Inflammatory bowel disease (IBD) is an overarching term that describes disorders that cause chronic inflammation in a person’s digestive track. The two conditions that are categorized as IBD are Crohn’s disease and ulcerative colitis.

Crohn’s disease can occur anywhere in the gastrointestinal (GI) tract, but it usually affects the portion of the small intestine that meets the colon. This condition causes inflammation of the lining of the GI tract that can penetrate multiple layers and can result in damaged tissues over time. Ulcerative colitis causes ulcers (sores) and inflammation in the innermost layer of the colon and the rectum.

Both Crohn’s disease and ulcerative colitis show similar symptoms such as diarrhea, abdominal pain and cramping, fatigue, blood in stools, decreased appetite, and unintended weight loss. The cause of IBD is currently unknown, but experts believe it is related to an issue with the body’s immune system that causes it to attack cells in the digestive track (in addition to foreign viruses and bacteria).

Unfortunately, IBD can have serious complications that may impact a person’s sex life and overall well-being. IBD can increase a person’s risk of colon cancer, blood clots, and eye, skin, and joint inflammation. Colon cancer and its treatment have been associated with sexual dysfunctions such as orgasmic disorders, vaginal dryness and pain during sex for women, and problems with ejaculation and erectile dysfunction (ED) for men. Inflammation throughout the body can cause pain or discomfort in general, at times making sex less desirable.

Additionally, it is not uncommon for surgery to be required for both Crohn’s disease and ulcerative colitis, albeit for different reasons. With Crohn’s disease, damage to the intestinal tissues can cause the wall of the intestines to thicken over time and obstruct the bowels. It can also cause fistulas (abnormal connections/passageways between two body parts) in the intestines and/or near the anus. When this happens, surgery may be required to remove the damaged portion of the intestine or fistula.

On the other hand, an ulcerative colitis flare-up can sometimes result in a perforated colon (a hole in the colon), which requires surgery to repair. Ulcerative colitis also has the potential to lead to a dangerous condition called toxic megacolon, in which the colon increases rapidly in size and may rupture. When surgery is required for ulcerative colitis, the surgeon removes the entire colon and rectum and creates either an internal pouch or an ileal stoma (permanent opening) in the abdomen connected to an external pouch to collect excrement.   

Individuals with IBD may have concerns about being intimate with a sexual partner, especially if their condition or surgery impacts their sexual or bowel function. A person with IBD may worry about experiencing fecal incontinence during sex, or about how their sexual partner(s) will perceive their stoma and colostomy bag. To minimize these concerns, it is a good idea to empty the colostomy bag or try going to the bathroom before having sex, and to speak honestly with partners about the situation. A caring partner will likely understand and make an effort to accommodate these needs. Another option to reduce the risk of having a bowel movement during sex is to take an over-the-counter anti-diarrheal drug ahead of time.

Anal sex may be painful or unadvisable for individuals with IBD, especially during a flare-up or after surgery. Again, speaking with sexual partners about this and pursuing other sexual activities that will not be harmful or aggravate symptoms is a good idea. Individuals who previously engaged in receptive anal intercourse and need to alter their sexual routine may consider working with their partner and a sex therapist to discover new avenues of sexual pleasure.

Finally, there are times when IBD symptoms may flare up and make sex less desirable. In these situations, (and at any point when sex is not appealing), it is completely normal to refrain from sex. However, if IBD symptoms are regularly interfering with a person’s desire and arousal, they may want to consult their health care provider about how to best manage their symptoms so that they can have a satisfying and fulfilling sex life moving forward.

Resources:

• Bernstein, S. Medically reviewed by Jennifer Robinson, MD. (2020, October 28). Don’t Let Crohn’s Ruin Your Sex Life. https://www.webmd.com/ibd-crohns-disease/crohns-disease/crohns-and-sex
  
  
• Centers for Disease Control and Prevention (CDC). (2018, March 22). Inflammatory bowel disease (IBD). https://www.cdc.gov/ibd/what-is-IBD.htm
  
  
• Crohn’s & Colitis Foundation. (2021, May). Fact Sheet: Sex, Intimacy, and IBD. https://www.crohnscolitisfoundation.org/sites/default/files/legacy/assets/pdfs/ibdsexuality.pdf
  
  
• Mayo Clinic. (2020, November 7). Inflammatory bowel disease (IBD). https://www.mayoclinic.org/diseases-conditions/inflammatory-bowel-disease/symptoms-causes/syc-20353315
  
  
• Pagan, C.N. Medically reviewed by Brunilda Nazario, MD. (2020, December 16). How UC Affects Your Sex Life. https://www.webmd.com/ibd-crohns-disease/ulcerative-colitis/features/uc-sex-life