When well controlled, the disease need not interfere with sexuality, pregnancy or childbirth.
Inflammatory bowel disease (IBD) is a chronic illness that, along with its gastrointestinal challenges,
frequently complicates sexuality and sexual function. Women with the disease have added concerns about fertility, pregnancy and breastfeeding. Dr. Sunil K. Khurana, CEO of Premier Medical Group and a leader of our Gastroenterology Division, assures women that, if the disease is medically managed and well controlled, those concerns are unfounded. “I am often asked by women, whether they can have a regular life with this disease,” he says. “There is ample evidence out there that the answer is yes.”
IBD affects sexuality, fertility and childbearing indirectly, in several ways. Uncontrolled IBD can cause symptoms that impede interest in and enjoyment of sex, such as increased bowel frequency, incontinence, perianal fistulas or abscesses. About a third of patients experience chronic pain and half of IBD patients are persistently fatigued. Any of these can quite understandably impair sexual desire and reduce sexual pleasure, Dr. Khurana says.
In addition, coping with IBD takes a psychological toll: patients often suffer from poor body image and are at risk for depression and anxiety. This is especially challenging, Dr. Khurana says, because, “The disease is diagnosed most often in young people, in their teens and early 20s, prime childbearing years and a time, sexual exploration and relationship building are most intense.”
He stresses, however, that when symptoms are controlled, IBD need not have a direct impact on sexuality. Women who feel fearful, uninterested or overwhelmed by sexual issues can look to Premier’s Women’s Center for Continence and Sexual Health for help. “Our female sexual dysfunction clinic deals with all issues regarding sexual function,” says Dr. Daniel Katz, director of the Center. “The symptoms of IBD can cause both psychological and physical concerns, but we have diagnostic and treatment capabilities for these concerns, regardless of the cause.”
IBD has no affect on fertility. However, Khurana says, “women often ask me, ‘Can I get pregnant while on medication and can I still use the medications during pregnancy? I never tell my patients not to get pregnant, but I help them understand that a time when they’re experiencing active disease is not the right time to try. If you get your disease under control, then there is no problem.”
Your gastroenterologist will work closely with your obstetrician to manage medications and monitor fetal growth and development. “There are a few drugs we have to be careful with, but the majority of medications we use to treat Crohn’s disease and ulcerative colitis can be used safely during pregnancy,” he says. Women who take steroids, or who have a flare-up while pregnant, may require additional ultrasound imaging every four weeks after about 18 weeks gestation.
The bottom line, Dr. Khurana says, is that: “Many of my female IBD patients go through pregnancy with these diseases, and none have any significant problems.”
Breastfeeding is not only safe, it is encouraged for the numerous benefits it brings to both mother and child. The majority of IBD medications can be used by breastfeeding mothers, he says. “Even if they are found in the breast milk, they are perfectly safe for the baby.”
The most important thing for women to remember is that active disease is more problematic than the medications used to control it. “Trouble comes when women stop taking their medication and their disease acts up,” Khurana says. “It is the activity of the disease, not the medications, that may harm the mother and fetus.”
Dr. Khurana notes that he and his colleagues develop long-term relationships with their IBD patients, which makes discussing sensitive issues such as sexual intimacy and pregnancy more comfortable. “I can assure women that all the GI specialists at Premier are well equipped to help women deal with the physiologic and psychosocial aspects of their disease,” he says.