Gynaecological and sexual function related to anatomical changes in the female pelvis after restorative proctocolectomy

  • T. Öresland
  • S. Palmablad
  • M. Ellström
  • I. Berndtsson
  • N. Crona
  • L. Hultén
Original Articles


Restorative proctocolectomy with an ileal pouch-anal anastomosis preserves anal sphincters, the normal route of defaecation and the normal body image and it has been suggested that the procedure might be associated with less gynaecological and sexual problems than conventional proctocolectomy. To shed further light on this subject 60 female patients were invited to participate in a study comprising a detailed interview, examination by a gynaecologist and investigation with hysterosalpingography and vaginography. Twenty-one women with a mean follow-up of 38 months after surgery agreed to participate. Their gynaecological state was considered normal although one woman complained of vaginal discharge. Five women experienced occasional dyspareunia and 2 patients had to take special precautions to avoid bowel leaks at intercourse. While the position of the vagina and uterus in the pelvis appeared normal, hysterosalpingography disclosed bilateral occlusion of the fallopian tubes in 2 and unilateral occlusion in another 9 patients with tubes adhering to the bottom of the lesser pelvis in 10 of the patients. Only one out of 14 patients succeeded in trying to conceive during the follow-up period. Among the remaining 39 women not specially studied 5 out of 14 had conceived after the operation.


La proctocolectomie avec confection d'un réservoir iléoanal permet de conserver la fonction sphinctérienne, de maintenir les voies habituelles de la défécation et de maintenir le schéma corporel normal; cette intervention pourrait entraîner moins de problèmes gynécologiques et sexuels qu'une proctocolectomie conventionnelle. Afin de préciser ces éléments, 60 femmes ont été invitées à participer à une étude comportant un interview détaillé, un examen par un gynécologue et des investigations radiologiques avec une hystérosalpyngographie et une vaginographie. Vingt et une femmes avec un suivi moyen de 38 mois après chirurgie ont accepté d'être inclues dans l'étude. Le status gynécologique des ces patientes a été considéré comme normal bien qu'une patiente se plaigne d'un écoulement vaginal. Cinq patientes se plaignent occasionellement de dyspareunie et 2 doivent prendre des mesures de protection particulière pour éviter une incontinence au cours des rapports sexuels. Bien que la position du vagin et de l'utérus apparaissent comme normal dans le petit bassin, l'hystérosalpyngographie a montré une occlusion bilatérale des trompes chez 2 malades et une occlusion unilatérale chez 9 malades avec des adhérences tubaires dans le petit bassin chez 10 malades. Une seule patiente sur les 14 qui se sont efforcées de devenir enceintes y est parvenue. Parmi les 39 autres malades qui n'ont pas fait l'objet d'une étude particulière, 5 sont devenues enceintes après l'opération.


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  1. 1.
    Fasth S, Filipsson S, Hellberg R, Hultén L, Lindhagen J, Nordgren S (1978) Sexual dysfunction following proctocolectomy. Ann Chir Gynaecol 67:8–12Google Scholar
  2. 2.
    May R (1966) Sexual function following rectal excision for ulcerative colitis. Br J Surg 53:29–30Google Scholar
  3. 3.
    Stahlgren F, Fergusson L (1959) Effects of abdominoperineal resection on sexual function in sixty patients with ulcerative colitis. Arch Surg 78:604–610Google Scholar
  4. 4.
    Watts J, deDombal F, Goligher J (1966) Long-term complications and prognosis following major surgery for ulcerative colit. Br J Surg 53:1014–1023Google Scholar
  5. 5.
    Köhler L, Pemberton J, Zinsmeister A, Kelly K (1991) Quality of life after proctocolectomy. Gastroenterology 101:679–684Google Scholar
  6. 6.
    Nilsson L, Kock N, Kylberg F, Myrvold H, Palselius I (1981) Sexual adjustment in ileostomy patients before and after conversion to continent ileostomy. Dis Colon Rectum 24:287–290Google Scholar
  7. 7.
    Devlin H, Plant J (1979) Sexual function — an aspect of stoma care. Br J Sexual Med 33–37Google Scholar
  8. 8.
    Grüner O-PN, Naas R, Fretheim B, Gjone E (1977) Marital status and sexual adjustment after colectomy. Results in 178 patients operated on for ulcerative colitis. Scand J Gastroenterol 12:193–197Google Scholar
  9. 9.
    Wikland M, Jansson I, Aszély M, Palselius I, Svaninger G, Magnusson O, Hultén L (1990) Gynaecological problems related to anatomical changes after conventional proctocolectomy and ileostomy. Int J Colorect Dis 5:49–52Google Scholar
  10. 10.
    Asztély M, Palmblad S, Wikland M, Hultén L (1991) Radiological study of changes in the pelvis women following proctocolectomy. Int J Colorect Dis 6:103–107Google Scholar
  11. 11.
    Pemberton JH, Phillips SF, Ready RR, Zinsmeister AR, Bears OH (1989) Quality of life after Brooke ileostomy and ileal pouch-anal anastomosis. Ann Surg 209:620–628Google Scholar
  12. 12.
    Köhler LW, Pemberton JH, Hodge DO, Zinsmeister AR, Kelly KA (1992) Long-term functional results and quality of life after ileal pouch-anal anastomosis and cholecystectomy. World J Surg 16:1126–1132Google Scholar
  13. 13.
    Metcalf ADR, Kelly K (1986) Sexual function in women after proctocolectomy. Ann Surg 204:624–627Google Scholar
  14. 14.
    Emblem R, Larsen S, Torvet S, Bergan A (1988) Operative treatment of ulcerative colitis: Conventional proctocolectomy with Brooke ileostomy versus mucosal proctectomy with ileonal anastomosis. Scand J Gastroenterol 23:493–500Google Scholar
  15. 15.
    Öresland T, Fasth S, Nordgren S, Hultén L (1989) The clinical and functional outcome after restorative proctocolectomy. A prospective study in 100 patients. Int J Colorect Dis 4:50–56Google Scholar
  16. 16.
    Funt MI, Thompson JD, Birch H (1978) Normal vaginal axis. South Med J 71:534–535Google Scholar
  17. 17.
    Lindquist K, Liljeqvist L (1992) Pregnancies and female infertility after restorative proctocolectomy at Huddinge hospital, Sweden. Ann Chir 46:20Google Scholar
  18. 18.
    Metcalf A, Dozois RR, Beart RW, Wolff BG (1985) Pregnancy following ileal pouch-anal anastomosis. Dis Colon Rectum 28:859–861Google Scholar
  19. 19.
    Nelson H, Dozois RR, Kelly KA, Malkasian GD, Wolff BG, Ilstrup DM (1989) The effect of pregnancy and delivery on the ileal pouch-anal anastomosis function. Dis Colon Rectum 32:384–388Google Scholar
  20. 20.
    Wexner SD, Jensen L, Rothenberger DA, Wong WD, Goldberg SM (1989) Long-term functional analysis of the ileo-anal reservoir. Dis Colon Rectum 32:275–281Google Scholar
  21. 21.
    Hagstad A, Jansson PO (1984) Sexuality among swedish women around forty — an epidemiological survey. J Psychosom Obstet Gynaecol 3:191–203Google Scholar
  22. 22.
    Barkel D, Pemberton J, Pezim M, Phillips S, Kelly K, Brown L (1988) Scintigrafic assessment of the anorectal angle in health and after ileal pouch-anal anastomosis. Ann Surg 208:42–49Google Scholar

Copyright information

© Springer-Verlag 1994

Authors and Affiliations

  • T. Öresland
    • 1
    • 4
  • S. Palmablad
    • 2
  • M. Ellström
    • 3
  • I. Berndtsson
    • 1
  • N. Crona
    • 3
  • L. Hultén
    • 1
  1. 1.Department of Surgery II, Sahlgrens' HospitalUniversity of GöteborgGöteborgSweden
  2. 2.Department of Radiology, Sahlgrens' HospitalUniversity of GöteborgGöteborgSweden
  3. 3.Department of Obstetrics and Gynaecology, Sahlgrens' HospitalUniversity of GöteborgGöteborgSweden
  4. 4.Department of SurgerySahlgrenska SjukhusetGöteborgSweden

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