Your sexual health is another area that’s often affected when you have inflammatory bowel disease (IBD), which includes UC and Crohn’s disease. “Erectile dysfunction or sexual dysfunction is very prevalent in the IBD population,” says Benjamin Click, MD, a gastroenterologist at the Cleveland Clinic in Ohio, adding that it’s “something we should be screening for in all our IBD patients.” Erectile dysfunction is defined as difficulty getting or maintaining an erection for sexual activity. There’s no definitive estimate of how common this problem is in men with UC. But one meta-analysis, published in March 2019 in the journal Inflammatory Bowel Diseases, found that men with IBD had a 41 percent higher risk of sexual dysfunction compared with men without. Here’s what you should know about the factors that can contribute to erectile dysfunction when you have UC, and how to go about addressing this problem with your doctor.
Causes of Erectile Dysfunction in UC
It’s likely that a number of different factors contribute to the higher rate of erectile dysfunction seen in men with UC, according to Dr. Click. “Probably the number one thing we think about is inflammation, or disease activity,” he says. “We know that as the disease is more active, sexual desire and function goes down.” Another important factor is the psychological toll UC can have, with higher levels of stress, anxiety, and depression than in the general population, says Click. “It’s well established that these behavioral comorbidities can influence sexual function,” he notes. A study in the July 2017 Journal of Crohn’s and Colitis highlighted the role of psychological factors in sexual and erectile dysfunction, finding that depression and poorer social and emotional function were predictive of sexual problems in men — while IBD activity was not. It doesn’t help that some antidepressant medications can lead to decreased sexual function as well. Other downstream UC symptoms, like malnutrition, negative side effects from steroid therapy, and changes in body image, may also contribute to sexual dysfunction, according to the 2019 meta-analysis. There may also be effects on your brain from UC that contribute to erectile dysfunction independently of psychological factors, according to Ashwin Ananthakrishnan, MBBS, a gastroenterologist at Massachusetts General Hospital in Boston. “We know all those inflammatory cytokines” — proteins created as part of the UC disease process — “have central effects,” he says, in addition to their local effect on your colon. Another factor for some people with UC is the side effects of surgery. “With a J-pouch, there is a risk of damaging some of the nervous system that helps control the sexual organs,” says Click, referring to one of the more common surgical procedures in people with UC. “We do rarely see some sexual dysfunction related to the surgery.” Of course, there may also be factors unrelated to your UC that contribute to erectile dysfunction, such as other sources of stress or anxiety, your cardiovascular health, and alcohol and tobacco use, Click notes.
Dealing With Erectile Dysfunction in UC
Even though sexual dysfunction is very common in people with UC, “both male and female sexual health are not asked about as often as they should be” at gastroenterology appointments, says Dr. Ananthakrishnan. Part of the reason for this, he says, may be simply that doctors have limited time with patients, and they want to make sure they thoroughly cover your gastrointestinal problems. But doctors should “bring it up and address it more regularly,” he adds. Of course, even if your doctor doesn’t ask about it, you should bring up any concerns related to erectile dysfunction. “Bring it up with your gastroenterologist, or with your primary care provider, just like you would mention joint pain or eye problems,” says Ananthakrishnan, noting that the systemic nature of UC means it can cause problems outside your digestive tract that your doctor should be aware of. A discussion with your doctor about your erectile dysfunction should explore all the potential factors behind it, which will inform any treatments your doctor prescribes, says Click. Your doctor may also refer you to a urologist or a behavioral health specialist, such as a psychologist or sex therapist, depending on the specifics of your situation. There is emerging evidence that biologic therapy may also help improve sexual function in patients with IBD, according to research presented at the 2021 American College of Gastroenterology Annual Scientific Meeting. RELATED: The Pros and Cons of Biologics for Ulcerative Colitis If a medical treatment is indicated for your erectile dysfunction, you’ll most likely be prescribed a medication from a class called phosphodiesterase type-5 inhibitors. This group includes the major drugs marketed for erectile dysfunction in the United States, including Viagra (sildenafil) and Cialis (tadalafil). It’s fairly common for men with UC who experience erectile dysfunction to take one of these drugs, Click notes. In fact, a study published in September 2018 in the American Journal of Gastroenterology found that men with UC who hadn’t had surgery were 17 percent more likely to take a drug for erectile dysfunction than men without UC. Those who had had surgery were 43 percent more likely to take one of these drugs. While drugs can be helpful, says Click, it’s important for your doctor to look at individual factors when treating erectile dysfunction. This means “talking about the impact of sexual dysfunction on the patient’s life, and putting it into context,” he notes. It also means following up to make sure than any prescribed treatments are working — and if they’re not, coming up with a new plan. Your sexual health is “something that we should check in on with our follow-up visits, and make sure we’re getting a desired outcome,” Click emphasizes. “And if we’re not, exploring the factors that may be contributing to not getting that success,” which may include referral to a specialist at this point in the process. Ananthakrishnan senses “a lot of reluctance” among many patients with IBD to bring up or discuss erectile dysfunction. But he senses that doctors may be growing more willing to raise the topic with IBD patients, especially since studies in the last few years have made clear just how widespread this problem is. So don’t hesitate to raise any concerns about your sexual health at your next gastroenterologist visit. “I strongly encourage patients to bring up the topic,” says Click. “We’re more than willing to talk about it.” RELATED: How to Talk to Your Doctor About Sex If You Have IBD Additional reporting by Monroe Hammond.
