even when the sexual dysfunction was broken down by age, those older than age 40 had a 15.7% rate of sexual dysfunction, still considerably lower than the rate of more than 80% found in our cohort.¹⁶ On the other hand, a recently published study including 69 men with newly diagnosed IBD reported a 39% prevalence of sexual dysfunction,¹⁸ which is half as prevalent compared to our cohort. Compared to our veteran cohort, this US cohort of patients with IBD is younger with a higher proportion of white subjects, a lower likelihood of being married, and none of the subjects were on thiopurines or biologics.

Despite only 19% of subjects having a diagnosis of ED and only 13% on treatment, we found a 92% prevalence of ED in this cohort. Our rates of ED are higher than those reported by a French study of 166 men with IBD⁶ who reported a 43% prevalence of any ED (defined as an IIEF EF domain score of <26, similar to our study) compared to a 92% prevalence of ED in this study. Our veterans had more active disease (>50% vs 28%) and more perianal involvement (21% vs 7%) possibly leading to the higher prevalence of ED between our cohorts. Another single-center prospective survey study incorporating IIEF score including 21 men with IBD reported 52% with impaired EF,¹⁹ which is again less than the prevalence in our cohort. A recent US multicenter study of men with recently diagnosed IBD reported a 94% prevalence of ED within 1 year of diagnosis, which is similar to the high prevalence in our cohort.¹⁸ The authors reported no significant change in the IIEF scores over a 2-year period of follow-up, consistent with our findings of a persistently high prevalence of ED in our cohort of patients with IBD with a mean of 13 years of disease duration.

Specifically looking at the components comprising the IIEF score in our cohort, 88% have a decrease in IS (63% with a moderate or severe decrease) and 81% have orgasmic dysfunction (65% with moderate or severe orgasmic dysfunction). Despite the high level of dysfunction, only half of our study subjects reported a decrease in SD or a decrease in OS. This is in contrast to the study of Mahmood et al.¹⁹ which reported a 23% prevalence of impaired OF and an 81% prevalence of impaired SD. This cohort also had low IS (24%) and low OS (26%) unlike in our cohort. We found a higher prevalence of ED (84%) and impaired OF (81%) but less of a decrease in SD (49%).

In our veterans, overall QOL was significantly decreased in those with ED (P = 0.0001), with decreased SD (P = 0.004), and with a decrease in overall sexual satisfaction (P = 0.001). Similarly, not having ED was associated with better QOL as evidenced by having a higher SIBDQ score. Some previous studies did not assess for QOL.^5,19 Rivière et al.⁶ found an association between lower SIBDQ scores with sexual dysfunction and ED on univariate analysis; however, these did not remain significant on multivariate analysis. The recent study by Shmidt et al.¹⁸ found an association between ED and lower scores on the Short Form Health Survey, consistent with poorer QOL, but there was no association with overall sexual dysfunction or any other subcategories of the IIEF survey.

In our study, treatment with biologic agents was associated with an almost 3-fold increased likelihood of overall sexual dysfunction which may be due to having more severe IBD. A survey study from 2 tertiary care centers in Spain also found that the use of biologic therapies, as well as depression and diabetes, were predictors of sexual dysfunction for men with IBD.⁵ Having a higher SIBDQ score, correlating with better QOL, having CD, and having a history of IBD surgery were all associated with a lower likelihood for overall sexual dysfunction. The association with improved sexual dysfunction for patients with CD differs from previous studies which have shown that patients with CD are more likely to have overall sexual dysfunction and ED⁶ or no difference in sexual dysfunction between patients with CD and UC.¹⁸ The findings regarding the impact of prior surgery are mixed. Previous studies have shown both improvement in male sexual function after surgery²⁰ and worsening of sexual function.⁶

In addition, having hypertension was associated with an almost 3-fold higher likelihood of having a decrease in SD, ED was associated with a decrease in overall sexual satisfaction while having a higher SIBDQ score was associated with higher overall sexual satisfaction. Compared to other studies that found depression,^5–7 diabetes,⁶ disease activity,⁵ and older age^7,8 as risk factors for sexual dysfunction in the population with IBD, our study did not find any association with any of these risk factors. In our cohort, one-quarter of the subjects had a diagnosis of depression. However, we did not prospectively screen our subjects for depression, which may have led to an underdiagnosis of depression in our cohort. Mahmood et al.¹⁹ found a higher prevalence of sexual dysfunction in those with active disease; however, it did not reach statistical significance, possibly due to the small sample size. In our study, disease activity was associated with sexual dysfunction on univariate analysis, but it did not remain significant on multivariate analysis. In the recent multicenter study by Shmidt et al.,¹⁸ there was no association between disease activity and sexual dysfunction. The studies that identified older age as a risk factor for sexual dysfunction had younger cohorts with a median age of 39 (range 28–47)⁶ and 40 (23–56)¹⁸ compared to our cohort with a median age of 50 at study enrollment (range 23–82).

This study has several strengths. As a multicenter, prospective survey study, each site was able to prospectively enroll patients and correlate survey responses with disease activity data and medication use from recent clinic visits. With the completion of the surveys during clinic visits, we were able to better ensure the completion of each survey at the time of submission. There are also several limitations to this study. We did not consistently track the number of patients who refused to participate, therefore an overall response rate is not available. The availability of biomarkers to assess disease activity is limited and, as such, disease activity is predominantly determined by the disease activity scores that are based on symptoms. As such, we may have over- or underestimated disease activity in our cohort.

In this prospective, multicenter VA study we found a high prevalence of sexual dysfunction among our cohort of male Veterans with IBD highlighting the underdiagnosis and undertreatment of sexual dysfunction. Over 50% had IIEF scores consistent with moderate to severe ED; however, only 19% of our cohort had a diagnosis of ED and 13% were being treated. Moreover, sexual dysfunction is associated with poorer QOL. Biologic use was associated with a higher likelihood of having sexual dysfunction, while having CD, prior IBD surgery, and having a higher SIBDQ score correlated with a lower likelihood for SD. We also found that more traditional risk factors, like hypertension, were also associated with sexual dysfunction. Given the importance of sexual health for overall QOL, more active evaluation for sexual dysfunction in patients with IBD, with treatment as indicated, could help to improve QOL in this patient population.

CONCLUSIONS

In this prospective, multicenter study, overall sexual dysfunction and ED are highly prevalent in male veterans with IBD and are associated with poorer QOL. Screening for and treating sexual dysfunction in men with IBD may improve QOL in this patient population.

Sources of Support: None.

Potential Conflict of Interest: J.K.J.G. received research support from Gilead, Boehringer-Ingelheim, Genentech, AbbVie, Janssen, Celgene, Bristol-Myers Squibb, and Takeda; speaker for Takeda and AbbVie; consultant for Bristol-Myers Squibb, Celgene, Samsung Bioepis. K.N., J.D., M.Y., D.J.C., and A.D.S. have no conflict of interest. J.K.H. is a speaker for Abbvie and Janssen; consultant for Pfizer, Janssen, Daiichi Sankyo, and Abbvie; received research funding from Abbvie, Janssen, Pfizer, Celgene, Eli-Lilly, and Redhill Biopharma. L.A.F. received research support from Takeda.