Sexual dysfunction in patients with inflammatory bowel disease

INTRODUCTION Inflammatory bowel disease (IBD) is likely to have an impact on sexual function because of its symptoms like diarrhea, fatigue and abdominal pain. The impact of the disease on sexuality and intimacy is one of the main concerns of IBD patients but there is still limited data on sexual (SD) and erectile dysfunction (ED) and its determinants in IBD. AIM OF THE STUDY This study aimed to evaluate sexual function and search for predictors of sexual dysfunction among patients with IBD during biological treatment. METHODS This was a prospective, one center study enrolled a cohort of 135 patients with Crohn’s disease (CD) and ulcerative colitis (UC) treated with biological treatment on the basis of the same inclusion criteria (CDAI>300 for CD, Total Mayo score>6 for CU). All IBD patients were invited to fill an anonymous validated questionnaire on their sexual function: Female Sexual Function Index (FSFI) or International Index of Erectile Function-5 (IIEF-5) and one question about how bowel problem limited sexual activity during the last 2 weeks from Inflammatory Bowel Disease Questionnaire (IBDQ). RESULTS Both groups of patients (CD and CU) considered for sexual function were treated with anti -TNF alfa agents. GKS were more frequent among females (24/68, 35%) than males (12/67, 18%), p = 0.037. Comorbidities index was also higher in females (31/68, 46% vs. 17/67, 25%), p = 0.023. In the entire study group SD occurred in 43,7% of patients, in comparable value of men and women (p =0,536). We didn’t demonstrate a relationship between the duration of IBD, taken drugs (GKS, immunosuppressants) and calprotectin levels and the results of the FSFI and IIEF-5 questionnaires. Self-assessment of limitation by disease (IBDQ) was significantly worse for females, than for men p < 0.001. There was a significant correlation between self-assessment of limitation by disease and IIEF-5 (p<0.001) and FSFI (p<0.001) scores in CU and CD patients. CONCLUSIONS According to our study SD and ED were mainly associated with psychological factors, the severity of the disease had no effect on them. The type of medication used to treat the underlying disease has no impact on the development of sexual dysfunction.

Background: There is evidence that many cancer survivors live with sexual dysfunction that impacts their quality of life. It is essential to identify factors that influence the development of sexual symptoms and understand their trajectory over time in order to guide potential interventions to treat sexual dysfunction. Most studies to date have been cross-sectional and longitudinal studies are needed to understand the change of sexual function over time. This study aims to investigate and describe the factors that impact sexual health and dysfunction in breast cancer patients during and after their cancer treatment. Methods: A longitudinal prospective trial is being conducted in premenopausal women 18-50 years of age with breast cancer being treated at MSKCC. Validated questionnaires on sexual health and function were administered to patients after they were diagnosed with breast cancer, but before they initiated cancer treatment and at one-year follow-up after initiation of primary breast cancer therapy. Demographic and treatment information was also collected. The female sexual function index (FSFI) total and individual domain scores were calculated. Baseline and 12-month scores were compared using paired t-tests. Multivariable linear regression was used to assess individual variable associations with 12-month FSFI total scores controlling for baseline scores. Results: 127 women were eligible for analysis at the time of this abstract and had a median age of 41. Eighty-nine percent of tumors were estrogen receptor positive and 24.4% were HER-2 overexpressing. Eighty-nine percent of patients received chemotherapy, 61.4% received Tamoxifen and 23% received a LHRH agonist in combination with an aromatase inhibitor. Mean FSFI total score was 20.4 at baseline and 21.2 at 12-months post diagnosis. More than half of women met FSFI criteria for sexual dysfunction (FSFI score<26) at baseline (57.5%) and 12-months (55.2%). Small increases in sexual activity were seen with 27.8% of patients inactive at baseline compared to 23.2% at 12 months. Similarly, women engaging in sexual activity more than once a week increased from 9.5% to 16.8%. Desire (libido) significantly improved (p = 0.023) from baseline to 12 months. Controlling for baseline score, younger age and treatment with tamoxifen were associated with better 12-month scores (p < 0.05). Conclusions: Mean FSFI scores in our patients with breast cancer before and after treatment are consistent with scores from other studies looking at cancer patients and are lower than those of healthy women. In the peri-diagnosis period patients had worse sexual function that showed signs of small improvements 12 months after initiation of treatment, especially in the desire domain. Patients are being followed to see if sexual function continues to improve over time, to better understand the factors causing sexual dysfunction in these patients and to determine the best time to intervene in order to improve symptoms. Citation Format: Goldfarb SB, Kamer S, Baser R, Quistorff J, Gemignani ML, Dickler M. Improvement in sexual function over time in premenopausal women with breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-12-12.

P203 Sexual Dysfunction in Chronic Inflammatory Bowel Disease: Myth or Reality?

Sexual dysfunction is a prevalent issue among individuals diagnosed with colorectal cancer (CRC), significantly impacting their quality of life. However, limited research has explored the factors associated with sexual dysfunction in CRC patients in Iran. This cross-sectional study aimed to identify the demographic factors that may contribute to sexual dysfunction in this population. A cross-sectional study involving CRC patients was conducted from April 1, 2022, to May 1, 2022, in Tabriz, Iran. Ethical approvals were obtained, and convenience sampling was employed at outpatient chemotherapy centers in five Tabriz hospitals. Validated questionnaires, including participants characteristics form, the Female Sexual Function Index (FSFI) for females and International Index of Erectile Function (IIEF) for males, were utilized. Data were analyzed using IBM SPSS Statistics version 24, employing descriptive statistics and stepwise linear regression to assess association between mentioned factors and sexual function. Among 256 participants, 50.4% were males, 49.6% were females, and 80.5% were married. The predominant age range was 50–60 years. The study findings revealed a high prevalence of sexual dysfunction among both female (Mean ± SD: 10.91 ± 8.67, Min–Max: 3.20–33.00) and male (Mean ± SD: 27.64 ± 16.28, Min–Max: 11–62) CRC patients. Factors such as the presence of a colostomy for FSFI (P < 0.001), type of treatment received for both FSFI and IIEF (P < 0.001), type of housing for both FSFI and IIEF (P < 0.001), occupation for FSFI (P < 0.001), presence of other diseases for FSFI (P = 0.047), and time since the last chemotherapy session for FSFI (P = 0.018), Education for IIEF (P = 0.026), and Age for IIEF (P = 0.002) were identified as significant factors of sexual dysfunction. These demographic factors demonstrated varying effects on sexual function, underscoring the complexity of this issue. The results underscore the significance of addressing sexual health concerns in CRC patients and highlight the necessity for tailored interventions to enhance their overall well-being. Healthcare providers should recognize the influence of demographic factors on sexual function and contemplate integrating sexual health assessments and interventions into the care of CRC patients. Further research is needed to comprehend better the underlying mechanisms and devise effective strategies for managing sexual dysfunction in this population.

We aimed to analyse the relationship between sperm parameters and International Index of Erectile Function (IIEF) score, the Female Sexual Function Index (FSFI) score, the testosterone (T) level in infertile men and between FSFI score and partners' fertility. Patients were divided into three groups; (group 1: azoospermia [n=57], group 2: sperm count <15million [n=41], group 3: sperm count >15million [n=81]). Patients and their partners filled the IIEF and FSFI forms. The normality of the tests was analysed with Kolmogorov-Smirnov and Shapiro-Wilk tests. Spearman's rho test, a nonparametric test, was used to correlate the data. A value of p<.05 was considered statistically significant. There was a positive correlation between the sperm count, other sperm parameters, morphology and motility and IIEF score, FSFI score and T (p=.037, .028 and .041 respectively). We found a positive correlation between IIEF score and FSFI score (p=.182). Infertile partners' FSFI score was lower than fertile partners' scores (p=.023). Male infertility causes severe sexual dysfunction in couples, and female sexual dysfunction increases in parallel to that of men. Male sexual function also tends to decrease with low sperm count. While the clinician evaluates infertile couples, psychological and sexual functions should also be evaluated and patients should not be deprived of appropriate treatment.

Psoriasis can have a significant impact upon sexual function. The aim of this study was to investigate sexual function in females and males with psoriasis and to evaluate whether coexistent depression has an additional negative effect on sexual function in these patients. A total of 66 female subjects (39 with psoriasis and 27 healthy volunteers as a control group) and 70 male subjects (39 with psoriasis and 31 healthy volunteers as a control group) were enrolled in the study. A Psoriasis Area and Severity Index (PASI) was used to determine the severity of psoriasis for the patient groups. The Female Sexual Function Index (FSFI) was used to assess female sexual function and the International Index of Erectile Function (IIEF) was used to evaluate male sexual function. Quality of life was assessed with the Dermatology Life Quality Index (DLQI). The diagnosis of depression was made according to the Structured Clinical Interview for DSM-IV (SCID-I) interview and Hamilton Depression Rate Scale (HDRS) was used for grading depression. FSFI total score was found to be significantly decreased in female psoriatic patients without depression and psoriatic patients plus depression compared with healthy controls (24.09 +/- 5.33 vs. 24.25 +/- 4.52 vs. 28.12 +/- 3.48, respectively, p = 0.004). However, FSFI score was not significantly different between patients with psoriasis without depression and those with psoriasis plus depression (p > 0.05). IIEF total score was also found to be significantly decreased in male psoriasis without depression and psoriasis plus depression patients compared with healthy controls (54.21 +/- 13.07 vs. 52.0 +/- 14.73 vs. 61.69 +/- 9.49, respectively, p = 0.023). The difference in IIEF scores between patients with psoriasis without depression and in those with psoriasis plus depression were not statistically significant (p > 0.05). The results of the study demonstrated that patients with psoriasis, especially females have distinct sexual dysfunction compared with healthy controls, and coexistent depression has no additional negative effect on sexual dysfunction in our patients. Patients with psoriasis should be evaluated in terms of sexual function in order to provide a better quality of life.

Prevalence and Correlates of Self-Reported Sexual Dysfunction in CKD: A Meta-analysis of Observational Studies

Background/aims: Extraintestinal manifestations are important causes of mortality and morbidity from inflammatory bowel diseases. However, sexual problems are usually underestimated in these patients in our daily clinical practice. In this study, we aimed to evaluate the prevalence of sexual dysfunction in inflammatory bowel diseases. Methods: The study included sexually active patients who had inflammatory bowel diseases in remission. Sexual activity was defined as at least one sexual intercourse per month. To evaluate sexual function, the Female Sexual Function Index was used for women and the International Index of Erectile Function for men. Results: The study included 21 female and 17 male patients. Sexual dysfunction was present in 54.54% of female patients with inflammatory bowel disease. The prevalence of sexual dysfunction was 69.23% in female patients with Crohnas disease and 33.33% in those with ulcerative colitis. Sexual dysfunction was present in 58.82% of male patients with inflammatory bowel disease. Of those patients, 3 (17.64%) had severe and 7 (41.17%) had mild erectile dysfunction, whereas 7 patients did not have erectile dysfunction. The prevalence of erectile dysfunction was 88.88% in patients with Crohnas disease and 75% in those with ulcerative colitis. Conclusions: Sexual dysfunction is frequently seen in patients with inflammatory bowel diseases; however, patients do not declare these complaints unless they are interviewed.

Background/Aims: Sexual dysfunction in patients undergoing peritoneal dialysis (PD) is highly prevalent, but studies addressing this issue are scarce. This cross-sectional study aims to evaluate sexual dysfunction and the determinants among PD patients. Methods: All chronic PD patients in 8 PD centers were asked to complete a self-reported questionnaire – the International Index of Erectile Function (IIEF) for men and the Index of Female Sexual Function (IFSF) for women – so that sexual function could be assessed. They also answered the Beck Depression Inventory (BDI) to measure depressive symptoms. Results: Among 294 patients invited for study, 54 men (mean age 48.8 ± 10.8 years) and 45 women (mean age 43.6 ± 7.4 years) were willing to and completed the sexual function questionnaires. The median IIEF score in the men was 56.25. The prevalence of erectile dysfunction, identified by the score in erectile domain of IIEF ≤25, was 51.9%. Older age and higher fasting glucose levels were independently associated with a decreased IIEF score. In women, IFSF score (with a median 27) was significant lower than in healthy peri- or postmenopausal control women. Factors of higher BDI score, receiving automated PD, and older age independently associated with a decreased IFSF score. Conclusions: Sexual dysfunction is clinically relevant and multi-dimensional among PD patients. Gender differences exist in the attributing factors of sexual functioning. These warrant more awareness and investigation in the global health care of dialysis patients.

Male and Female Sexual Dysfunction in Pediatric Cancer Survivors

BackgroundIncreased disease activity may be a risk factor for sexual dysfunction (SD) in patients with inflammatory bowel disease (IBD). This study investigated associations between objective measures of disease activity and sexual function.MethodsAdults with IBD undergoing ileocolonoscopy were prospectively recruited. Demographic, sexual function (Female Sexual Function Index and International Index of Erectile Function), disease activity (endoscopic, biomarker, and symptoms), psychological symptoms, and quality-of-life data were collected. Rates of SD and erectile dysfunction (ED) were compared between patients with active and inactive inflammation and symptoms using the Fisher’s exact test. Logistic regression examined associations between SD and ED, and disease characteristics and psychological symptoms.ResultsA total of 159 participants were included, 97 had Crohn’s disease and 85 were women. SD was reported in 36 of 59 and 13 of 59 sexually active women and men, respectively and ED in 22 of 59 sexually active men. Rates of SD and ED were similar between individuals with active and inactive IBD based on endoscopic indices (P > .05) and biomarkers (P > .05). Women with active IBD symptoms experienced significantly higher rates of SD (P < .05), but men did not (P > .05). Multivariable logistic regression identified that symptoms of severe depression (odds ratio, 5.77; 95% confidence interval, 1.59-20.94) were associated with SD in women, and severe anxiety (odds ratio, 15.62; 95% confidence interval, 1.74-140.23) was associated with ED in men.ConclusionsObjective measures of disease activity are not associated with SD or ED in patients with IBD. Clinicians should consider concomitant psychological symptoms contributing to the sexual health of patients with IBD.

Sexual Dysfunction and Satisfaction in Japanese Couples During Pregnancy and Postpartum

BackgroundMenopause-related endocrinological shifts are linked to sexual dysfunction, and women with endometriosis exhibit lower Female Sexual Function Index (FSFI) scores, indicating impaired sexual well-being.AimTo assess the impact of menopause on sexual function in women with endometriosis.MethodsAn anonymous online survey was conducted among 1586 French women diagnosed with endometriosis. The FSFI questionnaire was used to evaluate sexual function, and menopause was defined as ≥12 months of amenorrhea. Multivariable logistic regression was performed to assess the relationship between FSFI scores and menopause status, adjusting for tobacco use, education, number of symptoms, and history of surgery. Logworth analyses were used to determine the strongest components of FSFI associated with menopause.OutcomesThe primary outcome was the FSFI total score and its six domains (desire, arousal, vaginal lubrication, orgasm, satisfaction, and dyspareunia) in menopausal and non-menopausal women with endometriosis.ResultsMenopausal women had significantly lower FSFI scores (15.3 vs. 16.9, P = 0.021). After adjustment, FSFI remained significantly lower (P = 0.026) in menopausal women but did not reach the established FSFI cutoff for sexual dysfunction (P = 0.451). Stratified analysis by age showed a steep decline in FSFI between 46 and 50 years, partial improvement at 51-55 years, and further decline after 55 years, particularly in arousal, orgasm, dyspareunia, and satisfaction. Arousal (logworth = 4.53, P < 0.001) was the most affected domain, followed by satisfaction (logworth = 1.81, P = 0.015).Clinical ImplicationsArousal appears to be the key determinant of sexual function decline in menopausal women with endometriosis, highlighting the need for targeted interventions such as hormone therapy, pain management, and sexual counseling.Strengths & LimitationsThe study benefits from a large sample size and validated FSFI assessment but is limited by selection bias from online recruitment, self-reported diagnosis of endometriosis, and lack of hormonal status confirmation. The cross-sectional design prevents causal inferences.ConclusionMenopause is associated with a decline in FSFI scores among women with endometriosis, with arousal being the most affected domain, underscoring the need for further research on personalized management strategies for sexual dysfunction in this population.

ORIGINAL RESEARCH—COUPLES’ SEXUAL DYSFUNCTIONS: Women's Sexual Function Improves When Partners Are Administered Vardenafil for Erectile Dysfunction: A Prospective, Randomized, Double‐Blind, Placebo‐Controlled Trial

Infertility has a detrimental impact on the sexual function of involuntarily childless couples. However, the effect of male sexual function on female partner's sexual function in infertile couples remains unknown. In order to explore the association between these couples' sexual function, 324 consecutive couples with infertility and 326 female-age-matched fertile couples were enrolled in this study. The female sexual function index (FSFI) and sexual history were evaluated in female partners. In addition to the international index of erectile function-15 (IIEF-15) and sexual history, self-reported intravaginal ejaculation latency time was evaluated in male partners. The demographics and depression status of couples were also recorded. We observed a higher occurrence of female sexual dysfunction (FSD) in infertile females than in fertile females (58.6% vs. 50.3%, p=0.033). FSD was associated with a number of risk variables, including partner's erectile dysfunction (ED), depression and sexual frequency. The overall FSFI score was positively associated with the IIEF-15 score (r=0.347, p<0.001). Besides, six FSFI domains were positively correlated with five IIEF-15 domains (p<0.05). In conclusion, it is critical to assess and address FSD as well as the sexual problems in male partners in infertile couples.