Intimacy

It is natural to worry about the impact of inflammatory bowel disease (IBD) on your personal and sexual relationships. Intimacy is a valid and important concern for a lot of people who are living with IBD. You may feel the issue is too personal or embarrassing to speak with your doctor or nurse.

The good news is that, in most cases, IBD will not affect your physical ability to have sexual intercourse. But the truth is, there will probably be times when you just don’t feel like it, particularly during a flare-up. But just as IBD can be managed, so can its effect on sexual desire and activity. The most important thing is to deal with the emotional and psychological issues.

Emotions

You may be feeling many emotions when it comes to your condition. You may also feel a different set of feelings when it comes to your relationship with an existing or new partner. These may include feelings of embarrassment, anxiety, worry or upset.

These may be due to the physical issues (such as having uncomfortable or distressing symptoms) as well as how you feel about yourself and your confidence levels.

Worries you may have may include:

• Does ulcerative colitis or Crohn’s disease make sex painful?
• What if I smell?
• What if I need the toilet during sex?
• What effect will the medication I take have on my sex drive/ability to have sex?

These fears are completely natural. Talk to your doctor and your partner if you can. Remember that talking about any worries openly will help to avoid embarrassment and help to put you at your ease. Always try to remember that periods of disease activity are usually followed by much better periods of remission when you will be able to lead a ‘normal’ life once more.

Tell your partner exactly how you feel and when you might need his/her extra support. Sharing information about the condition, including how it is affecting your body image, can make intimacy easier. How you do this is important. Keep it simple. In the beginning, there is no need to include every detail about your IBD – you’ll have plenty of conversations as you both get more comfortable. Share yourself with honesty and confidence, not anxiety and pessimism. People will take their cues from you.

You could show your partner this site as a starting point for the discussion. Having loving relationships and a network of friends and family can make a huge difference to your quality of life.

The importance of talking and listening

If you are experiencing problems with sex, particularly if you are suffering pain resulting from intimacy, it is important to bring it up with your IBD specialist. If you do not feel comfortable discussing these issues with your specialist, you may feel more comfortable talking to your IBD nurse (if you have access to one) or your doctor.

Practical tips

There are a few things you can do to make intimacy go more smoothly:

• If you need to use a suppository at night, insert it after sexual intercourse. This will reduce the chances that you will need to go to the bathroom during sex
• Use a lubricating jelly if you experience pain or discomfort during sexual intercourse

Intimacy doesn’t always mean sexual intercourse. Kissing and cuddling without sex when you’re not feeling well can still bring plenty of pleasure to both partners.

Remember, even if at times you feel overwhelmed and embarrassed by your IBD, it is only one part of who you are. Try to keep in mind the whole relationship: your shared experiences, dreams and goals.

Common concerns

Although a physical relationship may be the last thing on your mind when you’re trying to deal with the symptoms and effects of IBD, you may find ways to help you to feel a little more at ease.

• I feel really tired: Make sure you get plenty of rest and sleep. The physical effects of IBD can also lead to strong emotions which can also make you feel tired. Try to relax as much as possible and, if appropriate, discuss anxieties with your partner. Consider finding time for intimate moments when you are less tired such as first thing in the morning rather than last thing at night
• My medication interferes with my sex life: Having ulcerative colitis or Crohn’s disease can mean using enemas or suppositories at bedtime, which might interfere with a spontaneous sex life. If this happens, try being spontaneous at another time of the day, rather than just at bedtime
• I don’t feel attractive: Speak to your partner about how you feel. You may be surprised at their response. Chances are they don’t see all the imperfections you do! Think about things you can do to make yourself feel more attractive: nice clothes, a new haircut or setting a nice setting for intimate moments
• Sex is painful: Complications of IBD (e.g. fistulae, infection and fibrosis or narrowing) may cause pain during intercourse. Speak to your doctor if this is the case
• How will surgery affect me? Surgery is only carried out if other forms of treatment have failed and your surgeon will try to minimise the risk of scarring. In a few cases you may need a stoma. Although this can take getting used to, and some adaptation, the best way for you and your partner to deal with any of these issues is to talk about them. The more informed your partner becomes about IBD, the more understanding he or she will be

IBD and surgery

You may have discussed surgery with your doctor as a possible treatment of your IBD. In patients with ulcerative colitis (UC) surgery can offer a cure; in patients with Crohn’s disease you may be offered surgery to help with a particular episode or if certain parts of your intestine are badly affected.

Although most patients undergoing surgery will make a full and complete recovery with few complications, it is important to be aware of some changes that may occur as a result of the surgery:

• Women: You may suffer from a reduction in or loss of libido (desire for sex); this usually results from a change in the way you perceive your own body and from feeling less attractive. You may experience reduced feeling in the sexual areas leading to a lack of arousal and vaginal dryness. These can sometimes make intercourse uncomfortable or painful
• Using a lubricating gel and experimenting with various positions can both help to improve your sexual relationship. The important thing is to talk to your partner and not to be afraid to ask for reassurance that your partner still finds you attractive
• Men: The nerves around the genital organs (which are very close to the bowel area) can sometimes be cut or damaged during surgery. This can lead to problems with erections and ejaculation. In most cases, the nerves will recover and a complete resolution can be expected, although this may take a few years. Talk to your partner and ask them to be patient. In the meantime, explore alternative methods of achieving sexual pleasure

Talk to your doctor if these problems persist for longer than two years. He/she may then refer you to a neuro-specialist for further advice.