Emma Druvefors

Background/Objectives: The aim of this study was to investigate the experiences of Swedish patients with inflammatory bowel disease (IBD) regarding intimacy and sexuality-related issues, and to explore both patients’ and healthcare professionals’ perspectives on discussing these topics. Methods: This cross-sectional cohort study used two internet-based questionnaires: one targeting patients and the other healthcare professionals. The patient survey examined the impact of IBD and its treatment on relationships and sexuality, as well as expectations on healthcare support. The survey of healthcare professionals focused on experiences of discussing sexuality-related topics with IBD patients. Responses were analyzed using both quantitative and content analysis. Results: A total of 556 IBD patients and 118 healthcare professionals responded. Among patients, 78% reported difficulties related to relationships and sexuality, with physical symptoms like pain, fecal urgency, and bloating, and psychological problems such as fear of leakage and reduced sexual desire. Over half wished for these issues to be addressed in routine care, yet 84% had never initiated such discussions themselves. Among healthcare professionals, 23% never addressed issues of relationship and sexuality with patients, and another 50% did so only occasionally. Only 15% had access to qualified sexologists for referrals, and just 8% offered sexual rehabilitation after pelvic surgery. Conclusions: Sexual health is frequently compromised in IBD patients, especially in women, but remains insufficiently addressed in clinical practice. Both patients and healthcare professionals expressed a need for more open discussions about relationships and sexuality. Improving care requires routine screening, multidisciplinary support, and the development of guidelines for managing sexual dysfunction in IBD.

Background/Objectives: The aim of this study was to investigate the experiences of Swedish patients with inflammatory bowel disease (IBD) regarding intimacy and sexu-ality-related issues, and to explore both patient and healthcare professionals perspec-tives on discussing these topics. Methods: This cross-sectional cohort study used two in-ternet-based questionnaires: one targeting patients and the other healthcare profession-als. The patient survey examined the impact of IBD and its treatment on relationships and sexuality, and expectations on healthcare support. The survey to healthcare profes-sionals focused on experiences of discussing sexuality-related topics with IBD patients. Responses were analyzed with quantative analysis and content analysis. Results: A to-tal of 556 IBD patients and 118 healthcare professionals responded. Among patients, 78% reported difficulties related to relationships and sexuality, with physical symptoms like pain, fecal urgency, bloating, and psychological problems such as fear of leakage and reduced sexual desire. Over half wished for these issues to be addressed in routine care, yet 84% had never themselves initiated such discussions. Among healthcare pro-fessionals, 23% never addressed issues on relationship and sexuality with patients, and another 50% did so only occasionally. Only 15% had access to qualified sexologists for referrals and just 8% offered sexual rehabilitation after pelvic surgery. Conclusions: Sexual health is frequently compromised in IBD patients, but remains insufficiently addressed in clinical practice. Both patients and healthcare professionals expressed a need for more open discussions about relationships and sexuality. Improving care re-quires routine screening, multidisciplinary support, and the development of guidelines for managing sexual dysfunction in IBD.

ObjectivesColectomy and subsequent bowel reconstruction in women with ulcerative colitis (UC) is associated with decreased fertility, this survey aims to investigate possible reasons for this.Material and methodsWomen with UC aged 18-44 years at colectomy 2000-2020 were identified and data were retrieved from the Swedish inflammatory bowel disease register (SWIBREG). Additional information was obtained using a study-specific questionnaire.ResultsThe survey was completed by 214 (72.8%) out of 294 eligible women. Mean age at disease onset was 22.9 years (standard deviation 0.5). No reconstruction was made in 67 (31.3%) women, whereof 24 (35.8%) had a completion proctectomy. Reconstruction was performed with ileorectal anastomosis (IRA) in 66 (30.8%) women and ileal pouch anal anastomosis (IPAA) in 81 (37.9%). Included women had on average 1.67 children (95% confidence interval 1.53-1.81) at the end of follow-up. The desire to have children was negatively affected by disease onset (59.4%), colectomy (44.9%) and reconstruction (36.7%). Altogether, 39.4% estimated that they had fewer children and 9.5% restrained completely from having children because of the disease. Difficulties to conceive were reported by 36.5% including 18.9% who expressed that they could not conceive at all. Difficulties to conceive was more common after reconstruction with IPAA (Odds Ratio [OR] 5.54) than IRA (OR 2.57).ConclusionsA majority of women with UC and colectomy expressed that the disease affected their desire to have children, more often limiting the number of children than completely refraining. For childless patients, difficulties to conceive was more common than voluntary childlessness.

Inflammatory bowel diseases (IBD) often present in adolescence or early adulthood and is thus frequently diagnosed in men and women in their reproductive age. Previous population-based studies of f ...

Background and Aims: Colectomy and reconstruction in patients with inflammatory bowel disease [IBD] may adversely affect fertility, but few population-based studies on this subject are available. Methods: Fertility was assessed in 2989 women and 3771 men with IBD and prior colectomy during 1964–2014, identified from the Swedish National Patient Register, and in 35 092 matched individuals. Results: Reconstruction with ileoanal pouch anastomosis [IPAA] was as common as ileorectal anastomosis [IRA] in ulcerative colitis [UC] and IBD-unclassified [IBD-U] but rare in Crohn’s disease [CD]. Compared with the matched reference cohort, women with IBD had lower fertility overall after colectomy (hazard ratio [HR] 0.65, confidence interval [CI] 0.61–0.69), with least impact with leaving the rectum intact [HR 0.79, CI 0.70–0.90]. Compared with colectomy only, fertility in female patients remained unaffected after IRA [HR 0.86, CI 0.63–1.17 for UC, 0.86, CI 0.68–1.08 for IBD-U and 1.07, CI 0.70–1.63 for CD], but was impaired after IPAA, especially in UC [HR 0.67, CI 0.50–0.88], and after completion proctectomy [HR 0.65, CI 0.49–0.85 for UC, 0.68, CI 0.55–0.85 for IBD-U and 0.61, CI 0.38–0.96 for CD]. In men, fertility was marginally reduced following colectomy [HR 0.89, CI 0.85–0.94], regardless of reconstruction. Conclusions: Fertility was reduced in women after colectomy for IBD. The least impact was seen when a deviated rectum was left intact. IRA was associated with no further reduction in fertility, whereas proctectomy and IPAA were associated with the strongest impairment. IRA therefore seems to be the preferred reconstruction to preserve fertility in selected female patients. Fertility in men was only moderately reduced after colectomy.

Summary: Background and Aims: Onset of inflammatory bowel disease (IBD) in men is most common during childbearing age, but little is known about the impact on fertility. Previous studies of fertility in men were small, which justifies this large nation‐based registry study.Methods: Fertility was assessed in a national cohort of men with IBD aged 15–44 years in 1964–2014, identified from the Swedish National Patient Register, and in a reference cohort matched for age and place of residence (ratio 1:5). Information about childbirths was found in the Swedish Multi‐Generation Register. Patients with indeterminate colitis or inconsistent IBD coding were classified as IBD‐unclassified (IBD‐U).Results: The cohorts included 29,104 men with IBD and 140,901 matched individuals. IBD patients had a lower fertility rate (number of births per 1000 person years) compared with the matched individuals; 1.28 (SD 1.27) versus 1.35 (SD 1.31; p < 0.001). Fertility was somewhat impaired in all IBD subtypes compared with the matched cohort; ulcerative colitis (UC) (hazard ratio [HR] 0.93, 95% CI 0.91–0.96), Crohn's disease (CD) (HR 0.95, 95% CI 0.92–0.98) and IBD‐U 0.92, 95% CI 0.89–0.95. The cumulated total parity and the parity progression were also decreased for all IBD subtypes. Within the IBD cohort disease severity, intensity of medical treatment (CD) and bowel surgery (IBD‐U) were further associated with impaired fertility.Conclusions: This nationwide cohort study shows only slightly impaired fertility in men with IBD.

Inflammatory bowel disease [IBD] has been associated with reduced female fertility. We analyse fertility in a national cohort of women with IBD. Fertility was assessed in women with IBD aged 15–44 years in 1964–2014, identified from the Swedish National Patient Register and a matched cohort [ratio 1:5]. Patients with indeterminate colitis or inconsistent IBD coding were classified as IBD-unclassified [IBD-U]. The cohorts included 27 331 women with IBD and 131 892 matched individuals. The fertility rate in IBD was 1.52 (standard deviation [SD] 1.22) births per 1000 person-years and 1.62 [SD 1.28] [p <0.001] in matched individuals. Fertility was impaired in all IBD subtypes compared with the matched cohort (hazard ratio Crohn’s disease [CD] 0.88, 95% confidence interval [CI] 0.85–0.91; IBD-U 0.86, 95% CI 0.83–0.89; and ulcerative colitis [UC] 0.96, 95% CI 0.93–0.98). Fertility improved during the study period for the IBD cohort except for CD. Parity progression ratio, the proportion of IBD women progressing from one parity to the next compared with the matched cohort, was decreased at all parity levels for CD and IBD-U, but only for multiparous women in UC. Contraceptive usage was higher in IBD, both before and after the diagnosis. Disease severity, bowel resections, and perianal disease in CD affected fertility negatively. Fertility was impaired mainly in women with CD and IBD-U, and less so in UC. During the study period, fertility improved in women with UC or IBD-U. Some results suggest a role of voluntarily reduced fertility.

The time of ovulation has since long been believed to be concealed to male heterosexual partners. Recent studies have, however, called for revision of this notion. For example, male testosterone concentrations have been shown to increase in response to olfactory ovulation cues, which could be biologically relevant by increasing sexual drive and aggressiveness. However, this phenomenon has not previously been investigated in real-life human settings. We therefore thought it of interest to test the hypothesis that males' salivary testosterone concentrations are influenced by phases of their female partners' menstrual cycle; expecting a testosterone peak at ovulation.