IBD and Sex: Let’s Talk About It!
First things first – you’re here! Welcome! As you begin to read, please keep in mind that it’s completely normative (and even expected!) to have curiosities, questions, and concerns about having intimate relationships as a person with IBD. Sexuality and sexual relationships can be an important part of your identity and your life.
Please know, this article takes a wide view of sex beyond just vaginal penetration, and as such will consider other acts such as anal or digital penetration, oral stimulation, and any number of other intimate behaviors to be considered “sex.”
This article also does not take the view that the purpose of sex is to become pregnant, and as such does not include information about fertility, family planning, pregnancy, and birth with IBD. For more information on any of the above, please check out our guides IBD and Pregnancy and IBD and Men’s Fertility.
Now, let’s get started!
The Emotional Side of Sex
Many people with IBD share that they have concerns about body image, sexual dysfunction, and intimacy related to their IBD. Body image concerns may be especially prevalent for people who have had a surgical operation for their IBD (such as an ostomy). People with IBD also often report overall lower sexual quality of life, which is an important factor to consider as having a higher sexual quality of life is associated with higher health-related quality of life and fewer depressive symptoms.
Research has also shown that those who identify as men with IBD worry about sexual performance, whereas those who identify as women are concerned about family planning, attractiveness/body image, and loneliness. Both men and women endorse concerns about energy level, effects of medication and/or surgery, being burdens, and the uncertain course of IBD, important areas that can very much affect sex and intimacy.
So, having concerns and worries about sex is extremely common for people with IBD! And these concerns can in turn affect experiences of mood and anxiety, which can in turn independently lower sexual drive or impact sexual functioning.
All of this is to say that there are many factors and complexities that can be challenging in thinking through sex. Know that you are not alone, and any qualms, questions, or concerns you are having related to IBD and sex are valid. The research has shown that sex is an important aspect of overall health and can have concrete outcomes on quality of life and mood! So, please know that concerns surrounding sex and intimacy are always valid topics to bring up to providers or members of your Care Team.
Talking about IBD with a Sexual Partner
A common consideration when it comes to having sex may be what and when to tell your sexual partner(s) about your IBD. These conversations can be complex and even uncomfortable to navigate and can be an important part of building intimacy (sexual or otherwise).
Trellus Health co-founder Dr. Marla Dubinsky has written an article discussing Sexuality Issues in IBD, and offers many important points on disclosure, including that:
- Disclosure can feel different depending on the stage of a relationship individuals are in
- Relationships can often improve after disclosure
- Trust is an important piece in helping disclosure feel safe
- How someone feels about their own IBD can shape the attitudes of the people they are disclosing to
- Having a game plan (what you want to tell, and to whom) can be helpful
- Disclosing can help reduce stress and anxiety!
Sharing and disclosing information can actually build intimacy and trust and can make sex more pleasurable for all involved. This Facebook Live has more information on discussion and disclosure!
IBD Symptoms and Sex
Many symptoms of IBD can have an effect on your sex life.
If incontinence is currently a symptom for you that is affecting your sex life, there are multiple strategies you can try including trying to express a bowel movement before sex, anti-diarrheal medication (make sure to consult with a prescribing physician before taking any medication), and/or planning sex for times when you are less likely to have incontinence. Using dental dam or a condom may also be helpful to consider.
Worries about incontinence can also reduce sex drive for any gender and may make it difficult for people with penises to maintain an erection. If you find worries about incontinence are affecting your sex drive or ability to have sex, please reach out to a member of your Care Team, who may be able to help with ways to address these worries.
Again, there are many ways to try and accommodate for symptoms of abdominal pain during sex. Certain sexual positions may increase or decrease the level of pain you are experiencing – don’t be afraid to experiment! If appropriate, certain medications may also help; however, make sure to consult with a prescribing physician before taking any medication.
Although perhaps less well-discussed, fatigue is an incredibly common symptom of IBD, and can have negative effects on sexual desire. Consider discussing your fatigue experiences and symptoms with your partner(s) so that clear, open, and hopefully supportive dialogues can exist. You may consider discussing topics such as how fatigue affects your desire and times of day where you may feel more or less desire. In addition, if fatigue is a symptom that is consistently impairing to your everyday life (sexual and otherwise), consider bringing it up to a member of your treatment team or Care Team.
Fistulas and abscesses can make sex uncomfortable, painful, and may rule out certain sexual acts or positions.
If you have a fistula or an abscess around the area of the anus are engaging in penetrative anal sex, speak with members of your Care Team about what sexual acts are safe for you.
Considerations for Ostomy
Research has shown that post surgery, most people resume sex within three months after surgery and report increased sexual satisfaction.
However, surgery can also have an effect on the ability to develop and maintain an erection, may make certain sexual positions uncomfortable, and/or may alter your view of yourself and your body. If you find you are having difficulty in any of these domains post-surgery, do not hesitate to discuss with your Care Team!
Of note, it is recommended to not insert anything (toys, digits, penis) into a stoma during sex. This increases risk of stoma complications.
IBD Treatments and Sex
Most IBD medications do not have an effect on sexual performance or desire.
If you take steroids, however, they may affect mood (which can affect sexual desire), sexual satisfaction, and may cause physical side effects that alter your feelings about your own desirability. Talk to a member of your Care Team if you are on steroids and feel that you may be experiencing negative side effects.
If you are taking medications via suppository or enema, you may need to time sex around when you are taking these medications.
Practicing Safe Sex
Safe sex is essential for any sexual relationship – make sure you and any partners have been screened for STIs, are all consenting, and are using contraception if no person is trying to become pregnant.
Wrapping it all up
Sexual health and wellness are a part of your overall health and quality of life! Please do not be embarrassed to bring up questions or concerns to members of your Care Team – they are there to help!
Remember, there are many ways to have sex and many ways to be intimate. The name of the game is communication and flexibility. Sex does not have to be at night, in bed, or involving penetration. Your sexual experience and sexuality are parts of you and so you are in control of your own sex life.