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Female sexual function and fertility after ileal pouch-anal anastomosis

Abstract

Purpose

A potential complication in women after ileal pouch-anal anastomosis (IPAA) is sexual impairment and reduced fertility. The aim was to evaluate sexual function and fertility after IPAA.

Methods

All female patients who underwent an IPAA between 2004 and 2013 were retrospectively included. Sexual function, fertility, and continence were explored by the female sexual function index (FSFI), telephonic interview, and Wexner’s score.

Results

Among 127 women included, 93 responded to the questionnaires (73.2 %). Seventy five were sexually active, and 48 (64 %) had normal sexual function (FSFI > 26). In univariate analysis, there was a significant relationship between ulcerative colitis (p = 0.0161), age > 40 years (p = 0.01311), number of bowel movements (p = 0.0238), nocturnal pouch activity (p = 0.0094), use of loperamide (p = 0.0283), and existence of sexual dysfunction. After multivariate analysis, age and nocturnal pouch activity were associated with a worse sexual function (p = 0.0235, OR = 3.3 (1.2–9.9) and p = 0.0094, OR = 4.1 (1.4–13.5)). Of 16 patients who wished to have children, 10 (63 %) became pregnant without recourse to in vitro fertilization, of whom 3 had two or more pregnancies. In total, there were 13 children born after IPAA. The mean time between the first pregnancy and surgery was 24.8 ± 22 months. At 12 and 24 months after cessation of contraception, 57 and 67 % had at least one pregnancy.

Conclusions

While sexual function is impaired in a limited number of patients, the impact of surgery can be regarded as modest. Age and nocturnal pouch activity were some independent factors of worse sexual function. The risk of infertility should not preclude consideration of IPAA as a treatment option.

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Correspondence to Jeremie H. Lefevre.

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Hor, T., Lefevre, J.H., Shields, C. et al. Female sexual function and fertility after ileal pouch-anal anastomosis. Int J Colorectal Dis 31, 593–601 (2016). https://doi.org/10.1007/s00384-015-2497-y

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Keywords

  • Ileal pouch-anal anastomosis
  • Ulcerative colitis
  • Familial adenomatous polyposis
  • Fertility
  • Sexual function
  • Women