Abstract Background Sexual health concerns significantly impact quality of life in inflammatory bowel disease (IBD), yet remain insufficiently addressed in clinical practice. We aimed to assess sexual quality of life (SQoL) in IBD patients compared to healthy controls while exploring patient-healthcare communication patterns. Methods We conducted a prospective single-center study of 78 IBD patients (45 with Crohn's disease [CD] and 33 with ulcerative colitis [UC]) and 49 healthy controls. Participants completed a comprehensive assessment including sociodemographic data and validated instruments: Short IBD Questionnaire (SIBDQ), Sexual QoL Questionnaire-Male/Female (SQoL-M/F), Nine-item Patient Health Questionnaire (PHQ-9), and specific questions about sexual health communication with healthcare providers. Disease characteristics and surgical history were also collected. Results The cohort included 43 females (55.1%) and 35 males (44.9%), with a mean age of 46.3 ± 13.8 years. IBD patients reported significantly lower SQoL scores compared to controls (males: 77.29 vs 83.83, p<0.001; females: 70.40 vs 81.63, p<0.001). A majority of patients (76.9%, 60/78) reported specific sexual health concerns. Physical symptoms affecting sexual life included pain during intercourse (34.6%), fatigue (42.3%), and incontinence concerns (29.5%). Psychological impacts were more prevalent, with fear of symptom occurrence during intimacy (51.3%) and decreased sexual drive (47.4%) being the most common concerns. Perianal disease (present in 23.1%, 18/78) significantly impacted male SQoL scores (70.2 vs 79.8, p=0.003) but not female scores. Depression symptoms (PHQ-9 ≥10) were present in 35.9% of patients and strongly correlated with reduced SQoL (r=-0.62, p<0.001). While 82.1% of patients desired healthcare provider-initiated discussions about sexual health, only 15.4% had raised these concerns themselves, citing embarrassment (56.4%) and perceived time constraints (41.0%) as main barriers. In multivariate analysis, independent predictors of reduced SQoL in males included age (β=-0.31, p=0.02), depression (β=-2.101, 95% CI: -2.505 to -1.696, p<0.001), and perianal disease (β=-0.28, p=0.03). In females, depression remained the sole independent predictor (β=-1.973, 95% CI: -2.313 to -1.632, p<0.001). Conclusion IBD patients experience significantly impaired sexual quality of life compared to healthy controls, with distinct gender-specific patterns in predictive factors. Despite high prevalence of sexual health concerns, there remains a substantial communication gap between patients and healthcare providers. These findings emphasize the need for routine screening of sexual health issues and proactive healthcare provider-initiated discussions as integral components of IBD care.
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